In the face of rising childhood obesity and nutrition challenges, particularly in indigenous communities such as the Navajo Nation, innovative strategies are essential to encourage healthy eating habits. Dr. Shirley Beresford, a professor in the Public Health Sciences Division at Fred Hutchinson Cancer Center, and colleagues and partners in New Mexico tackled this challenge in their study featured in AJPM Focus. They designed an innovative approach by integrating a school-based curriculum with a hands-on garden program, aiming to boost the confidence of Navajo elementary school students in selecting healthier food options, particularly fruits and vegetables.
This unique program was designed by Dr. Ornelas and colleagues and went beyond traditional classroom teaching about nutrition by actively involving students in cultivating their own food within school gardens. This hands-on experience was expected to empower students to make healthier eating choices, drawing on the cultural significance of land and tradition to the Diné people.
The research approach was methodically robust, with schools randomized to either receive the garden program intervention or act as a control group. The study involved nearly 300 students across six schools in northern Arizona and New Mexico, two of which participated in the garden program, while four served as comparisons. Data was collected at the beginning of the study and followed up at the end of the school year to assess changes in students' attitudes and behaviors toward eating and growing fruits and vegetables.
The results of the study demonstrated an improvement in the students' self-confidence related to consuming fruits and vegetables, known as self-efficacy, which is a crucial predictor of dietary choices. However, the study did not observe a significant change in the student’s confidence regarding growing food at home. While the increased self-efficacy is an achievement, it must be noted that other measures of dietary habits, such as the diversity of food intake, frequency of engaging in activities that promote healthy eating, and tendencies to snack on less nutritious foods, showed only modest improvements. This inconsistency raises important questions about how to create more profound and enduring changes in dietary habits and what mechanisms can sustain these healthier choices over time. It is also worth noting that the intervention appeared to have a stronger impact on certain segments of students, like younger children and those who already had a healthy weight, although these findings require additional research to be confirmed.
The study supports the idea that school-based initiatives can lead to better eating habits, especially in underserved communities. The progress made in boosting self-efficacy for healthy eating are commendable, even if the intervention did not address all dietary issues. The research team recognizes the need for a broader application of the intervention, which includes adapting the curriculum to align with educational standards in New Mexico and Arizona and ensuring sustainability within the school systems. Such adjustments aim to transition the program from research to everyday practice, maintaining its effectiveness over time. The significance of this study also lies in its attention to the dietary and cultural needs of indigenous children. Few interventions target this demographic with such tailored and culturally aware approaches. Created with and for the Navajo people, the program reflects their values and dietary traditions. The findings have paved the way for further exploration into how the curriculum can be better woven into Navajo educational standards and what steps are necessary for its broader application.
This initiative is more than a diet change; it's an example of how research can be meaningfully conducted with respect to a community's unique culture. It stands as a testament to the importance of culturally relevant interventions and the power of community partnership in driving health innovation. It's an affirmation that with the right approach, significant strides can be made toward the health and well-being of children in the Navajo Nation and potentially, for indigenous communities worldwide. The project's success was largely due to the close community connections with Navajo Nation facilitated by Dr. Lombard and colleagues at both NMSU and Diné College, that included the full partnership of Navajo colleagues, many of whom contributed as authors.
This study received support through the collaborative partnership between the Fred Hutchinson Cancer Center and New Mexico State University (NMSU) funded by the National Cancer Institute.
Fred Hutch/UW/Seattle Children’s Cancer Consortium member Dr. India Ornelas contributed to this work.
Beresford, S. A. A., Ornelas, I. J., Bauer, M. C., Garrity, G. A., Bishop, S. K., Francis, B., Rillamas-Sun, E., Garcia, L. V., Vecenti, F. S. A., & Lombard, K. A. (2022). Group Randomized Trial of Healthy Eating and Gardening Intervention in Navajo Elementary Schools (Yéego!). AJPM focus, 1(2), 100033.