Gardening as multiple health behavior change: Participant preferences for the development of a digital (eHealth) intervention to improve diet, physical activity and cardiovascular health (Preprint)

BACKGROUND Low dietary intake of fruits and vegetables (F&V) and physical inactivity are two modifiable risk factors for cardiovascular disease (CVD). Food gardening can provide access to fresh F&V and many gardening activities are considered moderate physical activity (PA). This makes gardening interventions a potential strategy for cardiovascular disease risk reduction. Previously developed gardening interventions have relied on in-person delivery models which limit scalability and reach. OBJECTIVE The purpose of this study was to ascertain potential participant preferences for delivery modalities and topics of interest to inform a digital (eHealth) gardening multiple health behavior change intervention. METHODS An online survey was delivered via Amazon Mechanical Turk (mTurk) including quantitative and open-ended questions. Eligible participants were at least 20 years old, could read and write in English, were United States residents, and had at least a 98% mTurk task approval rating. A multi-level screening process was used to identify and remove respondents with response inattention, poor language fluency, or suspected automated web robot (bot). Participants were asked about their interest in gardening programming, preferences for intervention delivery modalities (1-hour expert lectures, a series of brief <5 minute videos, or in-person meetings), and what information is needed to teach new gardeners. Comparisons were made between Never Gardeners (NG) and Experienced Gardeners (EG) in order to examine differences in perceptions based on prior experience. Quantitative data were summarized and differences between groups were tested using chi-squared tests. Qualitative data were coded and organized into intervention functions based on the Behavior Change Wheel. RESULTS 465 participants were included (45.6% NG and 54.4% EG). There was a high level of program interest overall (76.3%) though interest was higher in EG (67.0% NG, 84.2% EG, P< .001). The majority of participants preferred a series of brief <5-minute videos 60.7% (64.2% NG, 57.7% EG, P=.16) over 1- hour lectures (13.7% NG, 19.8% EG, P=.08) or in-person delivery modes (22.2% NG, 22.5% EG, P =.93). Key intervention functions identified were education and training (how to perform fundamental gardening and cooking activities), environmental restructuring (e.g., social support, provision of tools or seeds), persuasion (offering encouragement and highlighting the benefits of gardening), and modeling (using content experts and facilitating participant testimonials). Content areas of interest included the full lifecycle of gardening activities from the fundamentals of preparing a garden site, planting, maintenance, harvesting and cooking. CONCLUSIONS Adults who have never gardened are interested gardening interventions, prefer online intervention delivery modalities in the form of brief videos, and are interested in a multi-component intervention that encompasses how to garden from planting to harvesting and cooking. The next step in this line of work is to identify target behavior change techniques and pilot test the intervention to assess participant acceptability and preliminary efficacy. CLINICALTRIAL NA