An Inter-professional Framework for Quality Improvement of School Gardening Programming

Background: School gardens are exemplary learning environments for providing hands-on nutrition and health education, promoting time outdoors, and developing collaborative skills. However, randomized controlled trials of school gardening programming to provide evidence of the robust benefits to child health can be time consuming and costly. We therefore sought to develop an inter-professional framework for continuous quality improvement (QI) of school gardening programming to improve health outcomes while limiting program implementation and evaluation costs. Methods: This QI cohort study took place in two elementary schools and served 75 students in Palm Beach County, Florida during the 2019-2020 academic year. Students participating in a non-profit sponsored after-school gardening club completed investigator- designed pre- and post-assessments from which unique lessons pertaining to health and food literacy were developed to target knowledge deficits. We present a lesson pertaining to harvesting, preparing, and sampling foods as an exemplar for this framework. Paired and independent samples t-tests and chi- squared tests were used to compare student learning outcomes. Results: Twenty-seven students (36%) participated in the harvest lesson, which led to marginal improvement in overall food literacy compared to non-participants (X^2=3.6, P=0.057).Considering cumulative garden club activities, club participation improved students’ likelihood to individually prepare fresh fruits and vegetables (P=0.002). Conclusion: This project provides an important framework for inter-professional collaboration to engage in QI of small-scale school gardening programs. Future work should focus on the creation and implementation of further lessons to develop a full, individualized, health-oriented curriculum that optimizes learning outcomes, and thereby health, for elementary-aged children.