Discussion

The finding that school garden programmes in low-income countries are more effective in increasing students’ awareness, knowledge, and preferences and less effective in increasing students’ actual consumption of fruit and vegetables confirms the findings of two major reviews on the effect of school garden programmes on nutrition outcomes in high-income countries (Blair, 2009; Ohly et al., 2016).

In explaining the reasons for this lack of impact, it is important to bear in mind that school gardens themselves cannot supply students with a daily serving of vegetables. The size of a school garden is just too small for this and trying to do this would seriously distract students and teachers from the school curriculum. Hence, the purpose of a school garden is usually purely educational while vegetable harvests are small and irregular. Therefore, school gardens can only make an indirect impact on nutrition outcomes through stimulating students’ awareness of fruit and vegetables and enhancing their knowledge about the importance of eating a diverse range of fruit and vegetables for good health. The combination of these effects is assumed to nudge students to adjust their food behaviour and eat more fruit and vegetables.

The problem in this assumed impact pathway is that the school garden intervention does not adequately address the supply of fruit and vegetables to students. This is likely the main reason why none of the three impact studies showed convincing evidence for increased fruit and vegetable consumption. This constraint was also identified by the country implementation teams when reviewing the results of the programme.

The availability of vegetables in students’ homes may be very limited in many countries, while schools may not serve a school meal that includes vegetables. If school meals are served at all, then this is usually a combination of staple food grain and pulses with very small quantities of fresh vegetables. However, if vegetables are unavailable in the home or in the school then students do not have a real choice of eating fruit and vegetables, even if they wanted to.

To accomplish this and give children a healthy food choice, school garden programmes may need to be coupled to a school meals programme that serves fruit and vegetables as part of a mid-day meal, or to an intervention that promotes the availability of fruit and vegetables within the household or within the community. It is also important that primary caregivers understand the importance of serving vegetables to their children, which may not always be the case, especially in low-income countries.

Home gardens are an intervention that address both the household-level demand and supply of vegetables (World Vegetable Center, 2016). Home garden interventions typically couple training in garden management with nutrition education of mothers. There is evidence that home garden interventions have a significant effect on increasing household production and consumption of vegetables (Olney et al., 2009; Galhena et al., 2013; Schreinemachers et al., 2016). However, there is no evidence to date that such interventions influence the food attitudes, knowledge, or food behaviour of children 8-15 years old. It therefore appears ideal to couple a school garden programme - which has a proven effect on raising children’s interest in vegetables, to a home garden programme - which has a proven effect on increasing household production and consumption of vegetables.

The impact of such coupled intervention is currently unknown. Several of this paper’s authors are involved in an ongoing project in Nepal (2018-2020), titled ‘Nudging children toward healthier food choices: An experiment combining school and home gardens’, that pilots such coupled intervention in 15 schools. This project is part of the Drivers of Food Choice Competitive Grants Program funded by the UK Government’s Department for International Development and the Bill & Melinda Gates Foundation.

The ‘Vegetables Go to School’ project was successful in raising the interest of the governments of Bhutan and Nepal in school-based programmes combining agriculture, nutrition, and health. As a result of this project, Bhutan has adopted an integrated approach of tackling child malnutrition through a holistic approach combining school feeding, WASH, and school gardening. Also, as a result of this project, the government of Nepal launched the ‘Green School Program’ to roll out school gardens to public schools across the country and the Department of Education has meanwhile designed a school garden curriculum that integrates nutrition, agriculture, and health. There is a need to closely study these initiatives to gain a better understanding for how these programmes can optimally influence the healthy eating behaviour of children and parents and to draw lessons that can be applied to other countries considering similar programmes.

Conclusion

The evidence for high-income countries suggests that school garden programmes are more effective in improving knowledge and attitudes about healthy eating than at changing short-term actual food behaviour. The findings of three impact studies of school garden programmes in Bhutan, Burkina Faso, and Nepal, as presented in this chapter, confirm that school garden programmes are more effective in changing knowledge and attitudes than in changing actual food behaviour. Improvements in knowledge and attitudes can, of course, have long-term positive effects on food behaviour, which are difficult to measure. Yet, to achieve also short-term effects in terms of increased vegetable consumption, it may be necessary to couple school garden programmes to other interventions that raise the nutrition awareness among parents and increase the availability of vegetables in students’ homes and the community. Coupling school gardens with home gardens appears as one suitable combination to accomplish this.

Acknowledgements

Funding for this research was provided by the Swiss Agency for Development and Cooperation (SDC) under grant number 81017189 and the Drivers of Food Choice Competitive Grants Programs, which is funded by the UK Government’s Department for International Development (DFID) and the Bill & Melinda Gates Foundation, and managed by the University of South Carolina, Arnold School of Public Health, United States. Funding was also provided by core donors to the World Vegetable Center: Republic of China (Taiwan), DFID, United States Agency for International Development (USAID), Australian Centre for International Agricultural Research (ACIAR), Germany, Thailand, Philippines, Korea, and Japan.

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