Research
Research Paper
Harvest for Health, a Randomized Controlled Trial Testing a Home-Based, Vegetable Gardening Intervention Among Older Cancer Survivors Across Alabama: An Analysis of Accrual and Modifications Made in Intervention Delivery and Assessment During COVID-19

https://doi.org/10.1016/j.jand.2022.05.005Get rights and content
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Abstract

Background

Accelerated functional decline is a concern among older cancer survivors that threatens independence and quality of life. Pilot studies suggest that vegetable gardening interventions ameliorate functional decline through improved diet and physical activity.

Objective

The aim of this article was to describe the rationale, recruitment challenges, and enrollment for the Harvest for Health randomized controlled trial (RCT), which will test the impact of a home-based, vegetable gardening intervention on vegetable and fruit consumption, physical activity, and physical functioning among older cancer survivors. Modifications made to the intervention and assessments to assure safety and continuity of the RCT throughout the COVID-19 pandemic also are reported.

Design

Harvest for Health is a 2-year, 2-arm, single-blinded, wait-list controlled RCT with cross-over.

Participants/setting

Medicare-eligible survivors of cancers with ≥60% 5-year survival were recruited across Alabama from October 1, 2016 to February 8, 2021.

Intervention

Participants were randomly assigned to a wait-list control or a 1-year home-based gardening intervention and individually mentored by extension-certified master gardeners to cultivate spring, summer, and fall vegetable gardens.

Main outcome measures

Although the RCT’s primary end point was a composite measure of vegetable and fruit consumption, physical activity, and physical functioning, this article focuses on recruitment and modifications made to the intervention and assessments during COVID-19.

Statistical analyses performed

χ2 and t tests (α < .05) were used to compare enrolled vs unenrolled populations.

Results

Older cancer survivors (n = 9,708) were contacted via mail and telephone; 1,460 indicated interest (15% response rate), 473 were screened eligible and consented, and 381 completed baseline assessments and were randomized. Enrollees did not differ from nonrespondents/refusals by race and ethnicity, or rural-urban status, but comprised significantly higher numbers of comparatively younger survivors, those who were female, and survivors of breast cancer (P < .001). Although COVID-19 delayed trial completion, protocol modifications overcame this barrier and study completion is anticipated by June 2022.

Conclusions

This RCT will provide evidence on the effects of a mentored vegetable gardening program among older cancer survivors. If efficacious, Harvest for Health represents a novel, multifaceted approach to improve lifestyle behaviors and health outcomes among cancer survivors—one with capacity for sustainability and widespread dissemination.

Keywords

Cancer
Survivorship
Older adults
Physical function
Diet
Physical activity

Cited by (0)

J. R. Bail is an assistant professor, College of Nursing, University of Alabama, Huntsville. At the time of the study she was a postdoctoral fellow in the Demark-Wahnefried Laboratory, Department of Nutrition Sciences, University of Alabama, Birmingham.

C. K. Blair is an associate professor, Department of Internal Medicine, University of New Mexico, Albuquerque. At the time of the study she was a postdoctoral fellow in the Demark-Wahnefried Laboratory, Department of Nutrition Sciences, University of Alabama, Birmingham.

K. P. Smith is the state master gardener program coordinator, Alabama Cooperative Extension System, Auburn University, Auburn, AL.

R. A. Oster is a professor, Division of Preventive Medicine, Department of Medicine, University of Alabama, Birmingham.

H. Kaur is a doctoral student, Department of Nutrition Sciences, University of Alabama, Birmingham.

J. L. Locher is a professor emeritus, Division of Geriatrics, Department of Medicine, University of Alabama, Birmingham.

A. D. Frugé is an assistant professor, Department of Nutrition, Dietetics and Hospitality Management, Auburn University, Auburn, AL. At the time of the study he was a postdoctoral fellow in the Demark-Wahnefried Laboratory, Department of Nutrition Sciences, University of Alabama, Birmingham.

G. Rocque is an assistant professor, Department of Medicine, University of Alabama, Birmingham.

M. Pisu is a professor, Division of Preventive Medicine, Department of Medicine, University of Alabama, Birmingham.

H. J. Cohen is a professor, Department of Medicine, Duke University Medical Center, Durham, NC.

W. Demark-Wahnefried is a professor, Department of Nutrition Sciences, University of Alabama, Birmingham.

STATEMENT OF POTENTIAL CONFLICT OF INTEREST No potential conflict of interest was reported by the authors.

FUNDING/SUPPORT Supported by the National Institutes of Health (R01 CA201362, T32 CA047888, 5R25 CA076023, K07 CA215937, and K07 AG043588), American Cancer Society CRP-19-175-06-COUN, and the Diana Dyer Endowment of the American Institute for Cancer Research.

Trial Registration: ClinicalTrials.gov ID NCT02985411.