A systematic review of the health and well-being impacts of school gardening: Synthesis of quantitative and qualitative evidence

Abstract

Background:
School gardening programmes are increasingly popular, with suggested benefits including healthier eating and increased physical activity. Our objectives were to understand the health and well-being impacts of school gardens and the factors that help or hinder their success.

Methods:
We conducted a systematic review of quantitative and qualitative evidence (PROSPERO CRD42014007181). We searched multiple databases and used a range of supplementary approaches. Studies about school gardens were included if they reported on physical or mental health or well-being. Quantitative studies had to include a comparison group. Studies were quality appraised using appropriate tools. Findings were narratively synthesised and the qualitative evidence used to produce a conceptual framework to illustrate how benefits might be accrued.

Results:
Evidence from 40 articles (21 quantitative studies; 16 qualitative studies; 3 mixed methods studies) was included. Generally the quantitative research was poor. Evidence for changes in fruit and vegetable intake was limited and based on self-report. The qualitative research was better quality and ascribed a range of health and well-being impacts to school gardens, with some idealistic expectations for their impact in the long term. Groups of pupils who do not excel in classroom activities were thought to particularly benefit. Lack of funding and over reliance on volunteers were thought to threaten success, while involvement with local communities and integration of gardening activities into the school curriculum were thought to support success.

Conclusion:
More robust quantitative research is needed to convincingly support the qualitative evidence suggesting wide ranging benefits from school gardens.

Full text

R E S E A R C H A R T I C L E Open Access
A systematic review of the health and
well-being impacts of school gardening:
synthesis of quantitative and qualitative
evidence
Heather Ohly
1
, Sarah Gentry
2
, Rachel Wigglesworth
1
, Alison Bethel
3
, Rebecca Lovell
1
and Ruth Garside
1*
Abstract
Background: School gardening programmes are increasingly popular, with suggested benefits including healthier
eating and increased physical activity. Our objectives were to understand the health and well-being impacts of
school gardens and the factors that help or hinder their success.
Methods: We conducted a systematic review of quantitative and qualitative evidence (PROSPERO CRD42014007181).
We searched multiple databases and used a range of supplementary approaches. Studies about school gardens were
included if they reported on physical or mental health or well-being. Quantitative studies had to include a comparison
group. Studies were quality appraised using appropriate tools. Findings were narratively synthesised and the qualitative
evidence used to produce a conceptual framework to illustrate how benefits might be accrued.
Results: Evidence from 40 articles (21 quantitative studies; 16 qualitative studies; 3 mixed methods studies) was
included. Generally the quantitative research was poor. Evidence for changes in fruit and vegetable intake was limited
and based on self-report. The qualitative research was better quality and ascribed a range of health and well-being
impacts to school gardens, with some idealistic expectations for their impact in the long term. Groups of pupils who
do not excel in classroom activities were thought to particularly benefit. Lack of funding and over reliance on
volunteers were thought to threaten success, while involvement with local communities and integration of gardening
activities into the school curriculum were thought to support success.
Conclusion: More robust quantitative research is needed to convincingly support the qualitative evidence suggesting
wide ranging benefits from school gardens.
Keywords: School, Gardens, Systematic review, Health, Well-being, Mixed methods
Background
School gardening and food growing have become popu-
lar activities in thousands of schools around the world.
National school gardening programmes exist in some
countries, such as the Royal Horticultural Society Campaign
for School Gardening in the UK [1] and the Stephanie
Alexander Kitchen Garden Program in Australia [2]. The
individuals and organisations behind these programmes
believe that school gardening has the potential to improve
children’s health, social development and academic
attainment.
Since the 1990s, an increasing number of research
studies have attempted to evaluate the effectiveness of
school gardening programmes. More recently, several
reviews of the literature on school gardening have been
published [3–8]. Five of these reviews were limited to
US studies and, whilst they found some empirical
evidence for the health and well-being impacts of school
gardening, some of their conclusions were based on theor-
etical rationale [3–7]. They recommended further research,
using more rigorous study designs, on the effectiveness of
* Correspondence: R.Garside@exeter.ac.uk
1
European Centre for Environment and Human Health, University of Exeter
Medical School, Truro, Cornwall, UK
Full list of author information is available at the end of the article
© 2016 Ohly et al. Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0
International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and
reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to
the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver
(http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
Ohly et al. BMC Public Health (2016) 16:286
DOI 10.1186/s12889-016-2941-0
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school gardening programmes, mediation pathways and
implementation factors.
The most comprehensive review, by the National
Foundation for Education Research, included inter-
national studies and found evidence for positive impacts
of growing activities on pupils’nutrition and attitudes
towards healthy eating [8]. It also concluded there was
modest evidence for social well-being benefits, especially
for lower ability pupils or those who have become disen-
gaged from learning. This review was described as being
“underpinned by a systematic process for searching,
selection, screening, coding, appraisal and synthesis”
(page 3). However, it did not clearly and consistently
report methods (inclusion criteria; quality appraisal
criteria) and results (CONSORT flow diagram; number
of studies with health and well-being outcomes; descrip-
tion of included studies –design, methods, quality etc.)
as would be expected in a systematic review. In addition,
since 2011, more studies have been published on the
impact and meaning of school gardening programmes,
including a large cluster randomised controlled trial of
the Royal Horticultural Society Campaign for School
Gardening in the UK [9, 10] and several qualitative studies
from the UK and the US [11–13]. Therefore, it was
justified and timely to conduct a robust, mixed methods
systematic review of the health and well-being impacts of
school gardening, to support and inform the further devel-
opment of this popular school-based intervention. This
review aims to answer the following questions:
What are the health and well-being impacts of
school gardens?
Are there different impacts for different age groups?
What are the effects on other family and
community members?
What do school gardens mean to those who use them?
Are there any factors that help or hinder the
successful development, use or sustainability of
school gardens?
Methods
We conducted a systematic review of quantitative and quali-
tative literature according to a pre-specified protocol that
was registered with the International Prospective Register of
Systematic Reviews (PROSPERO: CRD42014007181). We
used the methods of thematic synthesis described by
J. Thomas and A. Harden [14]. As this was an evidence syn-
thesis of existing research, ethical approval was not required.
Search strategy
A search strategy was devised by the research team, led
by our Information Specialist (AB), through examination
of key studies and discussion. It captured the concepts
of school gardening and horticulture activities. The
following MeSH terms were used: school exp; gardening
exp; child nutrition sciences. No methods filters were
used. The master search strategy (Table 1) was adapted
and run in the following electronic databases in February
2014 and updated in May 2015: MEDLINE, EMBASE,
PsycINFO, HMIC and SPP (using the OVID interface);
AEI, BEI, ASSIA, BNI 1994-current and ERIC (using the
ProQuest interface); AMED and CINAHL (using the
EBSCOHost interface). Additional grey literature data-
bases were also searched: OpenGrey, EThOS and British
Library Catalogue. The review by the National Foundation
for Education Research was a useful source of includable
references [8]. Reference lists of included studies were
scrutinised for other relevant studies. Forward citation
searches were undertaken on included studies. Citation
searches were also performed in Web of Science using
three key references [15–17].
Inclusion criteria
Studies were considered eligible for inclusion if they met
the following criteria:
Population: School children, school staff, family and
community members (all ages) were included. Studies
conducted in OECD countries and published in English
were included.
Table 1 Search strategy for the health and well-being impacts
of school gardening (as used in Medline)
1 school*.tw.
2 educat*.tw.
3 garden*.tw.
4 horticult*.tw.
5 (horticult* adj3 (school* or educat*)).tw.
6 (Food or fruit* or vegetable*).tw.
7 ((Food or fruit* or vegetable*) adj2 grow*).tw.
8 ((Food or fruit* or vegetable*) adj2 production).tw.
9 ((Food or fruit* or vegetable*) adj2 producing).tw.
10 ((Food or fruit* or vegetable*) adj2 plant*).tw.
11 7 or 8 or 9 or 10
12 exp Schools/
13 exp Gardening/
14 *"Child Nutrition Sciences"/
15 1 or 12
16 3 or 13 or 14
17 15 and 16
18 11 and 15
19 (educat* adj3 garden*).tw.
20 17 or 18 or 19
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Interventions: Studies were included if they reported
the effects of participation in school gardening
activities. The definition of ‘school’included all
educational settings up to 18 years, including special
schools. The definition of ‘gardening’included growing
or cultivating any kind of plants (such as vegetables,
fruits, trees, shrubs and flowers). Gardening activities
included preparing the soil, planting, weeding,
watering, harvesting and garden-related cooking and
tasting activities. These gardening activities were either
integrated into the curriculum, or conducted outside of
lesson time (e.g. lunchtime clubs, after school clubs,
school-organised trips to community allotments).
Gardening activities for school-age children that did
not involve schools were not included (e.g. summer
holiday clubs or community youth interventions).
Comparators: Quantitative studies were only included if
groups participating in school gardening activities were
compared with control groups or groups participating
in alternative activities (such as nutrition education
without gardening activities). This criterion was not
relevant for qualitative studies.
Outcomes: Studies were included if they reported
quantitative or qualitative health and well-being out-
comes including dietary intake; food-related knowledge,
attitudes and preferences; physical, mental or emotional
health; quality of life indicators. Qualitative findings
also included themes, concepts and metaphors relating
to the experience and meaning of school gardens, and
any perceived factors that help or hinder their success.
Additional outcomes, including adverse or unintended
outcomes, were only considered where they were
reported alongside health and well-being outcomes.
Study design: Suitable quantitative study designs
included randomised controlled trials (RCT), non-
randomised controlled trials, and other ‘controlled
before and after’studies. Suitable qualitative study
designs included any recognised methods of data
collection and analysis from any discipline or theoretical
tradition. The types of data collection methods included
(but were not limited to): focus groups, individual
interviews, participant or systematic observation,
documentary analysis, audio/visual/note collection.
Methods of analysis included (but were not limited to):
grounded theory, narrative analysis, thematic analysis,
phenomenological analysis, discourse analysis.
Selection process
References identified through the search strategy were
uploaded into ENDNOTE (X7, Thomson Reuters).
References (titles/abstracts) were independently double
screened using the eligibility criteria (by reviewers HO/
RW/SG). Studies appearing to meet the criteria were ob-
tained as full text articles. Full texts were independently
double screened using the same criteria (by reviewers
HO/RW/SG/RG). Any disagreements were resolved
through discussion with the whole team.
During full text screening, additional inclusion criteria
were developed as an iterative process. For example,
studies in which school gardening was one of multiple
components in a ‘whole school approach’intervention
(in combination with farm visits, school food policy de-
velopment, school meals and catering reforms, nutrition
education or cookery programmes) were not included if
the reported outcomes were not specifically attributable
to school gardening. Some qualitative studies did report
health and well-being impacts attributable to school
gardening (i.e. distinct from other components) and
these studies were included. Studies that did not report
sufficient information about data collection and/or ana-
lysis methods to enable critical appraisal were excluded
(such as conference abstracts for which the full text was
not available).
Data extraction
Standardised, piloted data extraction sheets were developed
for the review to ensure consistency between studies and
between reviewers. The data extracted for each study in-
cluded, where possible: study design, sample characteris-
tics, description of school gardening activities (intervention
group), description of alternative activities (comparison
group), duration of intervention, data collection methods,
analysis methods and duration of follow up. For quantita-
tive studies, health and well-being outcomes (and other
secondary outcomes) were extracted. For qualitative stud-
ies, findings in the form of participants’quotes and author
themes and concepts were extracted. Data were extracted
by one reviewer (HO) and independently double checked
(by reviewers RW/SG/RG). Any disagreements were
resolved through discussion with the whole team.
Quality appraisal
The quality of included quantitative studies was appraised
using the Effective Public Health Practice Project (EPHPP)
Quality Assessment Tool for Quantitative Studies. Each
study was rated strong, moderate or weak for the follow-
ing components: selection bias, study design, confounders,
blinding, data collection, withdrawals and drop outs. A
‘global’or overall rating was then allocated using the
standard system: strong (no weak ratings), moderate (one
weak rating), or weak (two or more weak ratings).
The quality of included qualitative studies was appraised
using criteria suggested by Wallace et al. [18]. In addition
to the standard ratings of yes, no, can’t tell, we used ‘partial’
in some cases, for example studies in which some ethical
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issues were addressed and others were not (Wallace
criterion 12). We also generated overall quality ratings
using our own system: strong (11–12 ratings of yes);
moderate (6–10 ratings of yes); weak (1–5 ratings of yes).
Studies were appraised by one reviewer (HO) and in-
dependently double checked (by reviewers RW/SG/RG).
Any disagreements were resolved through discussion
with the whole team.
Data synthesis
It was not possible to meta-analyse any of the quantitative
data we extracted due to study design and data limitations
(further information provided in Tables). Authors were
contacted to clarify some study details (such as precise
methods of dietary assessment) before this decision was
confirmed. Data from quantitative studies were therefore
tabulated, grouped by similar outcomes and the effective-
ness of the school gardens in influencing health and well-
being outcomes was described narratively.
The qualitative data were synthesised thematically in
order to understand the perceived well-being and wider
impacts of gardens, as well as factors influencing success
and sustainability, in order to make practical recommen-
dations for interventions [14, 19]. Narrative synthesis
has three overlapping stages: 1) coding of the findings of
primary qualitative studies; 2) organising codes into de-
scriptive themes and concepts; 3) generating analytical
themes –this final stage goes beyond the interpretations
of the original studies and aims to generate new under-
standings or hypotheses in relation to the review ques-
tions [14]. Initially, all study findings were coded,
including those that did not relate directly to health and
well-being impacts. Where multiple publications re-
ported findings from the same qualitative study, we were
careful not to ‘double count’findings. Therefore, where
multiple publications by the same team of authors re-
ported similar themes, only one publication has been
referenced for each theme (the oldest one). In stages 1
and 2, we used an inductive approach to code the data
(line by line) and identify common themes and categor-
ies of themes between studies. This was done manually
rather than using software, using the principles of con-
stant comparison and reciprocal translation [20]. Care
was taken to recognise divergent data and to interpret
the raw data (where presented) rather than uncritically
accept the authors’interpretations. In stage 3, we devel-
oped a conceptual model to summarise and illustrate
proposed mechanisms for the health and well-being im-
pacts of school gardening. The qualitative synthesis was
completed by two reviewers (HO/SG) in discussion with
the rest of the team. Throughout the synthesis, we con-
sidered study quality, context and transferability as we
developed our conceptual model.
Results
Search results
Electronic searches identified a total of 3442 records
after the removal of duplicates. Title and abstract
screening resulted in the exclusion of 3279 records that
did not meet the inclusion criteria. 124 of the remaining
potentially relevant articles were obtained in full text
format (whilst 39 were unobtainable) and another 22
eligible articles were found by citation and manual
searching. Full text screening resulted in the exclusion
of 106 articles (Fig. 1). A total of 40 articles (hereafter
referred to as studies) were eligible for inclusion.
Study characteristics
The 40 included studies were from the UK, Portugal,
USA and Australia. Twenty four studies (including three
that were mixed methods studies) reported quantitative
methods and findings (Table 2). There was some dupli-
cation where multiple publications reported findings
from the same trials, which were: five cluster rando-
mised controlled trials (RCT) [9, 10, 21–23] and 13 non-
randomised controlled trials [15–17, 24–39] (Table 2).
Nineteen studies (including three that were mixed
methods studies) reported qualitative methods and
findings using a variety of study designs which met our
inclusion criteria [11–13, 24–26, 40–52] (Table 3). Again
there was some duplication where multiple publications
reported findings from the same sample (Table 3).
Only two school gardening interventions, the RHS
Campaign for School Gardening and the Stephanie
Alexander Kitchen Program, generated quantitative and
qualitative evidence for the same intervention (Tables 2,
3 and 4) [9, 10, 24–26, 50]. The studies were conducted in
pre-schools [21, 31, 49], primary schools [9, 10, 12, 15, 24–
26, 30, 43–45, 47, 48, 50–52], elementary schools [13, 16,
17, 23, 27–29, 31, 32, 35–37, 39, 41, 46], upper elementary
schools [33, 34], middle schools [38, 40, 46], junior high
schools [17], high schools [11, 42, 46] and secondary
schools [12, 44, 52] (Tables 2 and 3). The school gardening
interventions included a variety of components and cha-
racteristics (Table 4). For example, some were purely
gardening interventions [9–13, 17, 21, 27, 31, 39–42, 44,
46, 49–51], whereas others incorporated cooking and/or
nutrition education alongside the gardening activities
[15, 16, 22–26, 28–30, 32–38, 43, 45, 47, 48, 52].
Duplication and differences in reporting
Where multiple publications duplicated findings from the
same trials, we have been very careful to present and
synthesise the findings of these studies without duplica-
tion; for example elements of Morgan’sfindingswerere-
published by Jaenke [15, 30]). To confuse matters,
differences were found in the reporting of the same out-
comes between different studies. For example, Jaenke and
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Morgan both reported data from a school garden-based
nutrition education program in Australia (n=127) but
they reported slightly different findings in the control
group for fruit and vegetable intake [15, 30]. Neither of
these reported findings were statistically significant and we
have presented the most recent findings [15] (Table 7). An-
other case of duplication and differences in reporting was
in the evaluation of the pilot of the Stephanie Alexander
Kitchen Garden Program in Australia [25, 26]. Both studies
reported children’s willingness to try new foods, but with
slightly different sample sizes (n=770/n= 764) and there-
fore slightly different findings. We have presented the find-
ings from the original study which also reported the largest
sample size [25] (Table 9). As illustrated, in cases such as
these, the data from the study reporting the largest sample
size (or, if the sample sizes were equal, the most recent
study) were presented in our review tables.
Quality appraisal of included studies
Where multiple studies reported quantitative data from the
same trial (quantitative) or the same sample (qualitative),
they were appraised collectively (Tables 5 and 6). Most of
the quantitative studies were rated as weak, with six studies
rated as moderate [10, 15, 23, 28–30] (Table 5). Quality
criteria that were commonly rated weak (in more than half
the studies) using the EPHPP system were selection bias,
Fig. 1 Flow chart showing the identification and selection of studies
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Table 2 Summary of included quantitative studies (n= 18)
First author (year)
Publication type
Study design Country Type of schools Sample size (baseline) Sample characteristics Intervention group
(duration)
Comparison or
control group
Outcomes (health and
well-being only)
Block (2012)
a
[24]
Journal paper
Non-
randomised
controlled
Australia Primary 764 children (reported
as 770 in Block et al.
2009)
562 parents
8–12 years
54 % girls
Stephanie Alexander
Kitchen Garden
Program (45–60 min
in garden class &
90 min in kitchen
class/week for 12+
mnths)
No intervention (but
Gibbs et al. reported
that some children
were exposed to
some gardening and
cooking activities)
Child quality of life
Block (2009)
a
[25]
Report
Willingness to try new
foods
Gibbs (2013)
a
[26]
Journal paper
Willingness to try new
foods
Food and beverage
intakes including FV
Brouwer (2013) [27]
Journal paper
Cluster RCT USA Pre-school 12 children 3–5 years Watch Me Grow
(weekly activities for
four months)
No intervention
(delayed)
FV served and
consumed
Christian (2014) (1) [28]
Journal paper: Trial 1
Cluster RCT UK Primary 1138 children
(reported as 1256 in
the journal paper)
For two groups
respectively:
Mean 8.2/8.1 year
50/51 % boys
30/35 % White British
(diverse)
Royal Horticultural
Society (RHS) led
gardening activities
(18 months with
regular support visits
and termly teacher
training sessions from
RHS)
Teacher led
gardening activities
(18 months with
termly teacher
training sessions from
RHS)
Vegetable intake
Fruit intake
Food group and
essential nutrient
intakes
Christian (2014) (2) [9]
Report: Trial 1
As above plus:
FV knowledge
Attitudes towards FV
Christian (2014) (2) [10]
Report: Trial 2
Cluster RCT UK Primary 1391 children For two groups
respectively:
Mean 8.3/8.2 years
52/48 % boys
23/17 % White British
(diverse)
Teacher led
gardening activities
(15 months with
termly teacher
training sessions from
RHS)
No intervention Vegetable intake
Fruit intake
Food group and
essential nutrient
intakes
FV knowledge
Attitudes towards FV
Cotter (2013) [22]
Journal paper
Cluster RCT Portugal NR 155 10–12 years Aromas school
gardening club (2 h/
week for 6 months)
plus regular lectures
on the dangers of
high salt intake
Regular lectures on
the dangers of high
salt intake
Body Mass Index
(BMI)
Waist circumference
Blood pressure (SBP/
DBP)
Urinary sodium
Urinary creatinine
Estimated salt intake
Wells (2014) [23]
Journal paper
Cluster RCT USA Elementary 285 8–12 years Healthy Gardens,
Healthy Youth pilot
program: gardening
activities plus
curriculum of 20
lessons (1 year)
No intervention
(control group
received gardens at
the end of the study)
Physical activity
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Table 2 Summary of included quantitative studies (n= 18) (Continued)
Cotugna (2012) [27]
Journal paper
Non-randomised
controlled
USA Elementary 359 Age or gender not
reported;
For A/B/C
respectively: 73/41/
37 % White
37/34/38 % low
income
Gardening education
program (duration
unknown) first time in
School B and second
time in School C
No intervention
(School A)
Students who chose
salad for lunch
Davis (2011) [28]
Journal paper
Non-
randomised
controlled
USA Elementary 107 (reported as 104
in Davis et al. 2011)
9–11 years
59 % overweight or
obese
For two groups
respectively:
Mean 9.7/9.9 years
38/59 % boys
97/93 % Latino
LA Sprouts: cooking
and nutrition lessons
plus gardening
activities (90 min per
week for 12 weeks)
No intervention Body Mass Index
(BMI)
Waist circumference
Total body fat
Blood pressure
(SBP/DBP)
Vegetable intake
Fruit intake
Food group and
macronutrient intakes
Gatto (2012) [29]
Journal paper
Motivation to eat FV
Attitudes, preferences
and perceptions
relating to cooking FV
Jaenke (2012) [15]
Journal paper
Non-
randomised
controlled
Australia Primary 127 Fifth and sixth grade
students
11–12 years
54 % boys
Nutrition education:
How do you grow?
(3 h over 10 weeks)
plus gardening: How
does your garden
grow? (180 min per
week for 10 weeks)
Nutrition education
only: How do you
grow? (3 h over
10 weeks)
No intervention
Willingness to taste
vegetables
Taste ratings of
vegetables
Fruit intake
Vegetable intake
Morgan (2010) [30]
Journal paper
Fruit intake
Vegetable intake
Ability to identify
vegetables
Willingness to taste
vegetables
Taste ratings of
vegetables
FV knowledge
Quality of school life
McAleese (2007) [16]
Journal paper
Non-
randomised
controlled
USA Elementary 122 10–13 years
Mean 11.1 years
44 % boys
Nutrition education:
Nutrition in the
garden, plus
gardening (12 weeks)
Nutrition education
only: Nutrition in the
garden (12 weeks)
No intervention
Fruit intake
Vegetable intake
Vitamin A intake
Vitamin C intake
Fibre intake
Meinen (2012) [31]
Journal paper
Non-
randomised
controlled
USA Elementary schools and
early childhood sites
404 youth
567 parents
7–13 years
54 % boys
For two groups
respectively:
Mean 9.9/10.1 years
Majority/88 % White
Youth gardening
program: Got Dirt?
(4 months)
No intervention Willingness to try new
FV
Like/dislike of FV
Knowledge of FV
FV consumption
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Table 2 Summary of included quantitative studies (n= 18) (Continued)
Morris (2001) [32]
Journal paper
Non-
randomised
controlled
USA Elementary 97 First grade students Nutrition education
plus gardening
(8 months)
No intervention Nutrition knowledge
Willingness to taste
vegetables
Taste ratings of
vegetables
Morris (2002) (1) [33]
Journal paper
Non-
randomised
controlled
USA Upper elementary 215 (reported as 213
in journal paper)
9–10 years
8.4 % African
American
3.0 % Asian American
17.2 % Hispanic
66.5 % White
In-class nutrition
education including
hands-on gardening
activities (9 lessons
over 17 weeks)
In-class nutrition
education only (9
lessons over
17 weeks)
No intervention
Nutrition knowledge
Vegetable preference
Morris (2002) (2) [34]
Report
O’Brien (2006) [35]
Journal paper
Non-
randomised
controlled
USA Elementary 38 9–10 years
50 % boys
71 % White
After school
gardening club (8
lessons with 30 min
gardening over
10 weeks)
No intervention Nutrition knowledge
FV preference
FV consumption
self-efficacy
FV consumption
expectations
Parmer (2009) [37]
Journal paper
Non-
randomised
controlled
USA Elementary 115 70 % boys
For three groups
mean respectively:
7.3/7.5/7.4 years
46/27/28 % girls
Nutrition education
plus gardening (1 h
alternating nutrition
education and
gardening for
28 weeks)
Nutrition education
only (1 h every other
week for 28 weeks)
No intervention
FV knowledge
FV preferences
FV consumption
Parmer (2007) [36]
Dissertation
Ratcliffe (2011) [38]
Journal paper
Non-
randomised
controlled
USA Middle 320 11–13 years
22 % African
American
29 % Asian American
9 % Filipino American
30 % Latino
3 % Pacific Islander
7 % White or other
35 % overweight
64 % low income
Garden-based
learning activities
integrated into
science class (20 min
instruction and
40 min hands-on
gardening per week
for 4 months)
Covered the same
health and science
objectives but did not
include a gardening
program
Vegetable knowledge
Vegetables
preferences
Willingness to taste
Vegetable
consumption
Robinson (2005) [39]
Journal paper
Non-
randomised
controlled
USA Elementary 281 Third, fourth and fifth
grade students (no
further info)
School gardening
curriculum: Texas
Agricultural Extension
Service (varied
intensity over one
school year)
No intervention (until
after study period)
Life skills: working
with groups; self-
understanding;
leadership; decision
making;
communication;
volunteerism
Waliczek (2001) [17]
Journal paper
Non-
randomised
controlled
USA Elementary and junior
high
589 8–15 years
43 % boys at post-test
Project GREEN school
garden program
(Spring semester)
No intervention Interpersonal
relationships
a
also included for qualitative findings (see Table 3); FV fruits and vegetables
FV fruits and vegetables, SBP systolic blood pressure, DBP diastolic blood pressure
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Table 3 Summary of included qualitative studies (n= 16)
First author
(year)
Country Sample characteristics Aims Sampling methods Intervention Data collection
methods Analysis
methods
Ahmed
(2011) [40]
USA Administrators (n= 2),
teachers (n= 4) and
garden staff (n=3) at
one rural middle school;
school population 50 %
Native Hawaiian; low
socio-economic status
To examine
perceptions of
educators about the
effects of school-
based gardens on
children's health and
obesity
Snowball sampling
starting with the
school principle and
garden leader
School garden
program founded to
prevent nutrition-
related illness
(with community
involvement)
Semi structured
interviews (4 years
after garden
established)
Grounded Theory
approach using
descriptive, open
coding; list of themes
used to develop a
conceptual model
Alexander
(1995) [41]
USA Students (n= 52),
teachers (n= 5), parents
(n= 3), principal and
Master Gardener at one
inner city elementary
school; students 70 %
Hispanic; many from
single parent homes
To identify the effects
on school children
participating in
classroom gardens
NR Master Gardeners’
Classroom Garden
Project
Interviews (individual
and group) and
observation
Constant comparative
method; multiple
sources of data
evaluated for
emerging themes
Anderson
(2011) [42]
USA Students (n= 14) at one
rural high school
To determine the
impact of
hydroponically grown
vegetableson obesity
indices
Purposely selected
students twice during
the two-year project
Hydroponic
gardening system
Focus groups (n=7at
each time point i.e.
twice during the
two-year project)
Block (2012)
a
[24]
Australia Six program schools and
six comparison schools;
all primary
At program schools only:
classroom teachers
(n= 26), volunteers
(n= 17), other parents
(n= 20), children
(n= 124), kitchen and
garden specialist staff
(n= 10)
At all participating
program and comparison
schools: school principals
(n= 12)
To explore
participants'
expectations and
experiences of the
program, changes in
the school and home
environment,
highlights and areas
for potential
improvement
Convenience
sampling (all adults
invited to participate)
and purposive
sampling (teachers
selected children with
range of ages and
program experience)
Stephanie Alexander
Kitchen Garden
Program
Focus groups,
individual interviews,
participant
observation, field
notes and researcher
reflections (at various
time points before,
during and after the
program)
Inductive thematic
content analysis to
identify emerging
themes and patterns,
which were then
further analysed
according to their
relationship with the
existing evidence
base and theoretical
perspectives
Block (2009)
a
[25]
Gibbs (2013)
a
[26]
To evaluate the
achievement of the
program in increasing
child appreciation of
diverse, healthy food
Townsend
(2014) [43]
To explore
motivations for and
impacts of
volunteering with the
gardening program
Bowker
(2007) [44]
UK Two classes from one
primary school and one
secondary school;
7–14 years
To gain
anunderstanding of
what the children
themselves think
about school
gardening
Quota sampling to
identify two schools;
within each school a
class unit was
selected to further
refine the sample; 12
children in each class
were randomly
selected for interviews
Gardens for Life (to
support and extend
learning in other
curriculum areas)
Concept maps
(n= 72) supported
by contextual
observation, semi-
structured interviews
(n= 24) (after
6 months) and
children’s drawings
Interpretive approach
- broad concepts
were identified and
organised into
categories; concept
grids and depth
scores used to look
for patterns
Chawla (2014)
[11]
USA Students (n= 52),
teachers and school
principals from four high
Research questions:
How do students
experience natural
Purposive sampling to
span the high school
age range
Four different
gardening programs
at four high schools:
Ethnographic
observations recorded
through field notes,
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Table 3 Summary of included qualitative studies (n= 16) (Continued)
schools; students 14–19
years; 60 % girls;
European-American
(n= 29); Hispanic (n= 19);
Asian (n= 3); Pacific
Islander (n=1)
areas on their school
grounds? What values
do students find in
these natural areas?
gardening as school
service (elected);
agricultural biology
class (elected);
horticultural science
class for teen mothers
(required); after
school and summer
gardening program
(voluntary)
video or
photography, and
open-ended,
semi-structured
interviews
Data was repeatedly
reviewed with
attention to repetitive
refrains, recurring
patterns and resonant
metaphors;
triangulation of
methods to identify
similar themes and
discordant data
Chiumento
(2012) [12]
UK Students (n= 36) with
signs of Behavioural,
Emotional & Social
Difficulties (BESD) from
two primary and one
secondary schools; 10–15
years; 61 % boys; mix of
nationalities and
ethnicities including
children seeking asylum;
deprived ward in
Liverpool
NR Students were
referred by schools,
providing pen profiles
of current difficulties
including potential
behavioural risk
factors
Haven of Greenspace
(social and
therapeutic
horticulture); pupil led
sessions using NFER
five ways to well-
being framework
(monthly for
6 months)
Draw and write
journals (children);
closing semi-
structured interviews
(link teachers);
reflective process
diary by group
therapists
Thematic analysis of
interview transcripts;
random selection of
journals analysed with
quality checks
Cutter-
Macenzie
(2009) [45]
Australia Students (n= ?) from one
city primary school; 6–12
years; all students
participating in program
(n= 70) had English as a
second language and
some were recent
migrants
To assess the impact
of the program
against its objectives
which included
helping to develop
strong local
communities and
school communities;
and fostering healthy
eating habits
NR Multicultural school
gardens program
created to enable
disadvantaged
schools to establish a
culturally focused
gardening program
(2 years)
Children as
researchers including
journals, photographs
and peer interviews
(n= 10); researcher’s
field visits,
observations and
interviews with
children and teachers
(after 3 months)
Hazzard (2011)
[46]
USA Administrators, teachers,
parent and community
volunteers and garden
coordinators (n= ?) from
10 schools (elementary,
middle and high schools)
To ascertain and
report best practices
for schools
implementing or
sustaining
instructional school
gardens
Stratified random
sampling from list of
all schools with
exemplary
instructional school
gardens programs;
principals selected
individuals directly
involved with the
success of the
gardens
California Instructional
School Garden
Program (CISGP)
Interviews with key
members
Constant comparative
analysis; results used
to create best practice
modelsfor schools in
California and across
the United States
Henryks (2011)
[47]
Australia Parents of children
enrolled at the school
(n= 5) and another
member of the wider
community (n=1) at
one primary school
To explore the role
played by the school
kitchen garden in the
lives of its associated
volunteers
Purposive sampling
by email invitation to
volunteers
Stephanie Alexander
Kitchen Garden
Program
In-depth interviews
Thematic analysis
used to build a
conceptual map of
the experiences of
the school kitchen
garden volunteers,
including the
motivations, benefits
and challenges that
volunteers
experienced;
combination of
inductive and
deductive approaches
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Table 3 Summary of included qualitative studies (n= 16) (Continued)
Lakin (2008)
[48]
UK Head teacher, a governor,
a teacher and groups of
children in Year 3 (n=5)
and Year 6 (n= 5) at one
semi-rural primary school;
7–11 years
NR School B selected to
represent example of
good practice;
children selected by
the head teacher for
their involvement in
the innovations
Health Promoting
Schools:
Gloucestershire Food
Strategy
Detailed interviews;
observations;
classroom display and
classroom activities as
exemplified by the
children's workbooks
(over 3 days of visits)
Miller (2007)
[49]
USA Teachers (n= 19) and
children (n= ?) from one
early education setting:
Dimensions Educational
Research Foundation;
3–6 years
To examine the skills
young children are
developing when
they are engagedin
developmentally
appropriate activities
in the greenhouse
and garden
NR Dimensions outdoor
classroom including
garden and
greenhouse areas
(two small group
activities a month)
Teachers’
documentation
(nature notes) of
children interacting
with nature in the
garden/greenhouse;
children’s drawings
and work from their
garden/greenhouse
experiences (n= ?);
focus group
interviews conducted
with teachers (n= 19)
on three occasions
over two years.
Teachers’nature
notes and children’s
work were analysed
using a systematic
framework from prior
data analysis of
teachers’visual notes;
key themes identified
from focus groups
Ming Wei
(2012) [13]
USA Students (n= 20),
teachers (n= 9), school
principal, school
counsellor, student
services coordinator and
parents/caregivers (n=4)
from one rural
elementary school;
students 55 % girls; from
low to middle income
families; native culture
To better understand
the experience of
student learning in
the context of school
garden-based educa-
tion and to determine
the relevance of
school gardens as a
site for learning
making
Convenience sample
of third, fourth and
fifth grade Gifted and
Talented students
who spent two or
more hours in the
garden each week
The Discovery Garden:
using an
interdisciplinary
standards-based
school garden
curriculum
Formal interviews and
talk story (informal
chats); field notes
collected during the
garden classes and
garden-based
activities (over one
semester)
Listened and looked
for recurring patterns;
constructed of a
network of related
and connected
themes; content
analysis using
constant comparative
methods
Passy (2010)
[50]
UK Two samples (two stages)
from 10 primary schools
e.g. stage 1: senior
leaders (n= 11), garden
leads (n= 10), other
members of teaching
staff (n= 10), teaching
assistants (n= 2), parent
governors (n= 2), other
parents (n= 2) and pupils
(n= 43)
To assess the impact
that using a school
garden had on
primary pupils’
learning, behaviour
and health and
wellbeing
Stratified random
sampling from list of
participating schools;
weighted towards
those with higher
levels of benchmark
achievement
Campaign for School
Gardening (Royal
Horticultural Society)
Case studies including
interviews and
observations
(two stages over six
months); schools
were given disposable
cameras and diaries in
which to record
activities
Somerset
(2005) [51]
Australia Teachers responsible for
vegetable gardens at 12
primary schools
To investigate the
nature and extent of
the use of school
gardens in a defined
region of eastern
Australia
All schools with
vegetable gardens
(outdoor or
greenhouse) as
identified by
telephone survey
Schools with
vegetable gardens
(no one intervention)
Open ended
questionnaire; face-to-
face interviews
Data were then
categorised
thematically and
analysed
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control for confounders, and follow-up rate (withdrawals
and drop-outs) (Fig. 2). While five qualitative studies were
rated as strong, most of the qualitative studies were rated
as weak or moderate quality [11, 24–26, 43] (Table 6). This
reflects the often unclear reporting about some aspects of
quality in qualitative studies, such as theoretical perspective,
adequacy of sample and selection methods, data collection
methods, analysis methods, consideration of limitations
and of ethical issues.
Quantitative evidence for the health and well-being impacts
of school gardening
Fruit and vegetable intakes
Thirteen studies reported children’s fruit and vegetable
intakes [9, 10, 15, 16, 21, 26–28, 30, 31, 36–38] (Table 7).
Only two studies reported statistically significant increases
effects [16, 38]. Both used outcomes based on children’s
self-report, and were non-randomised studies that were
rated weak in the quality appraisal.
Nutrient intakes (and other dietary outcomes)
Six studies reported children’s nutrient intakes or other
dietary outcomes [9, 10, 16, 22, 26, 28] (Table 8). Four
studies reported statistically significant changes in nutrient
intake [9, 10, 16, 28]. However, in two studies there was
only one statistically significant finding from the multiple
nutrient indicators measured, [9, 28] one of which related
to a decrease in dietary fibre in the control group, rather
than improvements in the intervention group [28]. The
other study showed more convincing positive effects for
three nutrient indicators, but data were based on
children’s self-report and was selectively reported for three
nutrients only [16].
Food preferences
Thirteen studies reported children’sfoodpreferences,
including willingness to taste and taste ratings for fruits
and vegetables [15, 25, 26, 29–38] (Table 9). Eight of the
studies reported statistically significant intervention effects
showing increased preference for fruits and vegetables
[15, 30, 32–34, 36–38]. However, these are subjective
measures which are highly susceptible to social desirability
bias, especially in children who may be eager to please
after learning about healthy foods and growing vegetables
during school gardening time. We consider food prefer-
ences as an early step on the pathway towards behaviour
change, but not indicative of behaviour change in itself.
Knowledge and attitudes towards food
Ten studies reported children’s knowledge and attitudes
towards food [10, 30–38] (Table 10). Seven of the studies
reported statistically significant intervention effects
[10, 30, 33, 34, 36–38]. For the most part these were
positive effects, showing improved knowledge or attitudes
towards food in the intervention groups. Interestingly, one
cluster RCT (Trial 1) in the UK found that students who
participated in expert-led gardening activities (interven-
tion group) for 18 months were less likely to have positive
attitudes towards fruits and vegetables, compared with
students who participated in teacher-led gardening activ-
ities (comparison group), suggesting that teacher-led activ-
ities might be more effective [10]. However, this study had
mixed results with other outcome measures showing no
statistical difference between teacher and expert-led gar-
dening. As stated above for children’sfoodpreferences,
these measures of knowledge and attitudes are susceptible
to social desirability bias and reflect possible behaviour
change mechanisms rather than actual behaviour change.
Physical health and activity
Two studies reported physical health measures, both
including waist circumference, body mass index (BMI),
and systolic and diastolic blood pressure [22, 28]
(Table 11). The only statistically significant difference
was reported in a non-randomised controlled study for
diastolic blood pressure, which lowered more in the
intervention group (cooking, nutrition and gardening)
compared to the control group [28]. However, all of the
blood pressure readings in this study were within the
normal range for school children (systolic: 85–120;
diastolic: 50–80) so this finding may not be clinically
relevant as an improvement in physical health. Another
Table 3 Summary of included qualitative studies (n= 16) (Continued)
Viola (2006)
[52]
Australia Key informants from one
primary school (n=6)
and one secondary
school (n= 9); students in
grades 4–9; Indigenous
Australians; remote rural
communities
To examine how
effective school
gardens are as a
nutritional education
tool in Indigenous
Australian school
settings
Schools selected by
researcher;
participating grades
determined by school
principals; key
informants selected
from each community
advisory group
Outreach School
Garden Project
(incorporated formal
nutrition and
gardening education
lessons into the core
school curriculum
Semi-structured
interviews; reflective
journal; event log
(over six months with
outreach visits for 3–5
days every 6–8
weeks)Descriptive
qualitative approach;
triangulation of
research methods and
data sources
a
also included for quantitative findings (see Table 2)
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Table 4 Components and characteristics of school gardening interventions included in this review
First author (year)Multiple
studies about the same
intervention are grouped
together.
Name of school
gardening intervention
Gardening
component
Cooking as
key
component
Nutrition
education
component
Integrated
with wider
curriculum
Produce
used in
school
catering
Outdoors
some or
all of the
time
Delivered
by
specialists
Delivered
by
teachers
Teachers
trained
by
specialists
Community
involvement
Theory-led
intervention
Ahmed (2011) [40] No name (school garden
program founded to
prevent nutrition-related
illness)
✓✓ ✓
Alexander (1995) [41] Master Gardeners’
Classroom Garden Project
✓ ✓✓✓ ✓
Anderson (2011) Hyrdoponic gardening
system
✓✓ ✓
Block (2012) [24]
Block (2009) [25]
Gibbs (2013) [26]
Henryks (2011) [47]
Townsend (2014) [43]
Stephanie Alexander
Kitchen Garden Program
✓✓ ✓ ✓✓✓ ✓ ✓
Bowker (2007) [44] Gardens for Life ✓✓ ✓✓
Brouwer (2013) [21] Watch Me Grow ✓✓✓✓✓✓✓
Chawla (2014) [11] No name (four different
gardening programs at
four high schools)
✓✓✓✓
Chiumento (2012) [12] Haven of Greenspace
(social and therapeutic
horticulture)
✓✓✓✓
Christian (2014) (1),
[9] Christian (2014) (2) [10]
Passy (2010) [50]
Royal Horticultural Society
(RHS) Campaign for
School Gardening
✓ ✓ ✓ ✓✓✓✓ ✓
Cotter (2013) [22] Aromas school gardening
club
✓✓ ✓
Cotugna (2012) [27] Gardening education
program
✓✓
Cutter-Macenzie (2009) [45] Multicultural School
Gardens Program
✓✓ ✓ ✓ ✓ ✓
Davis (2011) [28]
Gatto (2012) [29]
LA Sprouts ✓✓✓ ✓✓✓✓✓ ✓
Hazzard (2011) [46] California Instructional
School Garden Program
✓✓ ✓
Jaenke (2012) [15]
Morgan (2010) [30]
How do you grow?/How
does your garden grow?
✓✓✓✓✓✓ ✓✓✓ ✓
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Table 4 Components and characteristics of school gardening interventions included in this review (Continued)
Lakin (2008) [48] Health Promoting
Schools: Gloucestershire
Food Strategy
✓✓✓✓✓✓ ✓
McAleese (2007) [16] Nutrition in the garden ✓✓✓ ✓
Meinen (2012) [31] Youth gardening
program: Got Dirt?
✓✓✓
Miller (2007) [49] Dimensions outdoor
classroom including
garden and greenhouse
areas
✓✓✓✓✓
Ming Wei (2012) [13] The Discovery Garden ✓✓✓✓✓
Morris (2001) [32]
Morris (2002) (1) [33]
Morris (2002) (2) [34]
No name (nutrition
education plus
gardening)
✓✓✓✓✓✓ ✓ ✓ ✓
O’Brien (2006) [35] No name (based on
Junior Master Gardener)
✓✓ ✓✓✓
Parmer (2009) [37]
Parmer (2007) [36]
No name (based on
Pyramid Café/Health and
Nutrition from the
Garden)
✓✓✓✓ ✓ ✓ ✓
Ratcliffe (2011) [38] No name (garden-based
learning activities)
✓✓✓✓✓✓ ✓ ✓ ✓
Robinson (2005) [39] No name (school
gardening curriculum)
✓✓✓✓✓✓
Somerset (2005) [51] No name (schools with
vegetable gardens)
✓✓
Viola (2006) [52] Outreach School Garden
Project
✓✓✓ ✓ ✓
Waliczek (2001) [17] Project GREEN school
garden program
✓✓ ✓
Wells (2014) [23] Healthy Gardens, Healthy
Youth
✓✓✓✓✓
Note: some studies did not report sufficient details about the intervention, so no tick may mean not applicable or not reported
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cluster RCT (elementary school based) reported physical
activity measures derived from both a questionnaire and
accelerometry [23] (Table 11). While children who
participated in school gardening (intervention group)
reported being ‘usually’less sedentary (p= 0.001) and
spent more time engaged in ‘moderate’physical activity
(p= 0.010) compared to the control group, there was no
increase in ‘light’physical activity or reduction in seden-
tary behaviour when measured objectively using acceler-
ometers. Note however that the accelerometer analysis
was based on a selected subsample of students.
Well-being
Four studies reported children’swell-beingusingavariety
of measures, only some of which used valid and reliable
scales, including quality of life, life skills and interpersonal
relationships [17, 24, 30, 39] (Table 12). Two of the four
studies did not find a significant difference between inter-
vention and control groups using their selected measures
at follow up [24, 30]. The other two studies did not report
their child wellbeing outcomes adequately [17, 39].
Overall, quantitative evidence for the impacts of school
gardens is limited with some suggestion of improvements
in knowledge, attitudes and preferences towards fruit and
vegetables, but little objective evidence of changes in
eating habits or physical health benefits.
Qualitative evidence for the health and well-being impacts
of school gardening
Qualitative evidence was synthesised narratively and is
described below in relation to the health, wellbeing and
educational impacts described by children, teachers and
parents, and those factors thought to be associated with
the success and sustainability of school gardens. Tables 13
and 14 show the subthemes which make up each of these
broad themes and which studies contributed to each.
Health impacts
Most studies described perceived nutritional benefits for
children involved in school gardening, including greater
knowledge and awareness, improved attitudes towards
food such as willingness to try new foods, and healthier
eating habits [13, 25, 40, 44, 45, 47–52] (Table 13).
Table 5 Quality appraisal of included quantitative studies (n= 18)
First author (year) EPHPP criteria for quantitative studies
Selection bias Study design Confounders Blinding Data collection Withdrawals and dropouts Overall rating
Block (2012) [24]
Block (2009) [25]
Gibbs (2013) [26]
Weak Strong Weak Moderate Moderate Strong Weak
Brouwer (2013) [21] Weak Strong Weak Moderate Strong Weak Weak
Christian (2014) (1), [9]
Christian (2014) (2) Trial 1 [10]
Weak Strong Moderate Moderate Moderate Weak Weak
Christian (2014) (2) Trial 2 [10] Weak Strong Moderate Moderate Moderate Moderate Moderate
Cotter (2012) [22] Weak Strong Weak Moderate Strong Strong Weak
Cotugna (2012) [27] Moderate Strong Weak Weak Weak Weak Weak
Davis (2011) [28]
Gatto (2012) [29]
Moderate Strong Strong Moderate Strong Strong Moderate
Jaenke (2012) [15]
Morgan (2010) [30]
Moderate Moderate Strong Moderate Weak Strong Moderate
McAleese (2007) [16] Weak Strong Weak Moderate Moderate Weak Weak
Meinen (2012) [31] Moderate Moderate Weak Weak Weak Moderate Weak
Morris (2001) [32] Weak Moderate Weak Moderate Weak Weak Weak
Morris (2002) (1) [33]
Morris (2002) (2) [34]
Moderate Weak Weak Moderate Moderate Strong Weak
O’Brien (2006) [35] Weak Weak Weak Moderate Weak Weak Weak
Parmer (2007) [36]
Parmer (2009) [37]
Weak Moderate Weak Moderate Weak Weak Weak
Ratcliffe (2011) [38] Weak Weak Weak Moderate Moderate Moderate Weak
Robinson (2005) [39] Weak Weak Weak Moderate Weak Weak Weak
Waliczek (2001) [17] Weak Weak Weak Moderate Strong Weak Weak
Wells (2014) [23] Weak Moderate Moderate Moderate Moderate Moderate Moderate
Where multiple publications reported quantitative data from the same study, they were appraised as one study
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When I grow them [vegetables] I feel like I should
always try it. And when I’ve grown them I like them
better than the shop ones. –Child, primary school [50].
This quote illustrates how participation in school gar-
dening created a sense of connection to the food grown,
which encouraged children to be more adventurous and
led to increased preference for vegetables. Staff and vol-
unteers observed these changes in children’s attitudes
and behaviour and some, like this administrator, became
optimistic about the potential of school gardens to
generate major shifts in food culture in the long term.
We’ve got to start with these kids now, so that when
they become the grandparents, they’re modelling
correctly for the kids. We’re probably not going to
change the values of today’s elderly and today’s
parents, but if we begin with the kids we’re going to
have a chance over time to change the health and
wellness of the population. –Administrator [40]
These kinds of aspirations may be idealistic, but they
contributed to enthusiasm and motivation to support the
school gardens, the importance of which will be explored
later in this review. The quote also illustrates the percep-
tion expressed in three studies [40, 50, 51] that starting at
an “early”age (not defined) could be an important factor
in the success of school gardening interventions for
encouraging the development of a healthy lifestyle.
Other studies described school gardening as an oppor-
tunity for physical activity for both children and adults
[13, 40, 50–52]. Primary school teachers appreciated the
Table 6 Quality appraisal of included qualitative studies (n= 16)
First author (year) Wallace criteria Total #
Yes ratings
Overall
rating
12 2b34 5 6 7 8 9 1011 12
Ahmed (2011) [40] Y N CT Y Y N Y Y Y Y Y Y Y 10 Moderate
Alexander (1995) [41] Y Y Y Y N P Y Y Y Y N N CT 8 Moderate
Anderson (2011) [42] Y Y CT Y Y CT P P N N P Y P 5 Weak
Block (2012) [24]
Block (2009) [25]
Gibbs (2013) [26]
Townsend (2014) [43]
Y Y Y Y Y P Y Y Y Y Y NA Y 11 Strong
Bowker (2007) [44] Y Y Y Y Y P Y Y P Y Y Y P 10 Moderate
Chawla (2014) [11] Y Y Y Y Y P Y Y Y Y P Y Y 11 Strong
Chiumento (2012) [12] Y P CT Y Y P P P Y Y N NA P 5 Weak
Cutter-Mackenzie (2009) [45] Y N CT Y Y P Y P N Y Y Y P 7 Moderate
Hazzard (2011) [46] Y N CT Y P P P P Y P N N P 3 Weak
Henryks (2011) [47] Y Y Y Y Y N Y P Y Y P NA P 8 Moderate
Lakin (2008) [48] Y N CT Y Y P Y CT N P N Y N 5 Weak
Miller (2007) [49] Y N CT Y Y CT Y Y P P N N N 5 Weak
Ming Wei (2012) [13] Y Y CT Y Y P Y Y Y Y Y NA Y 10 Moderate
Passy (2010) [50] Y N CT Y Y Y Y CT N Y N Y P 7 Moderate
Somerset (2005) [51] Y N CT Y N CT N P P Y N N CT 3 Weak
Viola (2006) [52] Y Y Y Y Y P Y P N P Y Y Y 9 Moderate
Where multiple publications reported qualitative data from the same study, they were appraised as one study
Yyes, Ppartial, Nno, CT can’t tell, NA not applicable
Overall quality rating: strong (11–12 ratings Y); moderate (6–10 ratings Y); weak (1–5 ratings Y)
Legend for Table 6: Wallace criteria (Wallace et al. [18])
1. Is the research question clear?
2. Is the theoretical or ideological perspective of the author (or funder) explicit?
2b. Has this influenced the study design, methods or research findings?
3. Is the study design appropriate to answer the question?
4. Is the context or setting adequately described?
5. Is the sample adequate to explore the range of subjects and settings, and has it been drawn from an appropriate population?
6. Was the data collection adequately described?
7. Was data collection rigorously conducted to ensure confidence in the findings?
8. Was there evidence that the data analysis was rigorously conducted to ensure confidence in the findings?
9. Are the findings substantiated by the data?
10. Has consideration been given to any limitations of the methods or data that may have affected the results?
11. Do any claims to generalisability follow logically and theoretically from the data?
12. Have ethical issues been addressed and confidentiality respected?
The scoring system used above was adapted for the purposes of this review
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physical aspect of gardening for certain groups of
students in particular: “the boys that you want to keep
physically busy”and those “children who cannot concen-
trate in class”[51]. In a rural Hawai’ian elementary
school, parents saw it as an opportunity “to teach work
ethics, to become physically strong and healthy, and to
raise awareness of how other people labour to make our
lives better and easier”[13]. School gardens are posi-
tioned as part of a social, even moral, education.
Well-being impacts
Most qualitative studies reported well-being impacts of
school gardening for children and/or adult participants
[11–13, 25, 40, 41, 44, 45, 47–52] (Table 13). We further
categorised these into personal and social well-being im-
pacts. The personal well-being impacts included enjoy-
ment and feelings of achievement, satisfaction and pride
from nurturing the plants, seeing them grow and eventu-
ally harvested the crops [11–13, 25, 40, 41, 44, 45, 47–52].
It makes me feel good inside, all fresh, good…I enjoy
touching the soil, the plants. You can feel them…I feel
part of them…Yes, it makes me feel that I can care
more about things…Being more gentle, caring more,
the plants are like people. –Student, age 17 [11].
These emotions are visceral and again there is the
sense of connection to nature, which is very different to
the classroom experience and brings different lessons –
based on empathy and care –to the children in terms of
how they interact with people.
Most studies described how children gained confi-
dence and self-esteem through school gardening
[11–13, 25, 41, 44, 47–52]. Developing and maintain-
ing the gardens gave children the opportunity to demon-
strate ownership and responsibility [12, 13, 24, 40, 48–50],
which may have contributed to these feelings of
confidence.
A child who struggled and had learning disabilities …
and just her confidence and her ability to outshine
other kids, who have strengths in other areas was just
amazing and she was just really comfortable, in her
element. She knew exactly what she was doing, she
was in control, she was starring while she was
organising the other kids. The building of confidence
was just amazing. –Teacher, primary school [25].
This quote echoes those above and suggests particular
benefits of mastery and empowerment for children who
do not excel in the usual academic setting, such as those
with learning or behavioural difficulties. The school
gardens allowed them to shine in different ways and to
experience success.
In some studies, children and adolescents described
school gardens as peaceful places (using words like ‘ref-
uge’or ‘sanctuary’) where they could slow down and let
go of any stresses [11–13, 24, 45]. Students who re-
ported these kinds of benefits included some with men-
tal health disorders like Attention Deficit Hyperactivity
Disorder (ADHD) and depression [11], behavioural and
emotional difficulties [12] and minority ethnic groups
including recent migrants [45]. Teenage gardeners artic-
ulated reasons why they found the garden so relaxing
[11]. For some, it was about being outdoors and the
connection with nature, which gave them a sense of
perspective. For others, the contrast of physical work
allowed the brain some quiet time for reflection and this
enabled them to process stress.
It's almost like meditation, like my body is present but
my mind just kind of drifts off and goes someplace else,
and thinks about things…It's brainless tasks most of
Fig. 2 Graph showing quality ratings of included quantitative studies (n= 24) using the individual EPHPP criteria and overall rating
Ohly et al. BMC Public Health (2016) 16:286 Page 17 of 36
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Table 7 Results of included quantitative studies: child’s fruit and vegetable intake
First author (year)
Sample (n)
Outcome measures Outcomes Intervention group Comparison group Control group Group x time results
(adjusted, if reported)
Baseline
Mean (SD)
Follow-up
Mean (SD)
Baseline
Mean (SD)
Follow-up
Mean (SD)
Baseline
Mean (SD)
Follow-up
Mean (SD)
Brouwer (2013) [21]
n=12
Structured dietary
assessment method
for pre-school
children (whilst in
care)
V served (servings/day)
V consumed (servings/day)
Fserved(servings/day)
Fconsumed(servings/day)
Serving size = one cup FV;
half cup dried fruit; FV
juices not included (source:
USDA MyPlate)
1.42 (0.67)
0.80 (0.68)
1.55 (0.99)
1.00 (0.89)
1.24 (0.57)
1.05 (0.67)
0.92 (0.56)
0.67 (0.22)
NA NA 1.13 (0.31)
0.80 (0.38)
0.59 (0.27)
0.32 (0.29)
0.75 (0.21)
0.63 (0.28)
0.49 (0.40)
0.46 (0.43)
NR
Christian (2014) (1) [9]
Trial 1; n= 1256
†
CADET (115 items) F intake (g/day)
V intake (g/day)
FV intake (g/day)
201 (9.3)
a
87 (4.4)
a
269 (10.7)
a
168 (11.8)
a
89 (9.0)
a
237 (14.5)
a
214 (9.5)
a
102 (4.3)
a
300 (10.5)
a
208 (11.5)
a
118 (8.6)
a
308 (14.0)
a
NA NA MD = −28 (16.4)
a
;p=0.08
MD = −13 (12.8)
a
;p=0.2
MD = −43 (22.8)
a
;p=0.06
Christian (2014) (2) [10]
Trial 1; n= 1138
†
Christian (2014) (2) [10]
Trial 2; n= 1391
CADET (115 items) F intake (g/day)
V intake (g/day)
FV intake (g/day)
206 (7.9)
95 (3.8)
299 (8.9)
219 (17.6)
a
111 (10.2)
a
328.8 (23.0)
a
NA NA 193 (8.2)
100 (4.7)
296 (9.6)
181 (17.1)
a
122 (9.9)
a
305 (22.4)
a
MD = −22 (24.3)
a
;p=0.3
MD = −7 (14.2)
a
;p= 0.6
MD = 15 (32.0)
a
;p= 0.6
Cotugna (2012) [27]
n= 359
Lunchtime observations Students who chose
salad for lunch (%)
17.4 24.0 22.2 NR due to
scheduling
issues
22.1 20.3 NR
Davis (2011) [28]
n= 104
Block Food Screener
(41 items)
F intake (servings/day)
V intake (servings/day)
Serving size not reported
4.0 (0.7)
1.6 (1.0)
3.9 (0.8)
1.6 (1.0)
NA NA 4.1 (0.9)
1.9 (1.3)
4.2 (0.8)
1.3 (1.0)
p= 0.83
p= 0.11
Gibbs (2013) [26]
n= 764
Parent questionnaire F ≥2 servings/day (%)
V≥5 servings/day (%)
Serving size = one apple
or orange, two kiwis or
apricots, one cup dried
fruit
84.2
7.7
79.8
7.3
74.6
5.9
72.5
9.5
NA NA OR = 1.68 (0.90 to 3.14); p= 0.11
OR = 0.87 (0.54 to 1.42); p= 0.59
Jaenke (2012) [15]
n= 127
24 h recall x 2 F intake (servings/day)
V intake (servings/day)
Serving size = 150 g fruit;
45 g dried fruit; 75 g
vegetables
1.2 (1.0)
2.0 (1.7)
Between
group mean
differences
only
1.5 (1.0)
1.9 (1.3)
Between
group mean
differences
only
1.0 (0.9)
2.1 (2.2)
Between
group mean
differences
only
p= 0.76
p= 0.06
Morgan (2010) [30]
n= 127 (some differences)
a
McAleese (2007) [16]
n= 122
24 h recall x 3 (workbook) F intake (servings/day)
V intake (servings/day)
Serving size not reported
0.8 (0.8)
1.2 (0.6)
1.9 (1.4)
2.6 (1.7)
0.3 (0.5)
1.8 (1.1)
0.5 (0.7)
1.7 (1.0)
0.7 (0.6)
1.7 (0.7)
0.6 (0.7)
1.4 (0.7)
F = 10.98; p< 0.001
F = 15.00; p< 0.001
Meinen (2012) [31]
n= 404
Parent survey Child ate F yesterday (# times)
Child ate V yesterday (# times)
2.8 (0.85)
2.5 (0.79)
3.0 (0.88)
2.7 (0.93)
NA NA 2.8 (0.78)
2.6 (0.79)
2.9 (0.78)
2.6 (0.86)
NR
Parmer (2009) [37]
n= 115
Lunchroom observations V consumption (0 = not
eaten; 1 = eaten)
0.70 (0.4) 1.0 (0.0) 0.64 (0.5) 0.64 (0.5) 0.83 (0.3) 0.50 (0.5) NR
Parmer (2007) [36]
n= 115
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Table 7 Results of included quantitative studies: child’s fruit and vegetable intake (Continued)
First author (year)
Sample (n)
Outcome measures Outcomes Intervention group Comparison group Control group Group x time results
(adjusted, if reported)
Baseline
Mean (SD)
Follow-up
Mean (SD)
Baseline
Mean (SD)
Follow-up
Mean (SD)
Baseline
Mean (SD)
Follow-up
Mean (SD)
Ratcliffe (2011)
[38]
n= 320
Garden Vegetables Frequency
Questionnaire (22 items)
V consumed more
than once a month
(# varieties)
NR Change
values only
reported
NA NA NR Change
values only
reported
p= 0.001
Taste Test
V consumed at school p= 0.010
V consumed at home p= 0.122
Ffruits, Vvegetables, FV fruits and vegetables, SD standard deviation (or standard error where
a
); MD mean difference, OR odds ratio, F= F statistic from ANOVA
a
see results text for explanation of how differences in duplicate data reporting were handled
†
same study but different sample sizes reported
No meta-analysis due to heterogeneity of outcomes (e.g. inconsistent definitions and reporting of FV serving size) and study designs (e.g. different comparison groups; lack of follow-up means; different data
collection methods)
Ohly et al. BMC Public Health (2016) 16:286 Page 19 of 36
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Table 8 Results of included quantitative studies: child’s nutrient intakes (and other dietary outcomes)
First author (year)
Sample (n)
Outcome
measures
Outcomes Intervention group Comparison group Control group Group x time results
(adjusted, if reported)
Baseline
Mean (SD)
Follow-up
Mean (SD)
Baseline
Mean (SD)
Follow-up
Mean (SD)
Baseline
Mean (SD)
Follow-up
Mean (SD)
Christian (2014) (1)
[9]n= 1256
†
CADET
(115 items)
Energy (kcal/day)
Protein (g/day)
Carbohydrates (g/day)
Fibre (g/day)
Total fat (g/day)
Total sugars (g/day)
Iron (μg/day)
Sodium (mg/day)
Folate (μg/day)
Carotene (mg/day)
Vitamin C (mg/day)
2034 (39.4)
a
75 (1.8)
a
265 (4.4)
a
13 (0.3)
a
82 (2.3)
a
132 (2.9)
a
11 (0.2)
a
2632 (76.3)
a
227 (5.3)
a
1956 (98.8)
a
108 (3.7)
a
1520 (178.2)
a
58 (7.1)
a
186 (21.5)
a
10 (1.3)
a
65 (8.2)
a
90 (10.5)
a
8 (1.0)
a
2272 (286)
a
169 (19.7)
a
1995 (864)
a
113 (31.7)
a
1993 (34.1)
a
73 (1.5)
a
267 (4.3)
a
13 (0.3)
a
78 (1.7)
a
134 (2.6)
a
11 (0.2)
a
2572 (57.6)
a
224 (4.5)
a
2352 (101.7)
a
105 (3.5)
a
1567 (168.4)
a
64 (6.7)
a
193 (20.6)
a
11 (1.3)
a
64 (7.7)
a
99 (10.0)
a
8 (0.9)
a
2257 (267.7)
a
180 (18.6)
a
2164 (878)
a
125 (31)
a
NA NA MD = −46-; p= 0.6
MD = −6; p=0.2
MD = −7; p=0.5
MD = −1; p=0.1
MD = 1; p= 0.8
MD = −8; p=0.1
MD = −0.4; p= 0.5
MD = 16; p= 0.9
MD = −11; p= 0.3
MD = 168; p= 0.5
MD = 13; p= 0.02
Christian (2014) (2)
[10] Trial 1;
n= 1138
†
Christian (2014) (2)
[10] Trial 2;
n= 1391
CADET
(115 items)
Total energy (kcal/day)
Fat (g/day)
Sodium (mg/day)
Total sugars (g/day)
Carotene (μg/day)
Vitamin C (mg/day)
Iron (μg/day)
Fibre (g/day)
Carbohydrates (g/day)
Folate (μg/day)
Protein (g/day)
2039 (32.7)
82 (18.0)
2742 (58.4)
133 (2.3)
2024 (74.9)
118 (3.2)
11 (0.2)
13 (0.3)
267 (4.0)
235 (4.5)
75 (1.4)
1845 (172)
76 (7.9)
2621 (259)
108 (11.4)
1841 (299)
75 (30.2)
10 (0.9)
12 (1.2)
227 (21.7)
192 (18.9)
70 (6.5)
NA NA 1932 (32.8)
78 (2.0)
2575 (64.2)
127 (2.4)
2089 (83.9)
118 (3.2)
11 (0.2)
12 (0.2)
254 (3.6)
220 (4.3)
69 (1.4)
1836 (170)
77 (7.9)
2656 (257)
107 (11.3)
2168 (329)
73 (30)
10 (0.9)
11 (1.2)
225 (21.6)
188 (18.8)
68 (6.4)
MD = 9; p= 0.9
MD = −1; p=0.8
MD = −34; p= 0.8
MD = 1; p= 0.8
MD = −327; p= 0.2
MD = 2; p= 0.7
MD = 0.1; p= 0.8
MD = 0.3; p= 0.6
MD = 2; p= 0.8
MD = 4; p= 0.6
MD = 2; p= 0.6
Cotter (2013) [22]
n= 155
24 h urine
samples; flame
photometry
Estimated salt intake(g/day) 7.5 (2.4) 6.4 (2.2) 8.1 (3.0) 7.5 (3.0) 7.7 (2.0) 7.4 (3.0) NR
Davis (2011) [28]
n= 104
Block Food
Screener
(41 items)
Energy (kcal/day)
Protein (g/day)
Fat (g/day)
Carbohydrates (g/day)
Added sugar (tsp/day)
Dietary fibre (g/day)
Meat (servings/day)
Dairy (servings/day)
Whole grains (oz/day)
2011.0 (1410.4)
85.4 (67.7)
79.8 (67.6)
244.2 (145.7)
11.8 (10.2)
16.1 (11.5)
2.1 (2.4)
2.1 (1.3)
0.8 (0.9)
1639.5 (1046.5)
65.1 (43.0)
62.6 (49.6)
211.3 (122.3)
9.9 (9.4)
16.1 (8.6)
2.8 (2.5)
1.7 (1.2)
0.9 (0.7)
NA NA 1961.0 (1077.5)
81.6 (49.0)
73.3 (52.4)
252.2 (119.6)
11.5 (7.6)
18.7 (10.3)
2.0 (1.7)
2.1 (1.1)
0.7 (0.7)
1535.2 (902.9)
58.3 (38.3)
57.8 (41.4)
202.8 (109.1)
11.2 (9.7)
13.3 (7.5)
2.5 (3.4)
1.7 (1.0)
0.6 (0.6)
p= 0.85
p= 0.59
p= 0.92
p= 0.94
p= 0.15
p= 0.01
p= 0.68
p= 0.97
p= 0.13
Gibbs (2013) [26]
n= 764
Parent
questionnaire
No sweet drinks (%) 74.1 75.6 76.2 68.1 NA NA OR = 1.33 (0.70 to 2.5);
p= 0.38
McAleese (2007)
[16]n= 122
24 h recall x 3
(workbook)
Vitamin A (μg/day RAE)
Vitamin C (mg/day)
Fibre (g/day)
430.4 (244.1)
58.2 (62.2)
12.7 (4.6)
612.4 (359.6)
143.4 (144.5)
16.9 (7.4)
428.5 (247.9)
47.5 (48.5)
10.7 (5.2)
358.8 (273.3)
60.8 (126.6)
9.9 (5.0)
621.4 (294.1)
83.1 (115.6)
15.3 (6.0)
549.5 (248.9)
76.2 (129.5)
12.6 (8.0)
F = 5.86; p= 0.004
F = 4.31; p= 0.016
F = 8.21; p= 0.001
SD standard deviation (or standard error where
a
), MD mean difference, OR odds ratio, FF statistic from ANOVA
†
same study but different sample sizes reported
No meta-analysis for due to baseline differences in vitamin C intake (McAleese, [16]/Christian, [10]) and lack of accounting for possible clustering effects (McAleese, [16])
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Table 9 Results of included quantitative studies: child’s food preferences (including willingness to taste and taste ratings)
First author (year)
Sample (n)
Outcome measures Outcomes Intervention group Comparison group Control group Group x time
results (adjusted,
if reported)
Baseline
Mean (SD)
Follow-up
Mean (SD)
Baseline
Mean (SD)
Follow-up
Mean (SD)
Baseline
Mean (SD)
Follow-up
Mean (SD)
Block (2009) [25]
n= 770
SAKG child
questionnaire (four
point scale)
Always willing to try new foods if…NA NA NR
Never tried it before (%)
Cooked it (%)
Grown it in the garden (%)
26
32
26
39
51
39
35
39
35
23
34
23
Gibbs (2013) [26]
n= 764 (some
differences)
a
SAKG parent
questionnaire
Child always willing to try new foods (%) 27 33 24 27
Gatto (2012) [29]
n= 107
Motivation for Healthy
Behaving (17 items)
Preference for fruits
Preference for vegetables
NR Change values
only reported
NA NA NR Change values
only reported
p= 0.9
p= 0.06
Combination of
measures (13 items;
seven point scale)
Fruit from the garden tastes better than
fruit from the store (/7)
Vegetables from the garden taste better
than vegetables from the store (/7)
4.9 (2.4)
4.4 (2.5)
6.2 (1.4)
5.8 (1.8)
4.8 (2.2)
4.2 (2.3)
4.8 (2.2)
4.3 (2.2)
NS
p< 0.05
Jaenke (2012)
n= 127 [15]
Food preference
assessment tool
Overall willingness to taste (/6)
Overall taste rating (/30)
Taste rating carrot (/5)
Taste rating pea (/5)
Taste rating tomato (/5)
Taste rating broccoli (/5)
Taste rating capsicum (/5)
Taste rating lettuce (/5)
4.54 (1.50)
18.5 (7.4)
3.7 (1.6)
2.9 (1.8)
2.9 (2.3)
2.6 (1.8)
2.4 (2.1)
4.1 (1.5)
Between group
mean differences
only
4.50 (1.94)
18.1 (9.0)
3.7 (1.6)
2.8 (1.8)
2.4 (2.3)
2.8 (2.0)
3.0 (2.1)
3.7 (1.9)
Between group
mean differences
only
3.93 (2.04)
15.5 (8.8)
3.5 (1.8)
2.0 (1.9)
2.5 (2.4)
2.1 (2.1)
2.1 (2.2)
3.3 (1.9)
Between group
mean differences
only
p< 0.001
p< 0.001
p= 0.071
p< 0.001
p= 0.03
p< 0.001
p= 0.12
p= 0.02
Morgan (2010)
[30]
n= 127 (some
differences)
a
Reported in Morgan paper only:
Willingness to taste:
Lettuce (proportion)
Carrot (proportion)
Capsicum (proportion)
Broccoli (proportion)
Tomato (proportion)
Pea (proportion)
0.94
0.89
0.60
0.71
0.60
0.69
0.97
0.92
0.74
0.93
0.76
0.77
0.83
0.89
0.77
0.74
0.56
0.74
0.85
0.88
0.64
0.61
0.48
0.76
0.77
0.82
0.51
0.58
0.60
0.63
0.61
0.70
0.35
0.36
0.40
0.41
0.24
0.14
0.04
0.01
<0.001
0.02
Wouldyoueatthisfoodasasnack?
Lettuce (proportion)
Carrot (proportion)
Capsicum (proportion)
Broccoli (proportion)
Tomato (proportion)
Pea (proportion)
0.60
0.67
0.22
0.06
0.46
0.21
0.68
0.60
0.43
0.40
0.48
0.61
0.54
0.64
0.26
0.18
0.48
0.24
0.69
0.60
0.29
0.18
0.32
0.32
0.39
0.63
0.23
0.19
0.42
0.25
0.30
0.61
0.29
0.06
0.34
0.11
0.15
0.89
0.39
<0.001
0.31
0.001
Meinen (2012)
[31]
n= 404
Student survey
(three point
scale)
Willingness to try fruits and vegetables:
If given a new kind of fruit at home (/3)
If given a new kind of fruit at school (/3)
If given a new kind of vegetable at
home (/3)
If given a new kind of vegetable at
school (/3)
Would you choose fruit as a snack? (/3)
Would you choose vegetables as a
snack? (/3)
2.5 (0.60)
2.2 (0.72)
2.2 (0.70)
2.1 (0.73)
2.4 (0.68)
1.8 (0.74)
2.6 (0.59)
2.3 (0.72)
2.3 (0.70)
2.1 (0.78)
2.5 (0.63)
2.0 (0.73)
NA NA 2.6 (0.58)
2.3 (0.69)
2.3 (0.69)
2.0 (0.71)
2.5 (0.66)
1.9 (0.78)
2.5 (0.65)
2.2 (0.69)
2.2 (0.71)
2.0 (0.75)
2.5 (0.64)
2.0 (0.75)
NR
Ohly et al. BMC Public Health (2016) 16:286 Page 21 of 36
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Table 9 Results of included quantitative studies: child’s food preferences (including willingness to taste and taste ratings) (Continued)
First author (year)
Sample (n)
Outcome measures Outcomes Intervention group Comparison group Control group Group x time
results (adjusted,
if reported)
Baseline
Mean (SD)
Follow-up
Mean (SD)
Baseline
Mean (SD)
Follow-up
Mean (SD)
Baseline
Mean (SD)
Follow-up
Mean (SD)
Parent survey (10
items; four point
scale)
Like/dislike of fruits and vegetables:
Apples (/4)
Watermelon (/4)
Broccoli (/4)
Tomatoes (/4)
Spinach (/4)
Swiss chard (/4)
Zucchinis (/4)
Cucumbers (/4)
Green beans (/4)
Peppers (/4)
3.8 (0.45)
3.7 (0.58)
2.8 (1.05)
2.3 (1.12)
2.2 (0.99)
1.6 (0.82)
2.3 (0.99)
3.0 (0.99)
3.3 (0.89)
2.4 (1.13)
3.7 (0.57)
3.6 (0.68)
2.9 (1.06)
2.5 (1.15)
2.4 (1.14)
2.0 (0.95)
2.4 (0.95)
3.0 (1.05)
3.4 (0.90)
2.6 (1.12)
3.8 (0.46)
3.6 (0.74)
2.9 (1.02)
2.4 (1.13)
2.2 (1.06)
1.7 (0.96)
2.3 (1.11)
2.9 (1.13)
3.3 (0.95)
2.3 (1.17)
3.8 (0.52)
3.6 (0.75)
2.8 (1.07)
2.5 (1.16)
2.1 (1.02)
1.7 (0.78)
2.3 (1.01)
3.1 (1.01)
3.4 (0.85)
2.3 (1.09)
Morris (2001)
[32]
n=97
Student
questionnaire (six
items; five point
scale)
Mean total tasting score indicating
willingness
to taste (/5)
Vegetables tasted: spinach, carrots,
peas,
broccoli, zucchini and red bell
pepper.
4.07 (0.31)
a
4.83 (0.23)
a
NA NA 3.90 (0.30)
a
3.90 (0.29)
a
p< 0.005
Morris (2002)
[33] (1)
n= 213
Vegetable
preference survey
(six items; five
point scale)
Vegetable preference score at post-
test:
NR Post-test: NR Post-test: NR Post-test:
Broccoli (/5)
Carrots (/5)
Jicama (/5)
Snow peas (/5)
Spinach (/5)
Zucchini (/5)
3.8 (0.1)
a
4.7 (0.1)
a
3.9 (0.2)
a
3.8 (0.2)
a
3.0 (0.2)
a
4.0 (0.2)
a
3.8 (0.1)
a
4.7 (0.1)
a
3.8 (0.2)
a
3.1 (0.2)
a
3.2 (0.2)
a
3.2 (0.1)
a
3.2 (0.2)
a
4.4 (0.1)
a
3.6 (0.2)
a
2.9 (0.2)
a
3.1 (0.2)
a
3.1 (0.2)
a
F = 4.840; p< 0.01
F = 5.768; p< 0.005
NR
F = 7.657; p< 0.005
NR
F = 10.012; p< 0.0005
Vegetable preference score at 6 m
follow up:
Follow up: Follow up: Follow up:
Broccoli (/5)
Carrots (/5)
Jicama (/5)
Snow peas (/5)
Spinach (/5)
Zucchini (/5)
4.0 (0.1)
a
4.6 (0.1)
a
3.8 (0.2)
a
3.7 (0.2)
a
3.4 (0.1)
a
4.0 (0.1)
a
3.7 (0.1)
a
4.7 (0.1)
a
3.4 (0.2)
a
3.0 (0.2)
a
3.2 (0.1)
a
3.4 (0.1)
a
3.5 (0.2)
a
4.4 (0.1)
a
3.2 (0.2)
a
3.0 (0.2)
a
3.3 (0.2)
a
3.2 (0.2)
a
NR
NR
NR
NR
NR
NR
Morris (2002)
[34] (2)
n= 215
Vegetable
preference survey
(six items; yes/no/
don’t know)
Vegetable preferences at post-test:
Do you eat this food at home? (/6)
Would you ask your family to buy
this food? (/6)
Would you eat this food as a
snack? (/6)
NR Post-test:
3.3 (0.1)
a
2.9 (0.2)
a
2.4 (0.2)
a
NR Post-test:
3.1 (0.1)
a
2.6 (0.2)
a
2.2 (0.2)
a
NR Post-test:
2.7 (0.2)
a
1.9 (0.2)
a
1.6 (0.2)
a
F = 4.165; p< 0.05
F = 7.181; p< 0.005
F = 5.239; p< 0.01
Vegetable preferences at 6 m
follow up:
Follow up: Follow up: Follow up:
Do you eat this food at home? (/6)
Would you ask your family to buy
this food? (/6)
Would you eat this food as a
snack? (/6)
3.2 (0.1)
a
2.6 (0.2)
a
2.4 (0.2)
a
3.1 (0.2)
a
2.5 (0.2)
a
1.9 (0.2)
a
2.8 (0.2)
a
2.4 (0.2)
a
1.5 (0.2)
a
NR
NR
F = 6.152; p< 0.005
Ohly et al. BMC Public Health (2016) 16:286 Page 22 of 36
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Table 9 Results of included quantitative studies: child’s food preferences (including willingness to taste and taste ratings) (Continued)
First author (year)
Sample (n)
Outcome measures Outcomes Intervention group Comparison group Control group Group x time
results (adjusted,
if reported)
Baseline
Mean (SD)
Follow-up
Mean (SD)
Baseline
Mean (SD)
Follow-up
Mean (SD)
Baseline
Mean (SD)
Follow-up
Mean (SD)
O’Brien (2006)
[35]
n=38
FV preference
assessment (four
point scale)
Total fruit preference (/8)
Total vegetable preference (/16)
Fruits and vegetables tasted
unknown
7.18 (0.31)
a
10.94 (0.92)
a
7.06 (0.34)
a
11.24 (0.92)
a
NA NA 6.05 (0.33)
a
8.81 (0.91)
a
6.05 (0.33)
a
9.05 (0.97)
a
NR
Parmer (2009)
[37]
n= 115
FV preference
questionnaire (six
items; five point
scale)
Willingness to taste (/6)
Ratings of tasted fruits and
vegetables (/5)
Fruits and vegetables tasted:
carrots, broccoli,
spinach, zucchini, cabbage and
blueberries.
4.82 (1.6)
3.45 (0.9)
5.50 (1.0)
4.38 (0.5)
5.11 (1.1)
3.85 (0.8)
5.33 (1.2)
4.15 (0.6)
3.84 (2.1)
3.99 (0.7)
4.23 (2.0)
3.82 (0.5)
F = 0.878; p= 0.42
F = 14.45; p< 0.001
Parmer (2007)
[36]
n= 115
FV preference
survey (15 items;
three point scale)
Fruit preference (/3)
Vegetable preference (/3)
2.59 (0.4)
2.08 (0.5)
2.60 (0.3)
2.03 (0.5)
2.70 (0.3)
2.20 (0.6)
2.73 (0.3)
2.14 (0.6)
2.59 (0.4)
2.10 (0.5)
2.57 (0.3)
1.98 (0.5)
NR
NR
Ratcliffe (2011)
[38]
n= 320
Taste test (five
items; five point
scale)
Willingness to taste vegetables (/5)
Preference for vegetables (/5)
Vegetables tasted: carrots, string
beans,
snow peas, broccoli and Swiss
chard.
NR Change values
only reported
NA NA NR Change values
only reported
0.286
0.279
Garden Vegetables
Frequency
Questionnaire (22
items plus two
added)
Preference for vegetables:
all (24 items)
grown in school garden (11 items)
not grown in school garden (13
items)
0.029
0.017
0.23
Willingness to taste vegetables:
all (24 items)
grown in school garden (11 items)
not grown in school garden (13
items)
<0.001
<0.001
0.025
Ffruits, Vvegetables, FV fruits and vegetables, SD standard deviation (or standard error where
a
); OR odds ratio, FF statistic from ANOVA
a
see results text for explanation of how differences in duplicate data reporting were handled
No meta-analysis due to heterogeneity of outcome measures
Ohly et al. BMC Public Health (2016) 16:286 Page 23 of 36
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Table 10 Results of included quantitative studies: child’s knowledge and attitudes towards food (including self-efficacy)
First author (year)
Sample (n)
Outcome measures Outcomes (data are means and SD
unless otherwise stated)
Intervention group Comparison group Control group Group x time results
(adjusted, if reported)
Baseline
Mean (SD)
Follow-up
Mean (SD)
Baseline
Mean (SD)
Follow-up
Mean (SD)
Baseline
Mean (SD)
Follow-up
Mean (SD)
Christian (2014) [10] (2) [9]
Trial 1; n= 1138
Child questionnaire:
FV knowledge
Attitudes towards FV
% of children who agreed:
I enjoy eating fruit
I like trying new fruits
I try to eat lots of fruit
I enjoy eating vegetables
I like trying new vegetables
I try to eat lots of vegetables
Eating FV every day keeps me
healthy
% agreed
94.5
78.0
83.0
65.6
58.9
64.6
93.5
% agreed
91.8
76.3
81.3
64.7
58.0
70.9
94.1
% agreed
96.4
83.3
86.7
66.9
61.0
66.7
94.1
% agreed
96.2
86.6
90.1
65.9
60.0
69.6
97.2
NA NA Odds ratio (95 % CI)
OR = 0.4 (0.1 to 1.0)
OR = 0.5 (0.2 to 0.9)
OR = 0.4 (0.2 to 0.9)
OR = 1.1 (0.6 to 1.9)
OR = 1.0 (0.7 to 1.5)
OR = 1.1 (0.7 to 1.7)
OR = 0.6 (0.2 to 1.6)
There is usually lots of FV to eat at
home
89.2 89.8 87.6 94.1 OR = 0.4 (0.2 to 0.9)
I'm good at preparing FV
My family encourages me to eat FV
% who knew that 5 FV per day are
needed to stay healthy
71.8
87.1
76.2
74.7
90.7
79.0
81.3
88.3
72.7
83.6
93.7
79.0
OR = 0.6 (0.3 to 1.1)
OR = 0.7 (0.3 to 1.5)
OR = 0.9 (0.4 to 1.6)
% who had tasted their own FV at
follow-up
62.3 62.1 52.4 67.8 OR = 0.8 (0.5 to 1.4)
Christian (2014) [10] Trial 2;
n= 1391
Child questionnaire:
FV knowledge
Attitudes towards FV
% of children who agreed:
I enjoy eating fruit (% who agreed)
I like trying new fruits
I try to eat lots of fruit
I enjoy eating vegetables
I like trying new vegetables
I try to eat lots of vegetables
Eating FV every day keeps me
healthy
% agreed
96.7
86.0
87.2
68.8
62.8
72.8
94.9
% agreed
97.6
84.0
88.2
69.5
59.5
75.5
97.0
NA NA % agreed
96.8
84.5
82.7
64.2
60.5
66.7
96.2
% agreed
97.0
80.4
85.8
61.7
56.9
68.6
96.4
Odds ratio (95 % CI)
OR = 1.1 (0.4 to 2.9)
OR = 1.2 (0.7 to 1.9)
OR = 1.0 (0.6 to 1.6)
OR = 1.2 (0.9 to 1.6)
OR = 0.9 (0.7 to 1.2)
OR = 1.2 (0.8 to 1.8)
OR = 1.2 (0.5 to 2.8)
There is usually lots of FV to eat at
home
89.6 92.8 88.9 89.5 OR = 1.5 (0.9 to 2.5)
I'm good at preparing FV
My family encourages me to eat FV
% who knew that 5 FV per day are
needed to stay healthy
% who had tasted their own FV at
follow-up
79.3
89.9
73.6
60.1
78.1
92.8
79.1
66.4
77.9
87.7
67.3
56.0
79.3
91.9
67.5
58.1
OR = 0.8 (0.6 to 1.1)
OR = 0.9 (0.5 to 1.6)
OR = 1.7 (1.1 to 2.5)
OR = 1.4 (0.8 to 2.4)
Meinen (2012) [31]n= 404 Knowledge of fruits and
vegetables
Knowledge of recommended daily
servings of FV (%)
33 35 36 42 NR
Morgan (2010) [30]
n= 127
Gimme 5 questionnaire
(eight multiple choice
questions)
FV knowledge (/8) 5.4 (1.4) Between
group
mean
differences
only
5.1 (1.3) Between
group
mean
differences
only
6.1 (1.8) Between
group
mean
differences
only
p=0.02
†
Food preference
assessment tool
Ability to identify vegetables (/1) 0.9 (0.1) 0.9 (0.1) 0.9 (0.1) p< 0.001
†
Ohly et al. BMC Public Health (2016) 16:286 Page 24 of 36
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Table 10 Results of included quantitative studies: child’s knowledge and attitudes towards food (including self-efficacy) (Continued)
First author (year)
Sample (n)
Outcome measures Outcomes (data are means and SD
unless otherwise stated)
Intervention group Comparison group Control group Group x time results
(adjusted, if reported)
Baseline
Mean (SD)
Follow-up
Mean (SD)
Baseline
Mean (SD)
Follow-up
Mean (SD)
Baseline
Mean (SD)
Follow-up
Mean (SD)
Morris (2001) [32]
n=97
Food identification
questionnaire (food groups/
recommendations)
Nutrition knowledge score (/5) 1.9 (0.2)
a
2.5 (0.2)
a
NA NA 2.4 (0.2)
a
2.5 (0.2)
a
NR
Morris (2002) (1) [33]
n= 213
Nutrition knowledge
questionnaire (30 multiple
choice questions)
Nutrition knowledge score at post-
test (/30):
NR 20.8 (0.4)
a
NR 20.5 (0.4)
a
NR 17.1 (0.4)
a
F = 24.238, p< 0.0005
Nutrition knowledge score at
6 m follow up (/30):
20.8 (0.4)
a
21.2 (0.4)
a
18 (0.4)
a
F = 18.270, p< 0.0005
Morris (2002) (2)
[34]n= 215
Vegetable preference
survey (six items)
Ability to correctly name
vegetables at post-test (/6)
NR 3.3 (0.1)
a
NR 3.0 (0.1)
a
NR 2.6 (0.1)
a
F = 9.795, p< 0.0005
Ability to correctly name
vegetables at follow up (/6)
3.2 (0.1)
a
2.9 (0.1)
a
2.8 (0.1)
a
NR
O’Brien (2006) [35]
n=38
Nutrition knowledge
questionnaire (derived from
Family Nutrition Program
evaluations)
Nutrition knowledge (/10) 7.53 (0.34)
a
7.18 (0.30)
a
NR NR 7.05 (0.29)
a
7.38 (0.33)
a
NR
Self-efficacy instrument
(Domel et al. 1996)
FV consumption self-efficacy
(/10)
8.94 (0.29)
a
9.06 (0.26)
a
8.33 (0.33)
a
8.67 (0.25)
a
Outcome expectations
questionnaire (Domel et al.
1995)
FV consumption expectations
(/6)
5.76 (0.18)
a
5.24 (0.27)
a
5.29 (0.24)
a
5.52 (0.16)
a
Parmer (2009) [37]
n= 115
Fruit and vegetable survey
(adapted Struempler &
Raby)
Food groups
Nutrient-food associations
Nutrient-job associations
FV identification
3.69 (1.8)
1.46 (1.1)
1.25 (1.0)
3.14 (0.7)
5.20 (1.2)
3.56 (1.6)
2.97 (1.9)
4.89 (0.9)
4.08 (1.7)
1.67 (1.5)
1.27 (1.3)
3.03 (0.6)
4.75 (1.9)
3.70 (1.8)
2.64 (1.6)
3.44 (0.8)
4.03 (1.8)
1.82 (1.4)
1.71 (1.2)
2.88 (0.9)
4.46 (1.3)
1.92 (1.3)
1.46 (1.0)
2.96 (1.0)
NS
F(2,122) = 11.84; p< 0.001
F(2,122) = 12.05; p< 0.001
F(2,78) = 28.08; p< 0.001
Parmer (2007) [36]
n= 115
Ratcliffe (2011) [38]
n= 320
Taste test Ability to identify vegetables NR Change
values only
reported
NA NA NR Change
values only
reported
p= 0.002
FV = fruits and vegetables, SD standard deviation (or standard error where
a
); OR odds ratio
†
Note: the p values reported for these outcomes relate to subgroup analysis (n= 109) of students with lower baseline scores (Morgan et al. 2010)
No meta-analysis due to heterogeneity of outcomes and different comparison groups (Christian, [10] Trials 1 and 2)
Ohly et al. BMC Public Health (2016) 16:286 Page 25 of 36
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the time, so it's also like zenful, so you get to listen to
things…I think about stuff, so I don't have to go home
and think about it right before bed, so instead I can
just go to sleep and stuff. I just feel happier in a way,
and more at peace. –Student, age 15 [11].
This is another example of the sensory, visceral nature
of gardening activities, which may have stress-reducing
or restorative effects similar to those described in
Ulrich’s psycho-evolutionary theory [53].
Children experienced positive and negative emotions
in the school gardens and participants described how
they were able to express themselves and manage
their emotions more effectively in that environment
[11, 13, 25, 41, 49–51]. For example, following the
vandalising of the school garden, a teacher said:
It really offended them that these students had done
this damage to their garden…So then we talk about it
and say, well, it made them feel very angry that these
children had destroyed part of their garden…it was a
positive experience that the children learn that doing
what to those children must have been a fun thing to
do to go tear up our garden, didn't make us feel good.
They were on the receiving end of it and so even
though it was a negative experience you can make it a
positive one. –Teacher [41].
In this example, the teacher had her own views about
how the negative experience has been turned into a
constructive learning experience, but this was not articu-
lated by the children themselves.
The social well-being impacts of school gardening
were mainly about building relationships [11–13, 25, 41,
44, 47, 49–52]. Children enjoyed interacting with their
friends, teachers, gardening specialists, parents and
volunteers –some of whom were people they would not
normally come into contact with.
You have to work together….It’s not about
individualism which is promoted in the school
structure in some ways, but really communicat[ion],
cooperation and ownership of something. –Garden
staff [40].
Table 11 Results of included quantitative studies: child’s physical health and activity
First author (year)
Sample (n)
Outcome
measures
Outcomes Intervention group Comparison group Control group Group x time
results (adjusted,
if reported)
Baseline
Mean (SD)
Follow-up
Mean (SD)
Baseline
Mean (SD)
Follow-up
Mean (SD)
Baseline
Mean (SD)
Follow-up
Mean (SD)
Cotter (2013) [22]
n= 155
Standard
clinical
measures
Waist circumference (cm)
BMI (kg/m
2
)
Systolic blood pressure
(mmHg)
Diastolic blood
pressure (mmHg)
Urinary sodium (mmol/
24 h)
67.8 (8.2)
19.0 (2.7)
117.4 (9.9)
66.9 (8.0)
126.6 (40.5)
68.6 (7.6)
19.3 (2.8)
113.9 (9.6)
66.2 (8.5)
108.2 (37.3)
68.1 (9.0)
19.0 (3.2)
115.1 (14.8)
65.4 (8.2)
138.4 (50.7)
69.9 (8.9)
19.0 (3.1)
111.3 (11.6)
64.8 (7.4)
128.2 (50.9)
69.5 (8.6)
19.1 (3.2)
122.1 (14.1)
73.5 (9.6)
131.3 (34.9)
71.5 (8.1)
19.1 (3.1)
113.9 (9.9)
67.0 (7.4)
125.3 (50.6)
NR
Davis (2011) [28]
n= 104
Standard
clinical
measures
BMI (kg/m
2
)
Waist circumference (cm)
Total fat (%)
Systolic blood pressure
(mmHg)
Diastolic blood
pressure (mmHg)
20.4 (4.2)
73.9 (13.3)
28.2 (12.6)
105.9 (8.20)
59.6 (8.4)
20.4 (4.0)
74.9 (13.6)
26.8 (12.4)
101.9 (10.4)
56.5 (5.6)
NA NA 21.8 (5.1)
75.7 (13.2)
29.0 (9.8)
108.9 (8.9)
60.8 (8.0)
22.0 (5.2)
77.3 (13.9)
27.6 (10.3)
104.5 (9.8)
58.7 (6.2)
p= 0.14
p= 0.67
p= 0.59
p= 0.53
p= 0.04
Wells (2014) [23] Physical
activity
GEMS Activity
Questionnaire:
Mean difference:
n= 227 (or
n= 124 for
accelerometry
data)
Activity - yesterday
Activity - usually
Sedentary - yesterday
Sedentary - usually
2.91 (0.19)
3.78 (0.18)
0.63 (0.04)
0.78 (0.05)
2.48 (0.20)
3.43 (0.19)
0.51 (0.04)
0.68 (0.05)
NA NA 2.74 (0.17)
3.61 (0.16)
0.57 (0.04)
0.68 (0.04)
2.51 (0.19)
3.63 (0.18)
0.54 (0.04)
0.77 (0.05)
−0.20; p= 0.312
−0.37; p= 0.083
−0.09; p= 0.064
−0.19; p= 0.001
Accelerometry: Mean difference:
Sedentary (%)
Light PA (%)
Moderate PA (%)
Vigorous PA (%)
MVPA (%)
55.23 (1.71)
34.62 (1.00)
5.17 (0.54)
5.01 (0.58)
10.14 (1.03)
55.00 (1.73)
33.17 (1.02)
5.62 (0.54)
6.24 (0.59)
11.82 (1.04)
54.75 (1.59)
35.09 (0.92)
5.41 (0.50)
4.99 (0.54)
10.35 (0.95)
56.11 (1.60)
33.07 (0.93)
5.28 (0.50)
5.78 (0.54)
11.03 (0.95)
−1.59; p= 0.144
+0.57; p= 0.492
+0.58; p= 0.010
+0.44; p= 0.213
+1.00; p= 0.044
SDstandard deviation (or standard error where
a
)
No meta-analysis due to lack of adjustment for possible clustering effects
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Table 12 Results of included quantitative studies: child’s well-being (including social skills)
First author (year)
Sample (n)
Outcome
measures
Outcomes Intervention group Comparison group Control group Group x time
results (adjusted,
if reported)
Baseline
Mean (SD)
Follow-up
Mean (SD)
Baseline
Mean (SD)
Follow-up
Mean (SD)
Baseline
Mean (SD)
Follow-up
Mean (SD)
Block (2012) [24]
n= 764
KIDSCREEN-10 Child quality of life score 48.9 (8.4) 50.3 (8.1) NA NA 48.2 (7.9) 49.1 (7.3) Adjusted statistic =
1.23 (0.7); p= 0.09
Teacher
questionnaire
Teacher strongly agrees that:
Student social behaviour
is good (%)
41.9 48.9 41.9 53.8 p= 0.2
Students cooperate well
with other students (%)
48.8 57.8 48.4 65.4 Adjusted statistic =
0.51; p=0.3
Morgan (2010)
[30]n= 127
Quality of school
life instrument (40
items)
Quality of school life 3.2 (0.2) Between
group mean
differences
only
3.2 (0.3) Between
group mean
differences
only
3.0 (0.4) Between
group mean
differences
only
p= 0.98
Robinson (2005)
[39]n= 281
Youth Life Skills
Inventory (32
questions; three
point scale)
Overall life skills score (/96)
Working with groups
Self-understanding
Leadership
Decision making
Communication
Volunteerism
83.02
(7.95)13.33
(1.74)16.78
(1.96)12.62
(2.05)13.71
(1.64)10.59
(1.55)16.57
(1.77)
84.51
(7.81)14.09
(1.41)18.02
(1.76)12.63
(1.85)13.72
(1.44)10.42
(1.46)16.23
(2.08)
NA NA 85.8 (6.14)
NR
NR
NR
NR
NR
NR
86.49 (6.19)
NR
NR
NR
NR
NR
NR
NR
Waliczek (2001)
[17]n= 589
Self-Report of
Personality Scale
for children and
adolescents
Interpersonal relationships Means by age
and gender
only
Means by age
and gender
only
NA NA Means by age
and gender
only
Means by age
and gender
only
NR
SD standard deviation
No meta-analysis due to heterogeneity of outcome measures
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Table 13 Contribution of individual qualitative studies to descriptive themes: Health and well-being impacts of school gardening
First author (year) Quality Health impacts Well-being impacts
Food/
nutrition
knowledge
Attitudes
towards
food
Healthier
eating
habits
Physical
activity
Enjoyment Achievement,
satisfaction,
pride
Confidence, self-
esteem, ownership,
responsibility
Relaxation,
stress
release
Express/
manage
emotions
Building
relationships,
belonging
Cultural
awareness,
cohesion
Ahmed (2011) [40] Moderate ✓✓✓ ✓ ✓
Alexander (1995) [41] Moderate ✓✓ ✓ ✓ ✓
Anderson (2011) [42]Weak
Block (2009, 2012) [24;25]
Gibbs (2013) [26]
Townsend (2014) [43]
Strong ✓✓✓ ✓✓ ✓ ✓✓✓ ✓
Bowker (2007) [44] Moderate ✓✓✓✓ ✓
Chawla (2014) [11] Strong ✓✓ ✓ ✓ ✓ ✓
Chiumento (2012) [12]Weak ✓✓ ✓ ✓ ✓ ✓
Cutter-Mackenzie
(2009) [45]
Moderate ✓✓ ✓ ✓
Hazzard (2011) [46]Weak
Henryks (2011) [47] Moderate ✓✓✓ ✓✓ ✓ ✓
Lakin (2008) [48]Weak✓✓✓ ✓✓ ✓
Miller (2007) [49]Weak✓✓✓✓✓
Ming Wei (2012) [13] Moderate ✓✓✓ ✓ ✓ ✓ ✓
Passy (2010) [50] Moderate ✓✓✓✓✓✓ ✓ ✓✓ ✓
Somerset (2005) [51]Weak✓✓ ✓✓✓ ✓ ✓✓
Viola (2006) [52] Moderate ✓✓✓✓ ✓ ✓
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Table 14 Contribution of individual qualitative studies to descriptive themes: Educational impacts & factors influencing the success of school gardens
First author (year) Educational impacts Factors influencing success and sustainability
Academic
improvements
Student
engagement,
motivation
Environmental
awareness
Development
for staff/
volunteers
Experiential learning
style, curriculum
integration
Supportive
environment,
inclusive, equal
Cultural
relevance
Support from
staff, volunteers
community
Pressure on staff,
volunteers,
timetable
Fundraising,
resources
Ahmed (2011) [40]✓✓✓
Alexander (1995) [41]✓✓ ✓✓
Anderson (2011) [42]
Block (2009, 2012) [24;25]
Gibbs (2013) [26]
Townsend (2014) [43]
✓✓ ✓ ✓✓ ✓ ✓✓ ✓ ✓
Bowker (2007) [44]✓✓ ✓
Chawla (2014) [11]✓✓
Chiumento (2012) [12]✓✓✓
Cutter-Mackenzie
(2009) [45]
✓✓ ✓✓
Hazzard (2011) [46]✓✓✓✓
Henryks (2011) [47]✓✓✓
Lakin (2008) [48]✓✓ ✓
Miller (2007) [49]✓✓ ✓
Ming Wei (2012) [13]✓✓ ✓ ✓ ✓
Passy (2010) [50]✓✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓
Somerset (2005) [51]✓✓✓✓
Viola (2006) [52]✓✓✓
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Gardening was seen as promoting teamwork and cooper-
ation, working together towards common goals, which may
help to break down some of the social boundaries and elit-
ism associated with traditional academic structures.
Teachers, parents and volunteers also enjoyed the
opportunity to interact with children in the garden setting
and described how it improved teacher-student and inter-
generational relationships [25, 47, 51]. Volunteers described
feeling valued and ‘belonging’in the school gardens
[43, 47]. This gave them a sense of purpose because
they felt they were doing something worthwhile –contribut-
ing to the children’s education and giving back to the com-
munity. In this respect, the personal and social well-being
impacts of school gardening are interrelated and this com-
bination of factors creates the motivation for volunteering.
Finally, participants described how school gardening
contributed to improved cultural awareness and cohe-
sion [12, 25, 40, 45, 50]. Parents from non-English-
speaking backgrounds who might not contribute to
other school activities felt comfortable in the garden
[24]. In multi-cultural communities, the combination of
gardening and cooking activities provided an opportun-
ity for children to learn about each other’s cultures [45].
It was also a successful medium for developing English
language skills as children relaxed and engaged in
“everyday conversations”[45].
Qualitative evidence for educational impacts of
school gardening
The most common outcomes reported alongside health
and well-being impacts were related to potential educa-
tional impacts of school gardening [11–13, 25, 40–42, 44,
45, 47–51] (Table 14). As we have included only studies
also reporting health and well-being impacts, we can only
present evidence for the educational impacts of school
gardening from these studies, and so this is not a compre-
hensive synthesis of the qualitative evidence for the educa-
tional impacts of school gardening. Six studies which
focussed on educational aspects were excluded during full
text screening because they did not match our primary re-
view focus on health and well-being outcomes (see Fig. 1).
Whilst none of the included studies reported academic
attainment outcomes (quantitative), two qualitative studies
reported children’s beliefs that school gardening was
having a positive impact on their school work [11, 44] and
these beliefs were echoed by teachers and volunteers in
four more studies [13, 25, 50, 51].
I'm able to complete my homework faster, because
I'minabetterplacetodootherthings,because
I just spent an hour not worrying about my
homework and my grades and my timing for
anything, because there's no deadline here. –High
School Student with ADHD, age 17 [11]
This quote provides further evidence that it might be
children with special educational needs that stand to
benefit the most from school gardening. It also suggests
that well-being impacts such as stress reduction may
lead to academic impacts for some students, echoing the
proposed mechanisms of Attention Restoration Theory,
which suggests that contact with nature can restore
depleted ability to concentrate [54].
Increased levels of engagement and motivation among
children who participated in school gardening was noted
in some studies, although it was not always clear if this
was referring generally to time spent in the garden, to
garden activities intended to promote academic learning,
or also to classroom-based learning [12, 13, 24, 41, 50].
In one study, teachers described how they harnessed this
potential by tailoring gardening activities to the needs of
individual children and creating opportunities for them
to demonstrate their skills and knowledge [24]. In our
view this has obvious links to the well-being impacts of
confidence and self-esteem. However, some children did
not work well in the gardens and teachers found them
difficult to ‘contain’in open spaces [25]. Suggested
reasons for this were that some tasks were repetitive and
the rewards of gardening were not immediate, resulting
in loss of engagement [25].
Some children developed a greater awareness of the
environment through school gardening [11, 25, 41, 44,
45, 48–50]. This varied from awareness of the immediate
garden environment, such as water conservation,
seasonality, composting techniques and local wildlife
[25, 44] to consideration of global environmental issues,
such as the food supply chain (“ground to plate”),
sustainability, recycling and the importance of protecting
the environment [44, 45, 48]. Gardening was seen as a
positive environmental behaviour and reinforced the
sense of connection with nature [11, 45, 48].
There were also ‘educational’impacts for adult
staff and volunteers in terms of learning new skills
in the school gardens and related activities like cook-
ing [25, 47, 50]. In some schools there were formal oppor-
tunities for volunteers to attend short courses and gain
certificates, which helped to keep volunteers motivated [43].
Qualitative evidence for factors influencing the success
and sustainability of school gardening programmes
Most qualitative studies discussed one or more aspects
of school gardening programmes that had contributed to
their success and/or challenges they had to overcome,
evidence which will be useful for schools considering,
implementing or managing a gardening programme
[12, 13, 25, 40, 41, 44–52] (Table 14).
The ‘experiential’or hands-on learning style was de-
scribed as an effective way to teach children academic
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subjects in a more applied and holistic way [25, 40, 44–
46, 48, 50–52].
We’ve done a lot of graphs, a lot of growth
measurement. Planted seedlings, measured them and
predicted at sixteen weeks, forecasting what size they
will be. They are graphed and monitored every
fortnight…And we’ve talked about sustainability,
compost and everything just ties in…We’ve used
maths, perimeter, and volume in the garden…Cubic
metres…That would have been a really good one for
the [grade] five/sixes, if they had actually bought the
soil, found out the costing. A lot of things like that you
think of in retrospect…There’s still more scope to have
time in the regular curriculum and a more consistent
approach, to have more of a strategic approach.–
Teacher [25].
This example from the Stephanie Alexander Kitchen
Garden Program illustrates the potential for schools to
integrate core curriculum subjects with fun gardening
activities, and suggests a strong mechanism underpin-
ning the potential well-being and educational impacts of
school gardens. However, not all the interventions
studies in this review integrated garden and curriculum
activities in this way (Table 4).
Some qualitative studies indicated that some form of
cooking or food preparation was integrated with the
school gardening intervention, or encouragement to be-
come involved in cooking or food preparation at school
or at home, for some or all of their participants (but
this was not necessarily a key component of the inte-
gration –see Table 4) [13, 24, 42, 45, 47, 48, 50, 52].
Doin’the cook-up with Miss…was fun. We put a recipe
book together for the tuckshop as well. We did this
every week so that the tuckshop would have healthy
food.–Student [52].
Cooking facilitated enjoyment and a sense of achieve-
ment. Passy also suggests that the sense of celebration
created by sharing cooked garden produce was also im-
portant in encouraging students to taste the food [50].
We have a whole bunch of young adults who know
howtogototheshoporthemarketandpickup
some vegetables and make themselves something
delicious out of it…imagine uni students nourished
on seasonal vegetables instead of two-minute
noodles. –Volunteer [47].
This example, from the Stephanie Alexander Kitchen
Garden Program, illustrates how combining experience
of gardening and cooking also gave children some of the
life skills needed to live healthily [47]. It also supports
the earlier quote from Ahmed et al. (2011) which
proposes the potential long term impacts of changing
attitudes to food through gardening.
School gardens were also described by teachers,
parents and volunteers as being supportive and inclu-
sive environments; a ‘level playing field’where all
children could participate equally [12, 13, 24, 47, 50].
This characteristic may help to explain well-being
benefits if children felt comfortable to be themselves
and participate without any sense of pressure or com-
petitiveness. One study described how achievements
in the garden were celebrated in school newsletters
or assemblies, which contributed to feelings of pride,
confidence and motivation among children who were
previously unruly [50].
Considering the socio-demographic and cultural char-
acteristics of the school community in the design of
school gardening programmes could ensure that they
effectively engage both children and the wider commu-
nity [12, 25, 40, 45, 52]. This connection with cultural
heritage and local foods was particularly important in
multi-ethnic or native/indigenous communities.
In eleven studies and across many different types of
schools, support from stakeholders –including staff,
volunteers and the wider community –was consid-
ered one of the most important factors influencing
the success and sustainability of school gardens [13,
25, 41, 45–52].
I bring in a variety of people throughout the year to
help with various facets of our garden …Last week we
had someone come in and show us how to prune our
fruit trees and so they get all different kinds of role
models…some people are perhaps more patient, some
people are less patient....they realize that not all men
are the same, not all women are the same, and they
get to see people who are not teachers. –Teacher.
This quote relates to gardening specialists, but support
from volunteers (including parents, grandparents and
other members of the community) and local organisa-
tions/businesses was also valued by teachers for similar
reasons –increasing capacity, diversity of skills, mate-
rials and resources. However, some schools experienced
difficulty recruiting enough volunteers [25, 46, 50].
The four of us especially have all realized they need
some support for this kitchen garden program, being
that our funding runs out at the end of this year. So
we ran this bloody fair and that was six months of my
life and that’s what I gave up to ensure that my
children still have this program in their school.
–Parent volunteer [43].
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This is clearly an example of overdependence on
volunteers, which became a source of resentment and
threatened the sustainability of the garden. This suggests
that schools need to consider the balance between making
use of volunteers and keeping them motivated. The same
applies to teachers (and other school staff) and two stud-
ies highlighted concerns about increased pressure on
workloads and fitting school gardening into an already
overcrowded timetable [25, 50]. One innovative way of
motivating teachers was to offer continuing professional
development (CPD) opportunities, benchmarks to work
towards and cash prizes [50]. A study of the California
Instructional School Garden Program found that when
schools formed a garden committee (including admin-
istrators, teachers, parent/community volunteers and
garden coordinators) it helped to define roles, share
responsibilities and reduce the risk of overburdening
any one person [46].
Finally, some schools experienced financial challenges,
such as securing ongoing funding and resources for the
school gardens [13, 25, 46, 50, 51]. Schools had found
various solutions included fundraising events, donations
from local businesses and grant applications [25].
There is a lot of sharing that goes on within the
gardening community, and I think it’s important to
reach out beyond the school gardens and contact
people in community gardens and local gardening
clubs. I have also contacted all of the retailers in this
area –all the big box stores, the local nursery stores if
they have damaged goods –if they have goods that are
unsalable in any way, if they’re just old seeds, I’ll take
them. –Member of staff [46].
This example demonstrates the importance of devel-
oping links with the wider community to increase the
visibility and sustainability of the school garden.
Discussion
In this mixed methods review, we have systematically
and transparently identified, selected, appraised and
synthesised the best available evidence on the health
and well-being impacts of school gardens. We have
used the highest quality international evidence avail-
able, although much of this, particularly the quantita-
tive evidence, was judged to be weak in our quality
appraisal (Tables 5 and 6).
We found some quantitative evidence for nutritional
impacts of school gardening, such as increased preference
for, and consumption of, fruits and vegetables. However,
many of the included studies relied upon self-reported
outcomes, likely to be affected by social desirability bias,
especially in children in school settings. It is notoriously
difficult to measure food consumption accurately, with
different measures having different challenges –the
CADET tool, for example, has been found to overestimate
fruit intake and underestimate vegetable intake [55]. It
was not possible to conduct meta-analyses due to study
design and data limitations. Measurement scales, or
methods of applying the same measures, were too hetero-
geneous to allow outcomes to be pooled. In addition, in-
terventions ranged in length from 10 weeks to 18 months.
We also found substantial qualitative evidence on a
wide range of health and well-being impacts but these
were rarely supported by the quantitative evidence,
either because these outcomes were not measured, or
because few studies identified significant impacts. It is
not clear why these perceptions in the qualitative evi-
dence synthesis are supported by few findings in the
quantitative evidence base; whether this should be
treated as evidence of no effect or whether, especially
due to limitations in the quantitative study designs, it
should be seen as no evidence of effect. It should also be
noted that only three studies used mixed methods to
evaluate impacts, and the quantitative and qualitative
evidence comes largely from different school gardening
interventions.
Our qualitative synthesis provides contextual informa-
tion about which aspects of school gardening may be
important, how health and well-being impacts may be
related to educational impacts, and what factors are
important for the success and sustainability of school
gardening programmes. This qualitative evidence pro-
vides plausible suggestions for how school gardens could
lead to health and well-being improvements which may
help to influence better study design and the elements of
school gardens that have the potential to be beneficial.
Based on the qualitative synthesis, we have developed
a conceptual model (Fig. 3) to visually represent some of
the possible mechanisms and pathways through which
gardening could lead to health and well-being impacts.
These are our interpretations of the evidence we have
synthesised and, to some extent, the model has been left
open to further interpretations, without the use of lines
joining up specific pathways. It should be read from left
to right to consider how the physical and social aspects
of school gardening, coupled with factors influencing
success and sustainability, might lead to health and well-
being (and other) outcomes. The bottom arrow suggests
a feedback loop mediated by feelings of enjoyment,
engagement and motivation. This model builds on the
‘social-ecological conceptual model’presented in a previ-
ous review, which depicted potential short-term (prox-
imal) and long-term (distal) effects of school gardens
and the interconnections between individual, family,
school and community-level effects [3]. Our model also
suggests the potential for broader intermediate and long
term impacts, although we have focused on more
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immediate, individual-level health and wellbeing ef-
fects as determined by our original review questions.
Such long term effects are supported in the broader
literature, particularly those suggested that under-
standing and appreciation of the natural world in
childhood may lead to environmental responsibility in
adulthood as well as support broader perceptions of
wellbeing and quality of life [56, 57].
Although much of the evidence from individual qualita-
tive studies is context specific, we have observed several
cross-cutting themes that we believe to be transferable be-
tween studies. Firstly, school gardening can be integrated
with the wider curriculum to maximise opportunities for
learning: from nutrition education, to practical growing
and food preparation skills, to core curriculum subjects
taught in fun ways. To achieve this it is important for
teachers to be involved in developing and delivering
school gardening activities, with support from other stake-
holders in the school and community. Secondly, school
gardens appear to have particular benefits for children
who have complex needs (behavioural, emotional, or edu-
cational) and do not thrive in an academic environment.
The evidence suggests that these children may be able to
express themselves better in the garden, leading to feelings
of calmness, self-esteem and success. Gardening may
therefore be described as physical, social and visceral;
distinct and complementary to the individual and
cerebral nature of classroom education. Thirdly, we
noticed a two-way flow whereby the perceived bene-
fits associated with school gardening meant that chil-
dren were motivated to continue gardening and
adults (teachers, parents and volunteers) were moti-
vated to continue to support the school gardening
programmes. This feedback loop contributes to the
ongoing success and sustainability of school gardening
programmes, as indicated in our conceptual model
(Fig. 3).
Strengths and limitations of the review
By combining quantitative and qualitative synthesis
methods, this review has highlighted the divergence be-
tween these research methods and the need for greater
synergy. The qualitative research suggests that health
and well-being impacts may be felt by those children
who struggle in a classroom setting, but quantitative
studies did not examine this subgroup. It is possible that
Fig. 3 Conceptual model showing the potential health and well-being impacts of school gardening
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average population outcomes obscure impact among
these children, or that the outcomes are less relevant to
them. Although improvements in eating habits and
physical activity were reported in the qualitative re-
search, these were poorly supported by the quantitative
studies. Again, it is unclear whether this is due to lack of
effect, or deficiencies in the study designs. The qualita-
tive research suggests holistic effects that may be diffi-
cult to quantify, as well as suggesting that impacts may
be felt in the medium to long term, whereas included
studies report only short term follow up.
Whilst the qualitative studies provided the greatest in-
sights, we recognise that by combining multiple studies
set in different contexts, some of the meaning and depth
of findings from individual studies will have been lost.
Whilst we added our own interpretations to those of the
authors, we were limited by the original study designs
and implicit biases. For example, the primary studies did
not consider the perspectives of children who did not
participate in school gardening and reasons for this.
School gardens can be seen as operating in line with
the WHO Health Promoting School’s Framework which
aims to take a holistic approach to health promotion in
schools [58]. Our focus was health and well-being im-
pacts and we did not include studies that focused only
on educational impacts of school gardens. Future re-
views could consider this broader remit which may be
important for school policy makers.
We had hoped to comment on whether there were dif-
ferent impacts of school gardening interventions on
health and wellbeing for different age groups. However,
the majority of studies focus on younger children, in
pre-school [21] or primary/elementary school [9, 15–17,
24–31, 33, 35, 37, 39] with only a small number of par-
ticipants of middle school [22, 38] or junior high age
[17] (Table 2). We therefore conclude that there is insuf-
ficient evidence to answer this question.
We restricted this review to OECD countries because
developing countries have very different baseline health
(and nutrition) characteristics and needs. Most of the
evidence comes from the UK, Australia and the USA
and it is unclear how transferable the findings are be-
yond these locations.
Implications and recommendations for future research
The quality appraisal of both quantitative and qualitative
studies included in this review highlighted weaknesses in
study design and reporting, despite using strict criteria
to exclude the weakest study designs. We would recom-
mend that future studies apply the quality criteria used
in systematic reviews at the design stage to improve the
robustness of the findings and facilitate meta-analysis.
More convincing quantitative evidence is needed to pro-
mote school gardening programmes as public health
interventions. Greater use of objective measures would
provide more robust evidence and consistency in mea-
sures used across studies would allow meta-analysis in
future reviews.
Our findings have some resonance with theories iden-
tified in a recent systematic review of how the school
environment impacts on student health [59]. For ex-
ample, the ‘theory of human functioning and school or-
ganisation’suggests that the ways in which schools
implement formal and informal modes of teaching, and
develop relationships between staff and students, influ-
ence students’commitment and engagement to learning
[60]. The ‘social development model’suggests that pro-
social activities can increase students’commitment to
school [61]. Activities that support social and emotional
learning have the potential to reduce stress and improve
behaviour, both of which may ultimately improve school
performance [62]. Although gardening was not one of
the mainstream activities tested in the meta-analysis by
Durlak et al., it has the potential to be. Considering in
more detail how school gardens are anticipated to im-
pact on the school experience, student health and well-
being and school outcomes, including through the devel-
opment of logic models or theories of change, garden
programmes’impact could be enhanced.
A set of theories in the broader literature suggest that
school gardening may have longer term impacts than
those addressed in the studies included in this review.
Positive and repeated contact with elements of the nat-
ural world in childhood has been suggested to relate to
pro-environmental behaviours and beliefs in adulthood
[57]. Pro-environmental behaviours and ‘connectedness
to nature’have been found to be related to dimension of
wellbeing [63]. Furthermore the type and frequency of
childhood exposure to natural environments is thought
to influence adult use of such spaces [64]. There is a
growing body of evidence which has shown robust asso-
ciations between use of natural environments (for leis-
ure, physical activity and so on) and a range of positive
health outcomes [65]. There is therefore interest in iden-
tifying ways in which children can be provided with
regular and meaningful opportunities to experience the
natural environment.
Future studies on school gardening could usefully
make use of theory-led methods, such as realist synthesis
or evaluation [66, 67], to develop evidence-based causal
explanations of how and why school gardens work, for
which groups of students, in which types of schools.
Conclusions
Despite their popularity, there is currently limited quan-
titative evidence that school gardens can have health and
well-being benefits for students, and the evidence that
does exist is based on self-reported outcome measures.
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The qualitative evidence suggests that participants in
school gardening programmes (including children and
adults) may experience and perceive a range health and
well-being impacts. Further high quality evidence is
needed to facilitate subgroup analysis of health benefits
and the extent of well-being benefits.
School gardens are complex interventions, yet few studies
articulated a logic model to show how it was believed that
school gardens might have an impact on health and
wellbeing. More appropriate study design, and more
consistency in the way food intake is measured, is required.
Competing interests
The authors declare that they have no competing interests.
Authors’contributions
All authors contributed to the design of this review, critically revised the
manuscript and approved the final versions. HO contributed to all stages of the
systematic review (searching, screening, data extraction, quality appraisal and
synthesis) and drafted the manuscript. SG and RW contributed to double
screening, double data extraction, quality appraisal and synthesis. AB devised
the search strategy, ran the literature searches and carried out citation
searching. BL read and commented on the paper and situated findings in the
broader literature. RG conceived the idea for the review and is the guarantor.
Acknowledgments
The European Centre for Environment and Human Health (part of the
University of Exeter Medical School) is part financed by the European
Regional Development Fund Programme 2007 to 2013 and European Social
Fund Convergence Programme for Cornwall and the Isles of Scilly. RG is
partially supported by the National Institute for Health Research (NIHR)
Collaboration for Leadership in Applied Health Research and Care (CLAHRC)
for the South West Peninsula (PenCLAHRC).
Author details
1
European Centre for Environment and Human Health, University of Exeter
Medical School, Truro, Cornwall, UK.
2
Norfolk and Norwich University
Hospitals NHS Foundation Trust, Norwich, Norfolk, UK.
3
NIHR CLAHRC South
West Peninsula (PenCLAHRC), University of Exeter Medical School, Exeter,
Devon, UK.
Received: 4 November 2015 Accepted: 8 March 2016
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