Qualitative Process Evaluation of the Yéego! Healthy Eating and Gardening Program at Two Navajo Elementary Schools

Abstract

Introduction: School-based health promotion interventions are one approach to reducing population health disparities, but few studies evaluate the implementation process to understand how it produced the outcomes. As part of a larger study to test efficacy, we conducted a qualitative process evaluation of the Yéego! Healthy Eating and Gardening Program, a school-based intervention which aims to promote fresh fruit and vegetable consumption among Navajo elementary school children. Methods: We collected data through lesson fidelity checklists completed by program intervention staff delivering the lessons and semi-structured interviews with program intervention staff and classroom teachers. We performed content analysis on the combined qualitative data set to identify themes. Results: We identified several themes related to evidence of fidelity, practices that supported delivery, and lessons learned about delivery. Intervention staff followed similar procedures to prepare for and deliver lessons, but timing, teaching styles, and school-level factors shaped overall implementation fidelity. Teachers and students had positive perceptions of the program, especially lessons that were highly visual, experiential, and connected to Navajo culture and surrounding community. Participants discussed enhancing the curriculum’s usability, narrowing the scope, improving its responsiveness to student experiences, and achieving strong alignment with school curriculum standards. Conclusion: The program was implemented with moderately high fidelity across contexts, and we identified program areas where modifications could improve engagement, acceptability, efficacy, and sustainability of the program. The study contributes to an evidence base for school-based health interventions to promote healthy eating among Navajo children.