Green Experience: The Effect of Horticultural Activities on Children’s Physical and Mental Health and Dietary Behavior

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Tzuhui Angie Tseng Department of Environmental and Cultural Resources, National Tsing Hua University, Hsinchu, Taiwan

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Jui-Jung Chang Department of Environmental and Cultural Resources, National Tsing Hua University, Hsinchu, Taiwan

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Yun-Chen Chang School of Nursing and Graduate Institute of Nursing, China Medical University, 406, Taichung City, Beitun District, Taiwan; and Nursing Department, China Medical University Hospital, Taichung, Taiwan

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Abstract

Child obesity is a major global public health issue. This study sought to identify means to improve children’s dietary behaviors through horticultural activities and effectively enhance their health and quality of life. The 129 participants were children in third grade through sixth grade in Hsinchu City, Taiwan. A quasi-experimental design was adopted as an intervention for school horticultural activities. The 68 students in the intervention group engaged in 40-minute horticultural sessions for 6 weeks. The pretest and post-test scores of both groups were measured using the Physical Questionnaire for older Children, the Connection to Nature Index, the Willingness to Taste Fruits and Vegetable Scale, and the Children’s Quality of Life Scale, as well as questionnaire items. The qualitative and quantitative data were analyzed through a parallel mixed-method approach. The findings showed that the intervention group’s physical activity levels, nature connectedness, and overall health were higher than those of the control groups. There were no significant differences in willingness to taste fruits and vegetables. This study demonstrates that engaging in natural school spaces and participating in horticultural activities improved the physical and mental health of children. Natural elements should be incorporated into the campus design, and children should be encouraged to participate in school horticultural activities.

Child obesity is a major global public health issue in the 21st century. Obesity harms one’s health and dignity and lowers academic performance (World Health Organization 2016). From a public health perspective, emphasis should be placed on children’s dietary behaviors and the means to improve their health and quality of life.

The environment and eating experiences are crucial to a child’s dietary behavior development (Birch 1999). Regarding the association between the living environment and a person’s growth stages, childhood is the earliest stage during which one can develop environment adaptability and experiential capacity. Changes to a child’s surroundings affect their development and even alter their behaviors in life. In recent years, some researchers have demonstrated the positive outcomes children gain when they engage with nature (Hammond et al. 2011; Kuo and Faber Taylor 2004), such as developing positive natural values (Davis et al. 2006), improving environmental attitudes (Aguilar et al. 2008; Waliczek and Zajicek 1999), improving psychological well-being (Davis et al. 2006), improving cognitive capabilities (Wells 2000), promoting higher levels of physical activity (Dyment and Bell 2007), developing visual–motor integration (Sommerfeld et al. 2021), and reducing the risk of attention deficit disorder (ADD) (Kuo and Faber Taylor 2004). Lack of engagement with natural elements or the natural environment could cause a child to have adverse developments and acquire nature-deficit disorder (Louv 2005).

Pretty et al. (2005) described three types of engagement with nature: viewing nature, immersing in nature, and actively participating in nature (such as horticulture, agriculture, trekking, camping, or interacting with nature). Previous studies of children’s engagement with nature have mainly focused on the positive outcomes of viewing or immersing in nature (Davis et al. 2006; Dyment and Bell 2007; Kuo and Faber Taylor 2004; Wells and Evans 2003), and few have explored engagement with nature through active participation. Studies of adults have also demonstrated that horticultural experiences can help people actively engage with the natural environment and improve their satisfaction in life, vitality, psychological well-being, positive influence, sense of community, and cognitive capacity (Gonzalez et al. 2010; van den Berg et al. 2010; Wood et al. 2016).

Because many previous studies of children have empirically investigated the effects, particularly the psychological effects, of exposing children to nature (Hammond et al. 2011; McFarland et al. 2014), the integrated effects of horticultural activities on children’s psychological health and overall behaviors need further evaluation. Because children are often at school, the school environment is an essential setting in life that affects their development (Myers and Wells 2015). The school is also essential for quantitatively and qualitatively assessing green spaces (McCormick 2017). For children living in urban areas, outdoor courses are an essential means to enhancing their physical activity. The positive effects of engaging with nature can be gained through horticultural activities (Lohr and Pearson-Mims 2005).

Horticulture and physical activity levels

Caspersen et al. (1985) defined physical activity as “any bodily movement produced by the skeletal muscles that result in energy expenditure.” The amount of energy spent during physical activity is determined by the intensity, duration, and frequency of muscle contractions (Taylor et al. 1978). Different types of activities and changes in the intensity, duration, and frequency of each activity may generate different physical activity levels. Zahl-Thanem et al. (2018) noted that children’s physical activity levels are determined by their time outdoors, activity participation, athletic self-concept, and prolonged sitting. Increasing the opportunities for children to engage in outdoor activities promotes their physical activity. Thus, increasing the area of urban green spaces and physical activity programs improves physical activity levels (Hunter et al. 2015).

Nonetheless, because many current activities require little physical effort, diverse activities should be provided to children to increase their physical activity. Wells et al. (2014) elaborated that horticultural activities can reduce prolonged sitting among children and help them attain medium to moderate-to-vigorous physical activity. Kweon and Matsuo (2008) measured the physical activity levels of gardening and everyday life and found a wide range of intensity in horticultural work, which was primarily associated with medium intensity (30%–60%).

Horticulture occurs outdoors and is considered a type of active participation and interaction with nature activity. This study posits that horticultural activities improve children’s moderate-to-vigorous physical activity. The following hypothesis was proposed: horticultural activities positively affect children’s physical activity levels.

Horticulture and nature connectedness

The connection between humans and nature is a psychological structure that reflects how individuals include the natural environment as a part of their identity (Schultz 2001). It is a subjective feeling of their relationship with the natural environment (Capaldi et al. 2014). Nature connectedness is a means to improve one’s environmental protection behaviors and is an active pro-environment behavior (Gosling and Williams 2010) that comprises a high level of concern for the environment (Schultz and Tabanico 2007). Engaging in leisure activities in the natural environment is a form of leisure involvement. The involvement measurement includes behaviors and psychosocial aspects (Kim et al. 1997). Behaviors include the length and frequency of involvement, such as the time spent and frequency of engaging in activities in nature. The psychosocial aspect is one’s intrinsic involvement and connectedness with nature. A vast body of research has stated that spending time outdoors improves children’s connectedness with nature, thereby affecting their environmental behaviors. Richardson et al. (2016) reported that a high level of nature connectedness among children benefits their health, satisfaction in life, pro-nature behaviors, and pro-environment behaviors. The means to engage with nature and generate behaviors include substitutive experiences without physical contact (such as viewing nature through a window, images, and film) and direct experiences in nature (Kellert 2002; Keniger et al. 2013; Pretty et al. 2005). Horticulture allows participants to directly and actively engage with the natural environment and generate changes through contact and experience. It also enhances children’s perception of the natural environment. The following hypothesis was proposed: horticultural activities positively affect children’s nature connectedness.

Horticulture and dietary behaviors

Children develop their food preferences during the early stages of childhood. However, food preferences constantly change during adolescence and adulthood (Nicklaus et al. 2004; Rollins et al. 2010). Additionally, food preferences continuously vary because of the influence of different biological, social, and environmental factors. A person’s distinct preferences or aversions are their innate tendencies, but their dietary preference can be developed or modified through experiential learning (Ventura and Worobey 2013). Personal preference is a determinant of the choice of food and dining quality.

Child obesity quickly leads to metabolic problems, cardiovascular disease, asthma, and depression. One study has shown that an increased intake of fruits and vegetables is a strategic approach to preventing and reducing the risk of obesity (de Oliveira et al. 2008). Horticultural spaces in schools are open spaces where children engage in entertainment, sports, and leisure, thus influencing the way they engage with nature and improve their health (Çelik and Ender 2017). Some horticultural activities at school have clear objectives, such as enhancing children’s health and nutrition literacy and intake of fruits and vegetables. Other courses aim to integrate students with their school and community through horticultural activities at school and based on an ecological and instructional perspective (Nowak et al. 2012). Horticulture at school is conducive to children’s teamwork skills and self-understanding (Robinson and Zajicek 2005).

Gatto et al. (2012) examined the effects of horticulture on fourth-grade and fifth-grade elementary school students’ motivation and preferences for eating fruits and vegetables. The results showed that the intervention and control groups significantly differed in their healthy eating behaviors. Christian et al. (2014) evaluated the effects of horticulture on the intake of fruits and vegetables of eight children. The children recorded the foods they had eaten using a 24-h dietary recall. The results revealed that horticultural activities increased the children’s daily intake of fruits and vegetables by 81 g. Davis et al. (2016) evaluated the effects of healthy cooking and on-campus horticulture on the dietary behaviors of third-grade to fifth-grade children. The results demonstrated that although the children improved their identification of fruits and vegetables, there was no difference in their willingness to try different fruits and vegetables. Leuven et al. (2018) explored the effects of indoor and outdoor horticultural courses on the identification of and preference for fruits and vegetables among 10- to 12-year-old children. The results revealed significant differences between the preference for fruit and vegetables and identification of fruits. Previous studies have mainly designed an experiment group and a control group to examine the effects of horticulture on children’s dietary behaviors. This study proposes the following hypothesis: horticultural activities positively affect children’s dietary behaviors.

Relation between horticulture and health

Health is a state of complete physical, mental, and social well-being, not merely the absence of disease or infirmity (World Health Organization 1998). In other words, health is a holistic concept involving physical, mental, psychiatric, emotional, group, and social health statuses (Christakis and Fowler 2013). Health concepts today focus on the quality of life in general. Horticulture is a highly accessible green activity with little restriction. It provides opportunities for people to be exposed to the natural environment and gain its benefits. Genter et al. (2015) showed that horticulture improves one’s social relations and helps one to relieve stress, connect with nature, develop individual skills, and lead a healthy life. To this end, this study assumes that participating in school horticultural activities allows children to promote their health. The following hypothesis is proposed: horticultural activities positively affect children’s health.

Materials and Methods

Participants and setting

This study recruited elementary schools in Hsinchu City willing to cooperate with us and implement a horticultural course. The participants were in units of the class. Third-grade to sixth-grade students from three schools (schools H, M, and P) participated in this study. Before implementing the horticultural activities, we discussed the space and curriculum of the course with the class instructors, who then distributed an informed consent form to the students and their parents so that they were informed of the purpose and procedure of this study.

Course design

This quasi-experimental study adopted the nonequivalent control group design. Because of the quasi-experimental nature of this study, the participants could not be randomly grouped; they were grouped according to their class. The intervention group or the control group was determined by the willingness of the class to participate. The intervention group participated in horticultural activities, whereas the control group continued their routine. Both groups were administered a questionnaire before and after the intervention, and the postquestionnaire was only distributed once after the course finished.

The questionnaire was designed with structure measurement and open-ended questions to collect qualitative text data. It asked the children in the intervention group why they liked various gardening activities based on the seven categories of children’s gardening benefits derived from Chang (2017). It also asked about the reasons that affect the intake of vegetables and fruits. Each questionnaire required 20 to 30 min to complete. The course was implemented weekly for 6 weeks, from Apr 2019 to Jun 2019, for 40 min per session.

The tremendous difference between horticultural and other activities is that the activity media are natural materials, and the activities can occur outdoors, indoors, or semi-outdoors (Tseng 2001). In Taiwan and other countries, horticultural activities primarily consist of artworks and handicrafts, group activities, hiking or going outdoors, indoor plantings, and outdoor planting (horticultural activities) (Tseng et al. 2007). Because engaging in nature is a green experience (Kaplan and Forst 2017), the activities in this study were based on green experiences and natural materials while centering on the actual simulation of the five senses. A diverse horticultural course with static and dynamic activities was designed (Table 1).

Table 1.

Comprehensive outline of the topics encompassed by the horticultural course curriculum.

Table 1.

Measurement instruments

Nature connectedness.

Natural environment experiences are a type of leisure that includes the behavioral and psychosocial domains. Because the psychosocial domain is long-term, nature connectedness is adopted as a measurement instrument. This study applied the Connection to Nature Index of Cheng and Monroe (2012), which consists of enjoyment of nature, empathy for creatures, a sense of oneness, and a sense of responsibility. Previously, Cheng and Monroe (2012) provided this Connection to Nature Index scale and achieved high index reliability (Cronbach’s α = 0.87). Bragg et al. (2013) examined the Connection to Nature Index with the highest internal consistency (α = 0.82). The 17 items were measured using a 5-point Likert scale to measure the self-rated perceptions of the children.

Physical activity.

This study applied the Physical Questionnaire for Older Children (PAQ-C) developed by Kowalski et al. (1997) for testing. The PAQ-C is a 7-d-recall self-administered questionnaire determining moderate-to-vigorous physical activity among fourth-grade to eighth-grade students (age 8–14 years). The 10 items were measured using a 5-point Likert scale, and the mean score of each dimension is determined by adding the scores of each item in the dimension. A higher score indicates a higher physical activity level. The PAQ-C has been tested in the United States, United Kingdom, Africa, China, and other countries, and it has good internal reliability (Cronbach’s α = 0.76–0.84) and test–retest reliability (r = 0.75–0.82) (Thomas and Upton 2014; Wang et al. 2016).

Dietary behaviors.

Powers et al. (2011) developed a scale for assessing students’ willingness to taste fruits and vegetables. The questionnaire items included acceptance of fruits and vegetables, willingness to taste, level of food neophobia, and willingness to taste fruits and vegetables in different environments such as at school, at home, and at peers’ homes. There were six items for fruits and vegetables. Each item was measured using a 4-point Likert scale. A higher score indicates more willingness to taste fruits and vegetables, and vice versa. The reliability of this scale was tested by Greer et al. (2018), and the reliability values of the vegetable and fruit items were, α = 0.9 and α = 0.88, respectively.

Overall health.

Varni et al. (1999) proposed the Pediatric Quality of Life (PedsQL) questionnaire, which consists of 23 items across four dimensions: physiological functioning (8 items); emotional functioning (5 items); social functioning (5 items); and school functioning (5 items). The PedsQL questionnaire is suitable for children between 5 and 18 years of age, and all items are measured using a 5-point Likert scale (1 = never; 5 = all the time). The reciprocal of the 5-point scores is linearly converted to a range of 0 to 100 as follows: 0 = 100; 1 = 75; 2 = 50; 3 = 25; and 4 = 0. The mean was calculated from the sum of each item, and a higher score represents a healthier quality of life. In the study of Varni et al. (2003), the reliability and validity of the scale were tested by mailing a questionnaire to investigate the health status of children 2 to 16 years of age. The reliability was α = 0.89 for children and α = 0.92 for parents.

Basic information and items.

The children’s grades, age, sex, parents’ education levels and occupations, personal gardening experience, and intake of fruits and vegetables were surveyed. The intervention group’s post-test included a self-assessment of the benefits of horticulture, the reasons for stating them, the degree of involvement, frequency and length of tending to plants, and reasons for influencing their intake of fruits and vegetables. A child’s socioeconomic status was classified based on the revision by Lin (2000) of the socioeconomic status index score of the two-factor index of social position designed by Hollingshead (1957). The index categorizes five types of parents’ education levels and occupations, with the score of the former multiplied by four and the latter multiplied by seven. The sum of both is the socioeconomic status index score.

Results

Participants’ primary data

Thirteen invalid questionnaires were removed from the recovered sample for incomplete data. There were 129 participants; 68 (52.9%) were in the intervention group and 61 (47.1%) were in the control group. The intervention group comprised 32 boys and 36 girls; the control group comprised 35 (57.4%) boys and 26 (42.6%) girls. There were 17 (35%), 33 (48.6%), 6 (8.8%), and 12 (17.6%) third-grade, fourth-grade, fifth-grade, and sixth-grade students, respectively, in the intervention group, whereas everyone in the control group was in fourth grade. The age range in both groups was 10 to 12 years. Most participants had a high socioeconomic status (55.9% in the intervention group and 44.3% in control). Forty-six (67.6%) participants in the intervention group had gardening spaces (such as courtyards or balconies) at home, compared with 32 (52.5%) participants in the control group. Fifty-four (79.4%) of the participants in the intervention group had gardening experiences (in the community, at school, or on a farm) at home, compared with 40 (34.4%) of the participants in the control group. Most participants in both groups spent 30 min, on average, performing previous experiential horticultural activities (38 participants or 55.9% in the intervention group; 28 or 45.9% in the control group). No significant differences between the household socioeconomic status, gardening spaces, previous gardening experience, and activity length of the two groups were found based on the independent t test results.

Group differences before and after horticultural activity

To understand the influence of horticultural activities on children’s physical activity, nature connectedness, dietary behaviors, and health, as well as to compare whether significant differences exist between the pretest and post-test scores of the two groups, a two-way analysis of covariance (ANCOVA) was performed because both groups had completed pretest and post-test questionnaires. The independent variable was the group type, the dependent variable was the post-test score, and the covariate was the pretest score. During the covariate analysis, the homogeneity of regression slopes must be checked. If the F-statistic is insignificant (P > 0.05), then the homogeneity of regression assumption is fulfilled, and the covariate analysis can be performed.

Physical activity level.

The test of homogeneity for physical activity in different groups showed that P = 0.788 (P > 0.05). The homogeneity of the regression assumption was fulfilled because the coefficients of regression within the groups were homogenous; therefore, the covariate analysis could be performed. The results showed that the after excluding the influence of the pretest physical activity level, the post-test mean physical activity level scores of both groups were significantly different [F (1, 126) = 11.96; P = 0.001; ηp2 = 0.087]. The post-test mean physical activity level score showed that mean (M) = 3.02 (SD = 0.86) for the control group, whereas M = 3.30 (SD = 0.74) for the intervention group. The intervention group had higher scores than the control group (Table 2).

Table 2.

Outcomes of the analysis of covariance of physical activity levels.

Table 2.

Nature connectedness.

The test of homogeneity for the physical activity levels of different groups showed that the coefficients of regression within the groups were homogenous; therefore, the covariate analysis could be performed (P = 0.788; P ≥ 0.05). The ANCOVA results showed that the nature connectedness in both groups was significantly different [F (1, 126) = 5.37; P = 0.02; ηp2 = 0.041]. The post-test mean nature connectedness score showed that M = 3.76 (SD = 0.82) for the control group, whereas M = 4.09 (SD = 0.70) for the intervention group. The intervention group had higher scores than the control group (Table 3).

Table 3.

Statistical analysis of the analysis of covariance-adjusted relationship between predictor variables and level of nature connectedness.

Table 3.

Dietary behaviors.

The homogeneity test of different groups showed that the covariate analysis could be performed for this set of data (P = 0.96; P ≥ 0.05). The ANCOVA results in Table 4 showed that F (1, 126) = 0.40, P = 0.53, and ηp2 = 0.003, indicating that there were no significant differences between the dietary behaviors of the intervention and control groups.

Table 4.

Results of the analysis of covariance of dietary behavior levels.

Table 4.

Overall health.

The test of homogeneity for overall health in different groups showed that P = 0.11 (P > 0.05), and that the ANCOVA could be performed (P = 0.788; P ≥ 0.05). The health of the intervention group and of the control group were significantly different [F (1, 126) = 4.76; P = 0.03; ηp2 = 0.036]. The post-test mean nature health score showed that M = 88.29 (SD = 7.64) for the control group, whereas M = 91.64 (SD = 8.35) for the intervention group. The intervention group had higher scores than the control group (Table 5).

Table 5.

Outcomes of the analysis of covariance of the adjusted relationship between predictor variables and overall health status.

Table 5.

Analysis of qualitative data

Benefits of horticultural activities.

The post-test results highlight the benefits gained by the intervention group from the horticultural activities. Chang (2017) investigated the horticultural experiences of elementary school children and highlighted that children gain seven benefits from gardening activities: “improving life skills,” “evoking pleasant feelings,” “promoting human interaction and finding friends in planting,” “improving knowledge,” “increasing willingness to eat fruits and vegetables,” “promoting physical health,” and “increasing engagement with nature.” In this study, the children were tasked with verifying these seven benefits, and the results showed that “increasing engagement with nature” was the most significant benefit (20.4%), followed by “increasing knowledge” (17%). Moreover, “increasing engagement with nature” was ranked highest by both boys and girls, followed by “increasing knowledge” for boys and “evoking pleasant feelings” for girls.

Degree of engagement in horticultural activities.

The children were asked to self-assess their degree of engagement using a scale of 1 to 5 points (in increasing degree of engagement) and the frequency (number of days per week: 1 = 1 d; 5 = >4 d) and time spent performing plant care (1 = <10 min; 5 = >40 min). The mean time that they spent taking care of plants was calculated. The children’s mean self-assessed degree of engagement was 4.44 points (high engagement); they spent, on average, more than 4 d taking care of plants every week, even though a single session was less than 10 min. This could be because the time of plant care coincided with recess; therefore, they spent less time on plant care.

Reasons for enjoying horticultural activities.

According to the attribution theory Heider (1958), human behavior consists of personal and situational factors. Therefore, this study used open-ended questions to survey the types of horticultural activities favored by the children after completing the course and attempts to identify the reasons for their choices. The student’s response is represented by the code “S,” followed by a number. Statistics presented in terms of percentage showed that the children most enjoyed planting succulent plants (29.4%), followed by planting vegetables (27.9%).

Enjoyment from planting succulent plants. The children enjoyed planting succulent plants because of personal preference (It is fun to plant succulent plants—S11), curiosity and their appealing appearance (I have never grown these plants before—S15), to gain more experiences and knowledge (Because I get to learn more about succulent plants—S12), and their tactile impression (I like to feel the texture of succulent plants—S16). Subsequently, the children enjoyed growing succulent plants because they improved their pleasure (I feel happy planting succulent plants—S14). Additionally, because succulent plants are easy to take care of, the children could quickly gain a sense of achievement in horticulture (Because there are higher chances of success at planting succulent plants—S18; There is no need to water succulent plants constantly—S19).

Enjoyment from planting vegetables. The children enjoyed planting vegetables based on their personal preferences or experience (I have constantly been growing vegetables at home—S02). By getting in touch with horticulture, the children have more chances to connect with nature and increase their personal horticultural experiences and knowledge. In addition, they experience an actual harvest that they could eat (They can be eaten—S0) and enhance their knowledge and experience (I get to experience vegetable growing—S07) and natural experiences (I get to dig the soil—S09). Furthermore, horticulture affected the children’s pleasure (I feel serene mentally—S05).

Enjoyment from plant rubbing. Plant rubbing is a static activity in horticulture. Collecting leaves is the first step to developing a relationship with nature among children (Louv, 2005) (Collecting leaves allows me to observe different types of leaves—S24) and improve their nature connectedness. During the process of plant rubbing, we found that children’s sensitivity to color encompasses personal preferences and imagination (I can create many things—S20; It is enjoyable; I like to look at colorful things—S21). Some children gained a sense of achievement from plant rubbing (I get to keep it as a souvenir—S22).

Enjoyment from planting ornamental plants. The children planted a wide range of flowers during the ornamental plant course and improved their knowledge (I learned about different types of flowers—S28). During the process, the children improved their interpersonal relations through corporation and assistance with their peers (Because we can help each other—S12; We can work with each other—S02). Furthermore, planting ornamental plants allowed children to gain a sense of achievement (Because it is challenging—S16; Because the surroundings become beautiful—S26) and achieve pleasure during the process (I feel relaxed physically and mentally—S27).

Enjoyment from making vegetable bouquets. To the children, making vegetable bouquets is a novel. This activity enhances their living skills and experiences (I can learn how to make bouquets—S20; I have never participated in this kind of activity. It is entertaining, and I get to learn something new—S21). Because the vegetables are the main component of the bouquets, the children become motivated to eat them (I get to eat delicious vegetables—S29; Because I get to bring them back home and eat them—S32).

In general, personal achievement and living skills enhancement were two significant benefits gained by the children after the activities. Sage (1984) reported that rewards increase learning motivations and activity participation, thus improving learning outcomes and knowledge.

What influences children’s intake of fruit and vegetable.

Before and after completing the questionnaire, the participants were asked to recall the mean daily number of servings of fruits and vegetables within the past month (4-point Likert scale: 1 point, less than one serving; 4 points, more than three servings). A standard serving of cooked vegetables is approximately half a bowl; a serving of fruit was measured based on fist size. In addition, the children were asked open-ended questions about the reasons for eating fruits and vegetables. The results in Table 6 show that the mean intake of fruits in both groups was higher than that of vegetables.

Table 6.

Analysis of changes in the consumption of fruits and vegetables measured using pretest and post-test assessments.

Table 6.

The children’s reasons for eating fruits and vegetables included the taste (Some fruits and vegetables taste weird—S32; The tenderness of vegetables and sweetness of fruits—S16), appearance and color (Some fruits and vegetables look strange—S33; Stir-fried green peppers are crunchy, colorful, and delicious—S02), intake experiences (I have eaten something that does not taste good—S14), personal preference (I do not eat vegetables, only fruits—S35; Vegetables are more delicious than meat—S36), and family environment factors (My parents forced me to eat it—S40; Because my mom forced me to eat—S39). Children’s dietary behaviors are influenced by extrinsic factors, personal preferences, and personal health awareness (Eating more fruits and vegetables is healthy—S38; I want to grow taller—S37). The influence of the family environment and family members are attractive because social support from parents can influence children’s health and behaviors (Dave et al. 2012). Parents who excessively control their children’s diet and diet type could sometimes reduce their desire to eat fruits and vegetables. Children’s fruit and vegetable intake at school is associated with their family, living environment, and peers (Gross et al. 2010).

Engaging in a natural environment improves children’s positive natural values and confers various health benefits and well-being (Cox et al. 2017; Gill 2014; McCormick 2017). The different approaches to engaging with nature depend on how one interacts with the natural environment. Horticulture is a means of engaging with nature through active participation (Pretty et al. 2005). Children often spend most of their time at school; therefore, this study examines the influence of school horticultural activities on children’s physical and mental health and behaviors.

This study found that the children’s physical activity differed significantly after engaging in horticulture. In line with the study by Hermann et al. (2006), who showed that horticultural programs offer children hands-on opportunities and effectively increase their daily physical activity after school. Horticulture also reduces prolonged sitting and promotes moderate-to-vigorous physical activity. Moreover, the World Health Organization recommends that children perform moderate-to-vigorous physical activity for at least 1 h per day. Even though the participants in this study had different physical activity levels, they were all medium levels, suggesting the need to improve Taiwanese children’s physical activity (World Health Organization 2012). Horticultural activities are diverse, have a wide range of activity intensities, and most works are moderate to vigorous; even though horticultural activities do not alter bodily functions much, they provide opportunities to move and maintain health (Kweon and Matsuo 2008).

School horticulture increases children’s outdoor learning. We found that horticultural activities effectively enhanced children’s nature connectedness through engagement with the natural environment. Mayer et al. (2009) reported that connecting with nature through engagement with actual environments offers a person more positive benefits than a virtual environment. The benefits include enhancing the children’s nature connectedness, attention, and positive emotions. Richardson et al. (2016) found that spending more time outdoors or in natural environments effectively improves children’s nature connectedness, thereby affecting their health, satisfaction with life, behaviors, and pro-environmental behaviors. The most significant benefit conferred based on the children’s self-assessment of their horticultural participation was “increased contact with nature.” This study also compensates for the lack of quantitative measurements of children’s nature connectedness through horticultural activities.

There were no significant changes in the children’s dietary preferences after participating in the horticultural course. The study by Davis et al. (2016) of nutrition and school horticultural courses revealed that children improved their awareness of horticulture and vegetables. However, their willingness to try fruits and vegetables was unaffected. In this study, the children’s self-assessed fruit and vegetable intake did not increase significantly after participating in the horticultural activities, which is consistent with the long-term findings of Hanbazaza et al. (2015) regarding the effects of school horticulture on children’s knowledge, preferences, and intake of fruits and vegetables. Therefore, it is posited that dietary habits are unaffected by short-term activities.

Because many studies of the effectiveness of horticultural activities on children’s fruit and vegetable eating behaviors have reported inconsistent results, this study used the text data of open-ended questions to identify the reasons that affect children’s intake of fruits and vegetables. The main reasons were the taste and appearance of the fruits and vegetables, as well as parents’ influence. For example, De Cosmi et al. (2017) examined the factors affecting children’s dietary preferences at different growth stages. They showed that a multitude of factors affects children’s dietary behaviors, such as family, peers, community, socioeconomic status, food, and the children’s experiences or attributes (Dave et al. 2012; Gross et al. 2010; Hass and Hartmann 2018; Lowe et al. 2004; Trost et al. 2003). Therefore, the children’s dietary behaviors have long-term interactions with various factors.

In this study, health was measured in terms of quality of life. Based on their responses to the open-ended questions, the children believed that horticultural activities increased their knowledge and experiences and significantly improved their pleasure and interpersonal relations. Bento and Dias (2017) suggested that increasing children’s opportunities to engage with nature through outdoor play strengthens their cognitive, physical, social, and emotional well-being, subsequently affecting their learning motivations and enthusiasm. Passmore and Howell (2014) suggested that a 2-week natural environment intervention positively influences mental health. Consolidating these arguments, engagement with nature effectively improves children’s health and quality of life.

Discussion

Theoretical contributions

This study applied a horticultural intervention during the learning process of children. The intervention yielded many benefits, such as increasing the willingness to taste vegetables, gaining horticultural experiences and knowledge, psychological benefits and a sense of achievement, and engaging with nature. Lewin (1951) proposed the field theory describing human behaviors and interactions with their surroundings. All perceivable environmental factors can interact with individuals and affect their emotions, attitudes, goals, and behaviors. School horticultural and landscaping activities are a new environmental factor for children. While engaging in horticulture, the children interact with their curriculum environment, which affects their attitudes and perceptions of plants, and connect with nature. Horticultural activities are in-depth natural experiences that complement the lack of research regarding the third type of engagement with nature.

Children gain the rewards of having a sense of personal achievement and enhanced life skills as a result of performing horticultural activities. Sage (1984) suggested that rewards increase learning motivations and activity participation, thus improving learning outcomes and knowledge. Therefore, the learning process and planting outcomes of horticultural activities affected the children’s motivation to learn horticulture. A person’s dietary behavior undergoes long-term and short-term changes, which are greatly influenced by the living environment. Bandura (1986) proposed the social cognitive theory of human functioning, which mainly explains that human behavior is based on interactions between individuals, behaviors, and the environment. The social cognitive theory includes the psychological dynamics that influence health behaviors and the means to promote behavioral changes. This study noted that changes in dietary behaviors require long-term influences.

Practical contributions

Urban developments have reduced the opportunities for children to engage with nature. Humans gradually shift from being close to nature (biophilia) to being close to videos (videophilia), such as watching television and videos, using a computer, and performing online activities. These behaviors gradually affect the normal physical and mental development of children. Louv (2005) termed this phenomenon of children’s alienation from nature as “nature deficit disorder” and explained the various problems caused by this disorder. The author advocated the various physiological, cognitive, and psychological benefits of engaging with nature. Louv (2016) further advocated that humans require vitamin N (“N” for nature) because it promotes mental health and improves the body’s recovery from illnesses. People should spend more time outdoors to cultivate their own “natural neurons” and “natural creativity.” Kuo (2011) stated that green environments are the fundamental component of healthy habitats for humans. In addition, the author also proposed that vitamin G (“G” for green) acquired through engagement with nature can promote personal health. Spending more time in green spaces positively affects human health and well-being, such as reducing stress and anxiety, strengthening physical activity levels, reinforcing immune functions, and indirectly improving social relations.

Limitations

This study was conducted at several schools, and the horticultural activities were conducted in different settings, which may have affected the results. The experimental settings should be consistent in subsequent studies or focus on examining whether different outcomes are gained from indoor and outdoor horticultural activities. Moreover, combining different natural elements in horticultural and landscaping spaces is of interest, and the most suitable horticultural elements for children should be identified. Horticultural courses used by previous studies had varying lengths. Future studies should discuss whether different course lengths confer different learning outcomes.

In this study, the participants were allowed to answer self-administered questionnaires and text items. We recommended that parent or teacher observation forms or questionnaires should be administered to highlight the dimensions affecting children’s responses. Even though Wells et al. (2014) observed children’s horticultural activity behaviors and instrumentally measured their physical activity, this study collected the physical activity of all groups at one time based on their recall of physical activity levels within the past 7 d. The questionnaire responses still differed based on the participants, and this study emphasized the benefits of horticultural intervention. In this study, students of similar age were selected for gardening activity courses. In the future, children of different age groups should be examined. Age will have different effects on learning, cognition, and physical fitness. The children’s growth backgrounds and parents’ socioeconomic backgrounds should also be examined in future studies.

This study applied school horticultural activities to increase children’s opportunities to engage with nature directly and positively, and it subsequently explored the physical and mental benefits and behavioral effects of horticultural activities on children. Based on the results, horticultural activities not only allow children to be exposed to nature but also have many health benefits. Children need nature to stimulate their sensory development to evoke their learning capabilities and creativity. The sensory experiences of engaging with plants allow children to associate emotions with nature. Moreover, because children spend most of their time at school, nature courses should be limited to lessons and creative campus design incorporating natural elements.

References Cited

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    • Search Google Scholar
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    • Search Google Scholar
    • Export Citation
  • Chang Y-Y. 2017 Exploring the benefits of school gardening for children and identifying the influencing factors (PhD Diss) National Taiwan University Taipei, Taiwan https://hdl.handle.net/11296/q8r928

    • Search Google Scholar
    • Export Citation
  • Cheng JCH & Monroe MC. 2012 Connection to nature: Children’s affective attitude toward nature Environ Behav.44 1 31 49

  • Christakis NA & Fowler JH. 2013 Social contagion theory: Examining dynamic social networks and human behavior Stat Med.32 4 556 577

  • Christian MS, Evans CE, Nykjaer C, Hancock N & Cade JE. 2014 Evaluation of the impact of a school gardening intervention on children’s fruit and vegetable intake: A randomised controlled trial Int J Behav Nutr Phys Act.11 1 99 https://doi.org/10.1186/s12966-014-0099-7

    • Search Google Scholar
    • Export Citation
  • Cox DT, Shanahan DF, Hudson HL, Fuller RA, Anderson K, Hancock S & Gaston KJ. 2017 Doses of nearby nature simultaneously associated with multiple health benefits Int. J. Environ. Res. Public.14 2 172 https://doi.org/10.3390/ijerph14020172

    • Search Google Scholar
    • Export Citation
  • Dave JM, Evans AE, Condrasky MD & Williams JE. 2012 Parent-reported social support for child’s fruit and vegetable intake: Validity of measures J Nutr Educ Behav.44 2 132 139

    • Search Google Scholar
    • Export Citation
  • Davis B, Rea T & Waite S. 2006 The special nature of outdoors: Its contribution to the education of children at aged 3-11 Aust. J. of Outdoor Educ.10 2 3 12

    • Search Google Scholar
    • Export Citation
  • Davis JN, Martinez LC, Spruijt-Metz D & Gatto NM. 2016 LA Sprouts: A 12-week gardening, nutrition, and cooking randomized control trial improves determinants of dietary behaviors J Nutr Educ Behav.48 1 2 11

    • Search Google Scholar
    • Export Citation
  • De Cosmi V, Scaglioni S & Agostoni C. 2017 Early taste experiences and later food choices Nutrients.9 2 107

  • de Oliveira MC, Sichieri R & Mozzer RV. 2008 A low-energy-dense diet adding fruit reduces weight and energy intake in women Appetite.51 2 291 295

  • Gatto NM, Ventura EE, Cook LT, Gyllenhammer LE & Davis JN. 2012 LA Sprouts: A garden-based nutrition intervention pilot program influences motivation and preferences for fruits and vegetables in Latino youth J Acad Nutr Diet.112 6 913 920

    • Search Google Scholar
    • Export Citation
  • Genter C, Roberts A, Richardson J & Sheaff M. 2015 The contribution of allotment gardening to health and wellbeing: A systematic review of the literature Br J Occup Ther.78 10 593 605

    • Search Google Scholar
    • Export Citation
  • Gill T. 2014 The benefits of children’s engagement with nature: A systematic literature review Child Youth Environ.24 2 10 34 https://doi.org/10.7721/ chilyoutenvi.24.2.0010

    • Search Google Scholar
    • Export Citation
  • Gonzalez MT, Hartig T, Patil GG, Martinsen EW & Kirkevold M. 2010 Therapeutic horticulture in clinical depression: A prospective study of active components J Adv Nurs.66 9 2002 2013

    • Search Google Scholar
    • Export Citation
  • Gosling E & Williams KJ. 2010 Connectedness to nature, place attachment and conservation behaviour: Testing connectedness theory among farmers J Environ Psychol.30 3 298 304

    • Search Google Scholar
    • Export Citation
  • Gross SM, Pollock ED & Braun B. 2010 Family influence: Key to fruit and vegetable consumption among fourth-and fifth-grade students J Nutr Educ Behav.42 4 235 241

    • Search Google Scholar
    • Export Citation
  • Greer AE, Davis S, Sandolo C, Gaudet N & Castrogivanni B. 2018 Agricultural experiences are positively associated with high school students’ fruit and vegetable perceptions and consumption J Nutr Educ Behav.50 2 133 140

    • Search Google Scholar
    • Export Citation
  • Hanbazaza MA, Triador L, Ball GD, Farmer A, Maximova K, Nation AF & Willows ND. 2015 The impact of school gardening on Cree children’s knowledge and attitudes toward vegetables and fruit Can J Diet Pract Res.76 3 133 139

    • Search Google Scholar
    • Export Citation
  • Hass J & Hartmann M. 2018 What determines the fruit and vegetables intake of primary school children: An analysis of personal and social determinants Appetite.120 82 91 https://doi.org/10.1016/j.appet.2017.08.017

    • Search Google Scholar
    • Export Citation
  • Heider F. 1958 The psychology of interpersonal relations John Wiley & Sons Inc. New York, USA

  • Hermann JR, Parker SP, Brown BJ, Siewe YJ, Denney BA & Walker SJ. 2006 After-school gardening improves children’s reported vegetable intake and physical activity J Nutr Educ Behav.38 3 201 202

    • Search Google Scholar
    • Export Citation
  • Hollingshead AB. 1957 Two factor index of social position Yale University Press New Haven, CT, USA

  • Hunter RF, Christian H, Veitch J, Astell-Burt T, Hipp JA & Schipperijn J. 2015 The impact of interventions to promote physical activity in urban green space: A systematic review and recommendations for future research Soc Sci Med.124 246 256

    • Search Google Scholar
    • Export Citation
  • Hammond DE, McFarland AL, Zajicek JM & Waliczek TM. 2011 Growing minds: The relationship between parental attitudes toward their child’s outdoor recreation and their child’s health HortTechnology.21 217 224 https://doi.org/10.21273/HORTTECH.21.2.217

    • Search Google Scholar
    • Export Citation
  • Kaplan SB & Forst L. 2017 Linking environmental sustainability, health, and safety data in health care: A research roadmap New Solut 27 2 189 209

  • Kellert SR. 2002 Experiencing nature: Affective, cognitive, and evaluative development in children 117 151 Kahn PH & Kellert SR Children and nature: Psychological, sociocultural, and evolutionary investigations.MIT Press USA

    • Search Google Scholar
    • Export Citation
  • Keniger LE, Gaston KJ, Irvine KN & Fuller RA. 2013 What are the benefits of interacting with nature? Int J Environ Res Public Health.10 3 913 935

  • Kim SS, Scott D & Crompton JL. 1997 An exploration of the relationships among social psychological involvement, behavioral involvement, commitment, and future intentions in the context of birdwatching J Leis Res.29 3 320 341

    • Search Google Scholar
    • Export Citation
  • Kowalski KC, Crocker PR & Faulkner RA. 1997 Validation of the physical activity questionnaire for older children Pediatr Exerc Sci.9 2 174 186

  • Kuo FE. 2011 Parks and other green environments: Essential components of a healthy human habitat Aus. Parks Leis.14 1 10

  • Kuo FE & Faber Taylor A. 2004 A potential natural treatment for attention-deficit/hyperactivity disorder: Evidence from a national study Am J Public Health.94 9 1580 1586

    • Search Google Scholar
    • Export Citation
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Tzuhui Angie Tseng Department of Environmental and Cultural Resources, National Tsing Hua University, Hsinchu, Taiwan

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Jui-Jung Chang Department of Environmental and Cultural Resources, National Tsing Hua University, Hsinchu, Taiwan

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Yun-Chen Chang School of Nursing and Graduate Institute of Nursing, China Medical University, 406, Taichung City, Beitun District, Taiwan; and Nursing Department, China Medical University Hospital, Taichung, Taiwan

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Contributor Notes

This work is based on the thesis of Chang, Jui-Jung, submitted in June 2018 at the National Tsing Hua University to acquire the academic Master’s degree in the field of social learning.

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Chang, Jui-Jung under the supervision of Tzuhui Angie Tseng. Chang, Jui-Jung authored the initial manuscript, with all authors offering input and contributions to subsequent iterations. All authors read and approved the final manuscript.

Y.C.C. is the corresponding author. E-mail: lisacow@mail.cmu.edu.tw.

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