The effect of a combination of nutrition education, soy and vegetable gardening, and food preparation skill training interventions on dietary intake and diversity in women: A case study from Qwa-Qwa

Objective: The objective of the study was to determine if an integrated food and nutrition intervention, including home gardening, nutrition education and recipe development and training, would improve dietary diversity in women. Design: This was a single-system case study. Setting: The study setting was peri-urban Qwa-Qwa, Free State province, South Africa. Subjects: Fifty randomly selected women were included in the study from three purposively selected tribes. Outcome measures: Three 24-hour recall questionnaires were used to determine dietary intake and nutrient adequacy, a dietary diversity questionnaire to calculate the dietary diversity scores (DDSs), and the Radimer-Cornell Hunger Scale questionnaire to ascertain food insecurity. Results: The median food variety score (FVS) was 23 at baseline, and improved significantly (p-value 0.002) to 29 at follow-up. Micronutrient intake was consistently low, despite the median adequacy ratio (MAR) improving significantly (p-value 0.002) from 0.49 to 0.63 at follow-up. Despite a significantly improved MAR at follow-up, the nutrient adequacy ratio (NAR) for only three nutrients met 100% at follow-up, namely dietary iron, phosphate and vitamin B₃. A strong significant positive correlation existed between FVS and the food group diversity score (r = 0.617, p-value 0.000). The FVS and DDS were higher in the food-secure group (n = 16, 32%) than in the food-insecure group (n = 34, 68%), but not significantly. Although most food groups were consumed by the women, limited foods from each group were included. Conclusion: Women in this resource-poor community lacked a variety of food in their diet, despite a high overall DDS. Thus, they had inadequate micronutrient intake and adequacy. A combination of nutrition education, soy and vegetable gardening, and food preparation skill training interventions, seemed to positively influence the nutrient adequacy and overall dietary diversity of the women participating in this study.