Operational Definitions:

The variables in this research are participation in gardening activity, depression

symptom severity, anxiety symptom severity, stress symptom severity, caregiver burden
(measured by the Zarit Burden Interview), patient age, patient sex, and patient's
relationship with the caregiver.
Participation in gardening activity was explicitly defined as whether or not the
participant engaged in gardening activities. Depression symptom severity, anxiety
symptom severity, and stress symptom severity were defined using the DASS-21
questionnaire. Caregiver burden was measured using the Zarit Burden Interview (ZBI).
Patient age, patient sex, and patient's relationship with the caregiver were self-reported
by the participants.

Significance & Aim:

Significance: This study is unique because it investigates the association between
participation in gardening and symptoms of depression, anxiety, and stress among
family caregivers of people with dementia in rural Uganda, which has not been
previously explored. The researchers aim to contribute to the understanding of the
benefits of gardening on mental health among caregivers in low- and middle-income
countries.
Aim: The aim of the study is to estimate the association between participation in
gardening and symptoms of depression, anxiety, and stress among family caregivers of
people with dementia in rural, southwestern Uganda. The purpose of the paper is to
investigate the potential benefits of gardening interventions in this population and how
it may ameliorate symptoms of depression, anxiety, and stress. The variables examined
are participation in gardening and symptoms of depression, anxiety, and stress.

Research question and/or hypothesis:

This study investigates the association between participation in gardening and symptoms of
depression, anxiety, and stress among caregivers of people living with dementia in rural,
southwestern Uganda. The study interviewed 242 family caregivers of people with dementia to
elicit their gardening activities; symptoms of depression, anxiety, and stress (Depression
Anxiety Stress Scales); and caregiving burden (Zarit Burden Interview). Linear multivariable
regression models estimated the association between participation in gardening and symptoms
of depression, anxiety, and stress. The results suggest that caregivers of people with dementia
who participate in gardening have lower symptoms of depression, anxiety, and stress. The
study highlights the potential benefits of gardening interventions in this at-risk population,
which may ameliorate symptoms of depression, anxiety, and stress. The study also highlights
the challenges for mental health systems in low and middle-income countries (LAMICs), where
mental health systems are poorly funded, and caregiving responsibilities for people with
dementia are borne primarily by family members.

Sample:
The final sample size is 242 participants.
The characteristics of the participants are as follows: they are family caregivers of people
with dementia living in rural southwestern Uganda. There is no mention of the genders
or ethnic groups of the participants. The age range of the participants is not specified
either. The inclusion criteria for the study were that participants had to be family
caregivers of people with dementia, and they had to be willing to participate in the
study. There are no special conditions mentioned that the participants should have had.
The selection criteria for the study is not explicitly mentioned, but the participants are
family caregivers of people with dementia who live in the study area and are willing to
participate in the study. Therefore, the selection method could be considered
convenient sampling.

Instrument(s):
The researcher used three instruments to measure the variables in the study. These are:
Depression Anxiety Stress Scales (DASS): This instrument was used to measure
symptoms of depression, anxiety, and stress among the caregivers. It is a self-report
questionnaire that consists of 42 items, with 14 items for each subscale. The responses
are provided on a 4-point Likert scale ranging from 0 (did not apply to me at all) to 3
(applied to me very much or most of the time). The total score for each subscale ranges
from 0 to 42, with higher scores indicating higher levels of depression, anxiety, or stress.
Zarit Burden Interview (ZBI): This instrument was used to measure caregiving burden
among the caregivers. It is a self-report questionnaire that consists of 22 items, and the
responses are provided on a 5-point Likert scale ranging from 0 (never) to 4 (nearly
always). The total score ranges from 0 to 88, with higher scores indicating higher levels
of burden.
Gardening activities questionnaire: This instrument was used to elicit information about
the participation of caregivers in gardening activities. It is a self-report questionnaire
that consists of 8 items, and the responses are provided on a 5-point Likert scale
ranging from 1 (strongly disagree) to 5 (strongly agree). The questionnaire was
developed by the researchers for this study.
Procedure:
The type of procedure used in the study is cross-sectional, as the researcher measured
the gardening activities, symptoms of depression, anxiety, and stress, and caregiving
burden among family caregivers of people with dementia at a single point in time.
The researcher recruited 242 family caregivers of people with dementia in rural,
southwestern Uganda. The participants were then divided into two groups based on
their involvement in gardening activities: those who were involved in gardening (n=131)
and those who were not (n=111).
The researcher used instruments such as the Depression Anxiety Stress Scales (DASS)
and the Zarit Burden Interview (ZBI) to measure the symptoms of depression, anxiety,
and stress, as well as caregiving burden among the participants.
The intervention in the study was gardening, and the researcher did not administer any
medications to the participants. The researcher implemented the gardening intervention
by interviewing the participants to elicit their gardening activities. The researcher did not
provide any standardized gardening interventions; instead, they measured the
participants' involvement in gardening activities, such as planting, watering, and
harvesting.
The researcher did not specify the duration of the sessions or what happened during
them, as the study was cross-sectional and did not involve any standardized gardening
interventions.
In summary, the procedure used in the study involved recruiting family caregivers of
people with dementia in rural Uganda, dividing them into two groups based on their
involvement in gardening activities, using instruments such as the DASS and ZBI to
measure the symptoms of depression, anxiety, and stress, and caregiving burden among
the participants, and estimating the association between participation in gardening and
symptoms of depression, anxiety, and stress using linear multivariable regression
models.

Results:
The study examined the association between gardening activities and mental health
outcomes (depression and anxiety) among family caregivers of patients with chronic
illnesses in Uganda. The research question is whether there is an association between
gardening activities and mental health outcomes among family caregivers of patients
with chronic illnesses in Uganda.
The results showed that 54% of participants participated in gardening activities. Those
who engaged in gardening activities were more likely to be men, have higher
educational attainment, and care for patients with less functional impairment. After
adjusting for covariates, the study found that gardening was significantly associated
with lower depression scores (β = −3.87, p = 0.010) and lower anxiety scores (β = −2.54,
p = 0.046).
The study had a hypothesis that gardening activities would be associated with better
mental health outcomes. The hypothesis was supported as the study found a significant
association between gardening and lower depression and anxiety scores. The p-values
were 0.010 and 0.046 for depression and anxiety, respectively, indicating that the results
are statistically significant.
The study findings were partially accepted since the study focused only on the
association between gardening and mental health outcomes, without exploring causality
or underlying mechanisms. Additionally, the study did not explore the long-term effects
of gardening on mental health outcomes. Nonetheless, the study provides evidence that
gardening activities may have a positive impact on the mental health of family
caregivers of patients with chronic illnesses in Uganda.

Practical implications:
The researchers suggest that gardening interventions may help alleviate symptoms of
depression, anxiety, and stress in caregivers of people with dementia. This is especially
important in low- and middle-income countries (LAMICs) where mental health systems
are poorly funded, and caregiving responsibilities for people with dementia are borne
primarily by family members. The study highlights the potential benefits of gardening
activities for mental health practitioners, researchers, and policy-makers in LAMICs who
may not be aware of these benefits. Therefore, gardening interventions can be used as
part of standard mental health treatment packages for people with psychiatric problems
in these settings.

Evaluation (weaknesses & strengths):

Strengths:
The study provides evidence of the association between gardening and lower symptoms
of depression, anxiety, and stress among caregivers of people with dementia.
The study contributes to the literature on the potential benefits of gardening and
horticulture for mental health.
Weaknesses:
The study is limited by its cross-sectional design, which precludes the establishment of
causal relationships between gardening and mental health outcomes.
The study does not address the mechanisms through which gardening may improve
mental health outcomes among caregivers.
Account for response: The strengths of the study lie in its contribution to the literature
on the potential benefits of gardening for mental health, particularly among caregivers
of people with dementia. The study provides evidence that may be useful in the
development of interventions to improve mental health outcomes among this
population. However, the study's cross-sectional design is a weakness, as it precludes
the establishment of causal relationships between gardening and mental health
outcomes. Additionally, the study does not address the mechanisms through which
gardening may improve mental health outcomes among caregivers, which is a
limitation. Understanding these mechanisms may provide insights into the development
of more effective interventions.