Right Choice Fresh Start Farmers’ Market Pilot Study

USC CPCRN Pilot Project

Location: Orangeburg County,

SC• Population (2010): 95,501

o 62.2% Black, 34.3% Whiteo Median household income (2009):

$33,567o Persons below poverty (2009):

24.5%o 67,326 in City of Orangeburg

• Home to 3 colleges (Claflin, SC State, Orangeburg-Calhoun Technical College).o Congressman James E. Clyburn

attended SC State University

• Civil Rights history – site of Orangeburg Massacre.

Location: Orangeburg County,

SC• County Health Ranking

(1=healthiest): 41 of 46

• Overweight or Obese: 75%

• Diabetes: 13%

• 4th highest county incidence of prostate cancer in SC

Site Selection• Community Readiness Assessment (June-October 2010)• Indictors of readiness for starting an environmental intervention

focused on improving access to healthy foods at a federally qualified health center (Freedman et al., 2011)

Site: Family Health Centers, Inc. (FHC)

• Umbrella organization that operates 7 FQHCs in rural SC. o Largest site in Orangeburg

• Serves >22,000 patients &employs > 160 persons. • Strong, community development, civil rights-focused

Executive Director (retired 12/2010).• Connections and involvement with local schools and

universities, hospitals, churches, and city government. • ≥50% FHC Board members are from target community.• Ability to address logistical factors (e.g., space, electricity,

phone, bathrooms, maintenance assistance).• Vision for farmers’ market integrated with mission of FHC

o Medical Director had a goal of reducing A1C levels after market season

Implementation Framework

• Community-based participatory research (CBPR)o Importance of contexto Intervention goals and procedures developed in collaboration with community

partner• Flexibility of intervention to achieve multiple goals

• Theory-based: Food access influenced by multiple dimensions (Freedman, Blake, & Liese, under review)o Economico Service Deliveryo Spatialo Socialo Temporalo Personal

• Data-driven: Informed by farmers’ market model developed with Boys and Girls Clubs and extant research on farmers’ markets

Timeline

Memorandum of Agreement (10/2010)

Community Visioning Meeting (11/2010), N=50

Advisory Council (2/2011-ongoing), N=9, plus 2 ex officio from FHC)

Market Season (6/2011-10/2011, 22 weeks)

Documentary Screening in Community (10/2011)

Right Choice Fresh Start Farmers’ Market

Project Goals

1. Increase access to healthy foods and healthcare among patients at Family Health Centers, Inc.

2. Improve dietary behaviors and A1C levels among adult patients at FHC diagnosed with diabetes.

3. Increase demand for fruits and vegetables grown by farmers in Orangeburg and the adjacent counties.

4. Disseminate findings using diverse mediums.

Right Choice Fresh Start Farmers’ Market

Domain Intervention Components

Spatial-temporal

FM is conveniently located in a space that is accessible to participants. It is easy to get to for people traveling by car, bus, and foot.

Economic FM sells foods at fair market prices, accepts food subsidies (e.g., food stamps, farmers’ market vouchers), and provides financial assistance to select group of patient-customers.

Social FM developed collaboratively with regular feedback from key stakeholders (consumers and farmers). FM is tailored to the needs and interests of the target population (i.e., patients of FHC). FM is a communal space that is welcoming to all.

Service Delivery

FM sells a wide variety of high quality produce, setting is clean and organized, and customers are treated with respect.

Personal Customers have knowledge, skills, and efficacy to purchase and prepare produce procured at the farmers’ market through patient-provider communication and activities at FM

Evaluation ProtocolProject Goal Data Collection

Increase access to healthy foods and healthcare among patients at Family Health Centers, Inc.

• Sales receipts from farmers’ markets (N= ~3,700) – teleform

• 2 customer satisfaction surveys • Survey 1, N=100• Survey 2, N=110

• Customer observations (~55)

• Ethnographic field notes (~65)

Evaluation ProtocolProject Goal Data CollectionImprove dietary behaviors and A1C levels among adult patients at FHC diagnosed with diabetes.

• 3 close-ended, face to face interviews with sample of randomly selected diabetic patients from FHC (N=45)• Repeated measure of F/V

intake• 98% retention rate

• Medical record review (2011) for height, weight, and AIC measures

Evaluation ProtocolProject Goal Data CollectionIncrease demand for fruits and vegetables grown by farmers in Orangeburg and the adjacent counties.

• Sales receipts from farmers’ markets (N= ~3,700)• ~22,000 units of food

sold• ~$15,000 revenue• ~18% of sales paid with

food subsidy• Inventory Assessments• Focus groups and

interviews with farmers• Farmer satisfaction surveys

Evaluation ProtocolProject Goal Data CollectionDisseminate findings using diverse mediums.

• Pre- and post-documentary assessments at community screenings (N=68)

• Pre- and post-documentary assessments with mailing distributions (N already 400+)

Scientific Outputs: Accepted

Presentations1. Freedman, D.A., Whiteside, Y.O., Brandt, H.; Young, V.; Friedman, D.; & Hebert, J.R. (2011,

April). Measuring readiness for establishing farmers’ markets at federally qualified health centers in South Carolina. Poster presentation at the James E. Clyburn Health Disparities Lecture Series, Columbia, SC.

2. Freedman, D.A. (2011, June). Innovative approaches for engaging communities in research. Symposium organized by Dr. Freedman for the Society for community Research and Action Conference, Chicago, IL.

3. Freedman, D.A. & Whiteside, O. (2011, June). A visioning process for generating research questions. Oral presentation at the Society for community Research and Action Conference, Chicago, IL.

4. Freedman, D.A., Young, V.M., Brandt, H.M., Armstrong, P., Cobbs, E., Friedman, D.B., & Hebert, J.R. (2011, August). Assessing readiness for establishing a farmers’ market at community health centers. Poster presentation at the National Association of Community Health Centers annual conference, San Diego, CA.

5. Freedman, D.A., Whiteside, Y.O., Young, V.M., Brandt, H.M., Willms, L., Hatala, J., Friedman, D.B., & Hebert, J.R. (2011, October). Pharmacies to farm stands: Assessing readiness for establishing a farmers’ market at a federally qualified health center. Power presentation at the 139th Annual American Public Health Association Conference, Washington, DC.

6. Brandt, H. & Freedman, D.A. (2011, December). Planting Healthy Roots: A look at the Right Choice Fresh Start Farmers’ Market. Invited colloquium at the University of South Carolina Science and Health Communication Research Group, Columbia, SC.

7. Kugler, K., Freedman, D.A., Butler, P., Friedman, D., & Hebert, J. (2012, April). Farmers’ markets: Promoting health by connecting community members in underserved environments. Poster presentation at the 33rd Annual Meeting and Scientific Sessions of the Society of Behavioral Medicine Conference, New Orleans, LA.

Scientific Outputs: Accepted Publications• Freedman, D.A., Whiteside, Y.O., Brandt, H.M.,

Young, V., Friedman, D.B., & Hebert, J.R. (2011). Assessing readiness for establishing a farmers' market at a community health center. Journal of Community Health. DOI: 10.1007/s10900-011-9419-x

Scientific Outputs: Papers in Progress

1. Influence of FM on F/V consumption and AIC levels among diabetics

2. Influence of patient-provider communication on usage of health center-based farmers’ market

3. Actors and social interactions at a health center-based farmers’ market

4. Sales trends and satisfaction among customers and farmers at health center-based farmers’ market

5. Multi-level, multicomponent evaluation approach6. Economic opportunity for small-scale rural farmers

vending at a health center-based farmers’ market7. Dissemination of health innovations through

documentary film

Community Dissemination

• Planting Healthy Roots Screeningso October 13, 2011, Trinity United Methodist Church, Orangeburg, SCo October 18, 2011, South Carolina State University, Orangeburg, SCo January 28, 2012, Nickelodeon Theater, Columbia, SC

• Documentary Distribution (free)o Mailings: December 2011-March 2012o Available online: by April 2012o Request free DVD at http://www.surveymonkey.com/s/QRKMGW2

Grants• University of South Carolina, Science and Health

Communication Research Group Grant (awarded March 2011) – funded documentary project

• U.S. Department of Agriculture, Community Food Project (developed but not submitted, November 2011)

• South Carolina Cancer Alliance (due January 2011)

• South Carolina Department of Agriculture, Community Transformation Grant Sub-contraction, $5M/year for 5 years with demonstrated effect (potential opportunity for evaluating SNAP usage at farmers’ markets)

Opportunities for Growth and Collaboration

• Expansion to more sites to test model

• More targeted marketing to reach low-income consumers

• Addition of interactive cooking classes

• Enhance patient-provider communication about health benefits of market/foods from marketo RCFS prescription v. FHC prescription

• More training for farmers to use sales data for planning and economic growth

Acknowledgements• Funders:

o This RCFS pilot study was supported by the South Carolina Cancer Prevention and Control Research Network funded under Cooperative Agreement Number 3U48DP001936-01W1 from the Centers for Disease Control and Prevention and the National Cancer Institute.

o Planting Healthy Roots documentary was supported by the USC Science and Health Communication Research Group.

• Partners: Family Health Centers, Inc., South Carolina Primary Health Care Association, RCFS Advisory Council

• Research Collaborators: James Hebert, Daniela Friedman, Heather Brandt, Madeline Broderick, Lyn McCracken, Tom Hurley.

• Research Assistants: Kassy Kugler, Lucy Willms, Natalia Carvalho, Shanna Hastie, Jason Greene, Paul Butler, Peter Georgantopoulos.

• Service Learning Volunteers: 22 students and community members.

Questions