Right Choice Fresh
Start Farmers’
Market Pilot Study
USC CPCRN Pilot Project
Orangeburg County, SC
• Population (2010): 95,501
o 62.2% Black, 34.3% White
o Median household income (2009):
o Persons below poverty (2009): 24.5%
o 67,326 in City of Orangeburg
• Home to 3 colleges (Claflin,
SC State, OrangeburgCalhoun Technical
o Congressman James E. Clyburn
attended SC State University
• Civil Rights history – site of
Orangeburg Massacre.
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 context
o Intervention goals and procedures developed in collaboration with community
• Flexibility of intervention to achieve multiple goals
• Theory-based: Food access influenced by multiple
dimensions (Freedman, Blake, & Liese, under review)
Service Delivery
• Data-driven: Informed by farmers’ market model
developed with Boys and Girls Clubs and extant
research on farmers’ markets
(11/2010), N=50
of Agreement
Advisory Council
N=9, plus 2 ex
officio from FHC)
Market Season
22 weeks)
Screening in
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
4. Disseminate findings using diverse mediums.
Right Choice Fresh Start
Farmers’ Market
Intervention Components
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.
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.
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.
FM sells a wide variety of high quality produce, setting is clean and
organized, and customers are treated with respect.
Customers have knowledge, skills, and efficacy to purchase and
prepare produce procured at the farmers’ market through patientprovider communication and activities at FM
Evaluation Protocol
Project Goal
Data Collection
Increase access to healthy • Sales receipts from farmers’
foods and healthcare
markets (N= ~3,700) – teleform
among patients at Family • 2 customer satisfaction surveys
Health Centers, Inc.
• Survey 1, N=100
• Survey 2, N=110
• Customer observations (~55)
• Ethnographic field notes (~65)
Evaluation Protocol
Project Goal
Data Collection
Improve dietary
• 3 close-ended, face to face
behaviors and A1C levels
interviews with sample of
among adult patients at
randomly selected diabetic
FHC diagnosed with
patients from FHC (N=45)
• Repeated measure of F/V
• 98% retention rate
• Medical record review (2011)
for height, weight, and AIC
Evaluation Protocol
Project Goal
Increase demand for
fruits and vegetables
grown by farmers in
Orangeburg and the
adjacent counties.
Data Collection
• Sales receipts from farmers’
markets (N= ~3,700)
• ~22,000 units of food sold
• ~$15,000 revenue
• ~18% of sales paid with food
• Inventory Assessments
• Focus groups and interviews
with farmers
• Farmer satisfaction surveys
Evaluation Protocol
Project Goal
Disseminate findings
using diverse mediums.
Data Collection
• Pre- and post-documentary
assessments at community
screenings (N=68)
• Pre- and post-documentary
assessments with mailing
distributions (N already 400+)
Scientific Outputs:
Accepted Presentations
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.
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.
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.
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.
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.
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.
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 approach
6. Economic opportunity for small-scale rural farmers
vending at a health center-based farmers’ market
7. Dissemination of health innovations through
documentary film
• Planting Healthy Roots Screenings
o October 13, 2011, Trinity United Methodist Church, Orangeburg, SC
o October 18, 2011, South Carolina State University, Orangeburg, SC
o January 28, 2012, Nickelodeon Theater, Columbia, SC
• Documentary Distribution (free)
o Mailings: December 2011-March 2012
o Available online: by April 2012
o Request free DVD at http://www.surveymonkey.com/s/QRKMGW2
• 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
• Addition of interactive cooking classes
• Enhance patient-provider communication about
health benefits of market/foods from market
o RCFS prescription v. FHC prescription
• More training for farmers to use sales data for
planning and economic growth
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.