identifying emergent social networks at a federally qualified health center-based farmers’ market
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ORIGINAL ARTICLE
Identifying Emergent Social Networks at a Federally QualifiedHealth Center-Based Farmers’ Market
Kassandra A. Alia • Darcy A. Freedman •
Heather M. Brandt • Teri Browne
� Society for Community Research and Action 2013
Abstract Identifying potential mechanisms connecting
farmers’ market interventions with health, economic, and
community outcomes could inform strategies for address-
ing health disparities. The present study used social net-
work theory to guide the in-depth examination of naturally
occurring social interactions at a farmers’ market located at
a federally qualified health center located in a rural, low-
income community. Trained observers recorded 61 obser-
vation logs at the market over 18 weeks. Thematic analysis
revealed a range of actors and nonhuman facilitators
instrumental to the farmers’ market context. These actors
connected with one another for communication and rela-
tionship development, economic and financial exchange,
education, resource sharing, community ownership of the
farmers’ market, and conflict resolution. These interactions
provided opportunities for social networks to develop among
attendees, which may have facilitated the acquisition of
social supports related to improved health, economic and
community outcomes. Results provide insight into the role
social networks may play in mediating the relationship
between a farmers’ market intervention and individual
benefits. Findings also contribute to defining the typology of
social networks, which may further disentangle the complex
relationships between social networks and health outcomes.
Future research should identify strategies for purposefully
targeting social networks as a way to reduce diet-related
health disparities.
Keywords Farmers’ market � Social network theory �Health disparities � Food access � Minority
Introduction
There is growing interest among policy makers, practitioners,
and researchers to develop food environment interventions to
address obesity-related health disparities (Birch et al. 2011;
Prevention Institute 2008). Farmers’ markets have been rec-
ognized as a strategy for curtailing obesity trends and dis-
parities via increased access to fresh, high quality foods
(Centers for Disease Control and Prevention 2010). They also
have the potential to address other contextual factors asso-
ciated with health disparities by providing opportunities for
economic and community development (Alonso and O’Neill
2011; Brown and Miller 2008). An added benefit of farmers’
markets is that they tend to be easy to implement and less
costly as compared to other food systems approaches, such as
grocery stores (Centers for Disease Control and Prevention
2010). Given these factors, it is unsurprising that farmers’
markets have grown in popularity. National statistics indicate
that the number of farmers’ markets has increased by 150 %
since 2000, with a total of 7,864 registered in 2011 (United
K. A. Alia (&)
Department of Psychology, University of South Carolina,
Columbia, SC 29208, USA
e-mail: kuglerk@email.sc.edu
D. A. Freedman
Department of Epidemiology and Biostatistics, Case Western
Reserve University, Cleveland, OH, USA
D. A. Freedman � H. M. Brandt
Statewide Cancer Prevention and Control Program, University of
South Carolina, Columbia, SC, USA
H. M. Brandt
Department of Health Promotion, Education, and Behavior,
University of South Carolina, Columbia, SC, USA
T. Browne
College of Social Work, University of South Carolina,
Columbia, SC, USA
123
Am J Community Psychol
DOI 10.1007/s10464-013-9616-0
States Department of Agriculture 2012). While these statis-
tics are encouraging, it is important to note that little is known
about the potential of these interventions in low-resource
communities. The present study seeks to build on past
research by conducting an in-depth examination of naturally
occurring social interactions within the context of a farmers’
market intervention located in a low income, rural commu-
nity (Freedman et al. 2013b; Friedman et al. 2013). This
research has the potential to illuminate the mechanisms
through which farmers’ market interventions may lead to
improved health, economic and community benefits, and as a
result enhance the effectiveness of future intervention efforts.
Social network theory provides a useful framework for
understanding the processes underlying farmers’ market
interventions. Social network theory posits that social
problems are best understood by examining the patterns or
regularities in relationships, known as social networks, that
exist among people in a social space (Neal 2012; Quatman
and Chelladurai 2008; Wasserman 1994). The individuals
within a network are called ‘‘actors’’. The relationships
among actors within a network, called ‘‘ties’’, are channels
for the transfer of resources which then provide opportu-
nities for or constrain individual behaviors. Important to
social networks are both their topology (structure of ties)
and their typology (function of linkages between the ties)
(Wenger 1991). Regardless of the structure or function of a
social network, a theme consistent throughout social net-
work theory is that social relationships are a driving force
behind behavior change.
Social network theory may be helpful to explain how
environmental interventions, including farmers’ markets,
work to produce changes in behavior. Hawe et al. (2009)
described interventions as events that are introduced into
systems, such as families, schools and communities. These
events (i.e. interventions) may interact with and alter the
social networks that exist in that context. Specifically,
interventions may provide settings or opportunities for
interaction, and it is those interactions which then produce
individual benefits. It is possible that farmers’ market
interventions provide a space for the development of social
networks, but that it is then the social networks which
facilitate the acquisition of resources related to positive
health, economic, and social outcomes. Although farmers’
markets are not often designed to target change in social
networks, the importance of social interactions at farmers’
markets has been frequently noted. Farmers’ markets have
been described as social spaces where diverse groups come
together to express a wide range of beliefs through action
(Smithers et al. 2008). Farmers’ markets support sponta-
neous interaction among disparate groups who may have
limited interaction in other settings (Morales 2011), thus
providing opportunities for strengthening weak ties among
actors in a network. These connections may increase social
capital among populations with limited access to healthy
foods (Walker et al. 2007). Furthermore, farmers’ markets
can provide opportunities for reconnecting consumers with
their food system via direct interactions with food pro-
ducers (Dowler et al. 2009). As a result, social networks
may be a mediating pathway connecting farmers’ markets
with change in health, social, and economic factors.
Although past research suggests the importance of social
interactions within farmers’ markets, more research is
needed to examine the generalizability of these findings in
low income, rural settings with limited access to healthy
food. Opportunities for social interaction have been cited as
a key motivation for attending farmers’ markets among
consumers (Feagan and Morris 2009; Payet et al. 2005;
Smithers et al. 2008), including in low income, urban
communities (Ruelas et al. 2012). Other studies have
expanded on this research by describing specific interac-
tions taking place within farmers’ markets (Alkon 2008;
Alonso and O’Neill 2011; Baber and Frongillo 2003;
Gagne 2011; Gerbasi 2006). However, much of this
research has focused on ethnographic evaluation of farm-
ers’ markets located in high-income communities. While
prior research provides useful insight into potential inter-
actions within markets, relatively little research has
explored interactions taking place at markets in rural
(Alonso and O’Neill 2011) or low-income (Alkon 2008)
communities. Research conducted in low-resource settings
seems to suggest that social interactions and their impor-
tance may differ depending on market context (Alkon
2008). Accordingly, more research is needed to understand
the generalizability of these findings in rural communities
with limited access to healthy foods and where health
disparities may be more prevalent.
The purpose of this study was to build on past research
by providing a rich description of social networks naturally
occurring within a farmers’ market located at a federally
qualified health center (FQHC) in a rural, low-income
community. Direct observation of people operating within
the farmers’ market context illuminated actors and forms of
interaction occurring there, which may be useful for
understanding the potential of farmers’ market interven-
tions in low income environments. This research could
identify potential mechanisms linking farmers’ markets to
health outcomes, and as a result could then be used to
enhance the effectiveness of such interventions.
Methods
Context
The study took place at a FQHC in a predominantly low-
income (23 % below the poverty level), minority (63 %
Am J Community Psychol
123
African American) rural county in South Carolina (United
States Census Bureau 2010a). The county has a ranking of
41 out of 46 (worst) in the state of South Carolina for
overall health status (Robert Wood Johnson Foundation
2013). In the target county, 41 % of the residents are obese
(BMI C 30) and 34 % are overweight (BMI 25.0–29.9)
compared to 36 and 30 %, respectively, for the state overall
(United States Census Bureau 2010b). The FQHC that is
the focus of this study is one of the largest in the state
providing comprehensive health care to over 25,000
patients; 75 % of the patients are African American and
71 % of the patients have incomes 100 % or below the
federal poverty level (Freedman et al. 2012). Most of the
patients at the FQHC are uninsured (30 %) or have Med-
icaid (30 %). This site was selected for the intervention
because it had high patient volume and a large staff (i.e.,
potential shopping base) and because of its proximity to a
large subsidized apartment complex, businesses, schools,
shopping, medical centers, and a bus stop. Further details
regarding the context and details of the intervention have
been published previously (Freedman et al. 2012, 2013b;
Friedman et al. 2013).
Intervention
The Right Choice, Fresh Start (RCFS) Farmers’ Market,
was a community-based participatory research study test-
ing the feasibility of implementing a farmers’ market
intervention at a FQHC (Freedman et al. 2012). The study
was part of the South Carolina Cancer Prevention and
Control Research Network funded by the Centers for
Disease Control and Prevention and the National Cancer
Institute and was approved by the University of South
Carolina Institutional Review Board.
The RCFS market is a multi-vendor, produce-only
farmers’ market that has operated in the FQHC parking lot
on 1 day per week for 5 months per year since 2011; the
focus of this analysis is on the market’s first year. The
market was organized through a community-university
partnership and is managed by a local community member
serving as the farmers’ market manager with guidance
from a Community Advisory Council. On average, five
small-scale rural farmers vend at the RCFS. A total of 13
vendors participated in the market during the pilot season.
The farmers were predominantly African American (69 %)
and male (92 %). Farmers were from eight cities/townships
in rural South Carolina, with the majority of the farmers
from the city that was the focus of this study. The Com-
munity Advisory Council coordinated two events during
2011: a grand opening and a celebration in honor of
National Farmers’ Market Week. Details on the events and
the development of the RCFS market have been previously
published (Freedman and Alia 2013).
The market is authorized to accept Supplemental
Nutrition Assistance Program (SNAP) and most vendors at
the market are authorized to accept Women, Infants, and
Children Program (WIC) and Senior and WIC Farmers’
Market Nutrition Program (FMNP) vouchers. In addition,
the market had two alternative financial supports that have
been described in more detail elsewhere (Freedman et al.
2013b; Friedman et al. 2013): a co-pay voucher program,
where physicians could write prescriptions to the farmers’
market, and a financial incentive program, where diabetic,
adult patients enrolled received financial incentives to shop
at the farmers’ market. During the pilot season, over 3,700
sales transactions were conducted and farmers made over
$15,000 in revenue, with 18 % of sales paid using federal
food assistance.
Data Collection
Purpose
The purpose of the data collection was to document social
network interactions naturally occurring at the farmers’
market. Though a primary interest of the observations was
to examine interactions that could potentially be related to
food access, naturally occurring interactions were also of
interest for furthering understanding of other economic-
and community-related outcomes. This ethnographic
observational study emerged through a reflection process
conducted by the RCFS research team (principal investi-
gator, four graduate research assistants, and the market
manager). During the project development phase, the
RCFS research team and the Community Advisory Council
jointly developed an evaluation plan for the farmers’
market (Freedman and Alia 2013). The evaluation plan,
which integrated both outcome and process evaluations,
was guided by prior research suggesting that food access is
a multidimensional concept related to spatiotemporal,
economic, social contextual, service delivery, and personal
factors (Freedman et al. 2013a). In order to evaluate the
social context of the intervention, we selected a modified
version of a systematic observational tool developed by
Baber and Frongillo 2003; to our knowledge, this tool is the
only systematic observation tool available for observing
social interactions within a farmers’ market setting. This
tool enabled us to assess market attendees in terms of their
age (adult, child), shopping patterns (shopping along,
shopping in a group), gender (male, female), and race
(black, white, other); results from this assessment are not
reported in the current manuscript. However, through
weekly reflection meetings with the RCFS research team
we began to realize that the richness of the social inter-
actions taking place within the market was not being cap-
tured. It was our view that an open, ethnographic approach
Am J Community Psychol
123
would provide insight into the range and depth of social
network interactions occurring within the market space and
that collecting such data could enhance our understanding
of facilitators and barriers of food access as well as broader
community outcomes.
Research Assistant Training
A total of 22 research assistants assisted with data collec-
tion. Research assistants included undergraduate and
graduate students, RCFS Community Advisory Council
members, and community volunteers. Research assistants
received a didactic training prior to data collection that
included an overview of the farmers’ market study and
evaluation plan. This training typically occurred off-site
and took approximately 1-h to complete. On the day of data
collection, new research assistants were introduced to the
farmers, the market manager, and other market staff. They
were also provided a brief tour of the market facilities.
Approximately 30-min prior to the market opening, the
market research team met to discuss the evaluation plans
for the day, including the market observations. Research
assistants were asked to pay attention to any interactions
that they felt were positive or negative for each of the
following categories: between consumers, between farm-
ers, and between farmers and consumers. Research assis-
tants were instructed to be inclusive of all interactions
observed and were asked to take note of as much detail as
possible.
Procedures
On a given market day, research assistants were either
paired with a farmer to assist with sales and sales tracking
or were placed at the information booth to assist with
questions and EBT sales. In this way, research assistants
were able to serve as participants embedded within the
setting. This form of evaluation is in line with an ethno-
graphic research approach in which researchers are inte-
grated within the settings they are studying (Morse and
Richards 2002). Throughout the market day, research
assistants were asked to take note of positive and negative
interactions occurring between attendees. Research assis-
tants may have observed different interactions within the
setting depending on their role and location in the market.
For example, assistants working with farmers may have
observed more interactions related to sales transactions as
compared to those working at the information booth. Fur-
thermore, research assistants paired with farmers who were
working next to each other may have had the opportunity to
observe similar interactions whereas research assistants
located at opposite ends of the market may have observed
unique interactions. Variability in the role and location of
research assistants provided a range of observations
throughout the market space. The number of market days
attended by each research assistant may have also influ-
enced the interactions observed. Research assistants
attended a range of 1–18 markets (M = 3.69 ± 3.73). It is
possible that as the number of markets attended increased,
research assistants were more attuned to the interactions
occurring within. For example, they may have been able to
distinguish between new and returning customers. Fur-
thermore, customers and farmers at the market may have
grown more comfortable with research assistants overtime
and thus may have interacted more naturally or directly
with the observers. Such phases and stages of data col-
lection are generally characteristic of ethnographic
research and allow for richness in the description of pat-
terns observed within a setting (Morse and Richards 2002).
After each market day, an observation recording form
was sent electronically to the research assistants to sys-
tematically record observation notes. This form included
six prompts pertaining to positive and negative interactions
observed between: consumer–consumer, farmer–farmer,
and consumer-farmer. For example, one prompt read:
‘‘Please note any positive farmer–farmer interactions seen
at the market. Examples include friendly conversations
between farmers, purchasing one another’s produce, etc.’’
Observations were recorded for 18 weeks with multiple
observations recorded on each date by different observers
for a total of 61 observations and an average of 3.8 ± 1.7
notes submitted per market. Observations were conducted
during the entire market day (4 h); data were collected over
a total of 72 h in the field.
Data Analysis
Data were analyzed using an iterative process in which
three independent reviewers (authors KA, DF, HB) used an
inductive approach to code the observations. We had dif-
ferent roles with the farmers’ market including principal
investigator (DF), graduate research assistant (KA), and
project co-investigator (HB). Both the principal investiga-
tor and graduate research assistant attended the market on a
regular basis (i.e., 3–4 markets per month); the co-inves-
tigator was familiar with the market but attended less fre-
quently (i.e., \1 market per month). First, observations
were reviewed using an open-coding process. Reviewers
met to discuss emergent themes related to the variety of
actors present and forms of social interaction observed at
the farmers’ market. An interaction was defined as an
exchange between two or more actors. An ‘‘actor’’ was
defined as any person(s) involved in a given interaction.
Non-human facilitators were also considered if they were
active in the observed interaction (Clarke 2005; Hawe et al.
2009). For example, weather was identified as a non-human
Am J Community Psychol
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facilitator given that interactions between actors occurred
as a result of the weather conditions. Next, two reviewers
used a preliminary codebook to re-analyze the data and
further refine and finalize the coding structure. Finally, two
reviewers coded the entire dataset using the finalized
codebook using a consensus model of coding where any
areas of disagreement were debated and clarified until
consensus was achieved (Harry et al. 2005). An outside
reviewer (author TB) who was not involved in the farmers’
market project assisted with the interpretation of findings in
order to minimize potential bias. Data were entered into
Dedoose qualitative software to assist with data manage-
ment (Dedoose 2012).
Results
Findings revealed a range of human actors and non-human
facilitators were involved in diverse social network inter-
actions that naturally occurred at the market. Results are
organized using these emergent themes. It should be noted
that quotes including personal identifiers (i.e., specific
names) were revised to retain anonymity.
Actors and Non-Human Facilitators
A range of human actors and non-human facilitators were
involved in diverse interactions at the market. Human
actors included three broad categories: (1) farmers, (2)
customers, and (3) research/market staff. Both vending and
non-vending farmers were considered. A vending farmer
was any farmer who had a booth at the market and was
selling produce on a given market date. A non-vending
farmer was a farmer who was either not an official market
vendor or someone who had completed a vendor agreement
but was not selling produce on a given day. For example,
one observer stated that ‘‘Farmers have friends who are
farmers who will come and hang out with them and sell
under the vendor.’’ Customers included health center staff
(e.g., providers and administrative staff), patients at the
health center, children, families, couples, members of the
local Boys and Girls Club, community members, friends,
and participants involved in the financial incentive program
(described previously). A distinction was also made for
regular customers versus first timers or infrequent users; for
instance, one observer noted that ‘‘the farmers gave deals
to return customers’’. However, there was not a precise
metric of market usage that classified a customer as a
regular. Research and market staff included research
assistants, the market manager, and the principal investi-
gator. Interactions observed included various combinations
of strong and weak ties between human actors. For
example, interactions involving strong social ties included
families, friends, or couples shopping together. Alterna-
tively, examples of weak social ties included interactions
between farmers and Boys and Girls club children and
public housing residents with market staff.
Non-human facilitators were inanimate objects that
facilitated an interaction; without these actors, the inter-
action may not have occurred. Three dimensions observed
included: (1) specified food, (2) forms of payment, and (3)
weather. Food included specified items, such as boiled
peanuts, watermelons, and coffee. Common forms of
payment were food subsidies (i.e., EBT/SNAP, WIC/WIC
FMNP vouchers, and Senior FMNP vouchers) and cash.
Other forms of payment included various financial incen-
tives. For example, RCFS program vouchers, including the
RCFS financial incentive program vouchers and the co-pay
prescription vouchers, were discussed as non-human
facilitators. Other financial incentives included vouchers
that were designed by community groups. Specifically, a
local Boys and Girls Club designed a set of vouchers for
their youth; these vouchers were unrelated to the RCFS
research study in that they were developed by community
leaders without intervention by the research team. Weather,
including cold, hot and rainy weather, also emerged as non-
human facilitators. As an illustration, interactions were
observed where health center staff brought coffee to
farmers and research staff on a cold market day. Non-
human objects were considered facilitators in the interac-
tion if the interaction would not have taken place had the
object not been present. For example, food provided the
opportunity for friends and farmers to socialize at the
market as one observer noted in the following interaction:
‘‘One farmer was boiling peanuts and all of the consumers
seemed to make their way to that area. Many of the con-
sumers were standing around this area laughing and chat-
ting it up!’’
Forms of Social Interactions
Communication/Relationship Development
Interactions related to communication and relationship
development were those that had the goal of developing or
enhancing relationships.
Examples of camaraderie and fellowship were fre-
quently observed at the market. Camaraderie included
shared experiences (e.g., inviting someone over for dinner,
discussing time spent together), sharing food to eat, jokes,
sharing space, and general friendliness. Overall, these
interactions promoted a positive market climate, which
may be important for increasing social support for positive
health behaviors as well as for promoting sense of com-
munity. As one observer noted, ‘‘The market seems like a
pleasant small village. Patients, community members,
Am J Community Psychol
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[health center] staff, etc. stop by to shop and inevitably see
someone they know and end up chatting. It is not uncom-
mon to hear comments like, ‘How are your parents,
grandparents, children… how are you doing… how’s
work…’’’ Interactions observed also included the devel-
opment of new relationships. Early in the market season,
farmers were seen positively interacting with others as
noted by this observer, ‘‘Farmers were all very cordial to
one another. They all walked around and looked at each
other’s produce and were very positive when talking to
each other.’’ Over time, these relationships seemed to
develop a deeper level of connection. For example,
‘‘Almost all of the farmers purchased food from each other.
They are also much more talkative to each other now as
compared to the beginning of the summer.’’ The develop-
ment of stronger relationships and trust was also observed
in other interactions. In particular, one observer recorded
that, ‘‘One customer left her newborn at a booth while she
went to get money.’’
Interactions related to communication about shopping,
such as what produce to purchase and how much, were also
observed. For example, ‘‘I watched a mother teaching her
child how to shop and pick produce.’’ Furthermore, con-
sumers, including health center staff, frequently shopped
together and jointly decided what to purchase.
Economic and Financial Exchange
Opportunities for economic exchange were common at the
market. These interactions were either directly or indirectly
related to economic benefit for farmers or consumers.
Interactions involving an economic exchange had the
potential to benefit customers by decreasing financial barri-
ers to purchasing healthy foods. One common form was deal
making, defined as any transaction in which the farmer dis-
tributed produce for less than the original price. Deal making
often occurred among customers experiencing financial
hardship. Farmers often gave deals to customers who were
using federal food assistance, RCFS study vouchers (finan-
cial incentive program or co-pay prescription voucher) or
other vouchers, including vouchers designed by community
stakeholders. In one example, a pair of farmers reduced the
price of their watermelons from $3.00 to $2.00 when, ‘‘the
Boys and Girls Club children started shopping and realized
that their vouchers were only worth $3, [Farmers] decided to
lower the price of their watermelons to $2 so that the kids
could get something else somewhere.’’ Other times, farmers
would tell customers that they were getting a deal just
because they (the consumer) ‘‘look[ed] like a nice person’’.
Bartering could have a similar benefit for customers. In one
example, ‘‘An older couple was able to exchange or barter
their blueberries for a variety of produce.’’ Farmers also gave
away free food; they did this for various reasons including
replacing damaged or bad quality produce, to encourage
customers to try produce, or to support customers for
financial reasons. For example, ‘‘Some consumers were also
given a deal if they did not have the money to purchase. One
consumer was given free muscatines, due to not having
money to purchase them.’’
Economic exchanges were also important for increasing
economic growth opportunities for farmers. For example,
the direct interaction between farmers and consumers
helped farmers sell larger quantities of food for a reduced
price. One observer noted that a farmer ‘‘sold an entire pot
of boiled peanuts for less than the calculated price’’
because a customer was interested in purchasing a larger
volume of peanuts rather than small individual bags. Deals
were also made at the end of the market day, which enabled
farmers to sell more of their produce before the market
closed. Observers also recorded interactions related to the
support of farmer sales, including advertising and helping
to manage a farmers’ booth. Interactions related to adver-
tising included any farmer or non-vending farmer adver-
tising the produce of another farmer. In one example, two
farmers helped ‘‘to promote boiled peanuts for [Farmer]
until he sold out. They would send anyone who mentioned
peanuts over to his stand.’’ Also, farmers would sometimes
help manage another farmers’ booth either by selling under
the farmer during days when they were not vending at their
own booth or helping to sell a farmer’s produce. One
observer recorded that, ‘‘The farmer that I worked with was
selling another farmer’s produce in order to help him get
rid of his product.’’ Overall, these exchanges had the
potential to increase farmers’ capacity to continue to sell
fresh fruits and vegetables to consumers. The support from
other farmers in advertising and managing booths could
also improve overall service delivery, which could increase
farmers sales and economic growth.
Educational Exchanges
Interactions were also observed related to opportunities for
educational exchange. These interactions had the intention
of educating another individual around farming, gardening,
cooking/handling produce or produce varietals.
These exchanges could have the potential for improving
dietary behaviors via increased knowledge. For example,
educational exchanges around cooking and handling pro-
duce could increase personal knowledge and efficacy
around fruit and vegetable consumption. As one observer
noted, ‘‘[Farmer] described to several people what the
‘chow chow’ [a Southern version of salsa] was, how it was
made, and how it could be used.’’ These interactions also
highlighted the provision of support and encouragement for
trying produce, as noted in this example, ‘‘One woman
convinced another shopper, who claimed she didn’t like
Am J Community Psychol
123
okra, to try cooking the vegetable in a different way to alter
its texture.’’
Educational exchanges could have educational benefits
for children as well. As one observer stated, ‘‘[Farmer] cut
two watermelons in half to show the differences between
seeded and seedless watermelons. He then walked around
the market to describe the difference to customers. Kids
from across the street came to check out the watermelons.’’
Additionally, interactions had the potential to increase
individual’s ability to grow their own fruits and vegetables.
This was common among farmers. Farmers were observed
sharing farming tips and suggestions (e.g., pesticide use,
irrigation systems); preparedness for market involvement;
and sharing farming educational resources. For example,
one observer noted that two farmers ‘‘discussed all natural
methods to keep bugs away from their plants.’’ Farmers
also educated customers on the gardening/farming process,
including ‘‘how to plant heirloom tomatoes’’.
Resource Sharing
Resource sharing exchanges were defined as interactions
that had the goal of exchanging goods, information, or
services. Exchanges observed included sharing supplies,
providing job access (e.g., serving as a reference for a job
application), information sharing, increasing access to
professional networks, labor, and giving money to another
person.
The provision of instrumental and informational social
support was one example of resource sharing. As one
observer commented, ‘‘A farmer helped an elderly woman
bring purchased vegetables to her car.’’ In another exam-
ple, customers were seen sharing money: ‘‘I saw one
consumer give a dollar to another consumer in order to buy
an item since they did not have enough cash.’’ These
interactions may have provided resource for improving
health behaviors as well as for building sense of commu-
nity. Information shared among farmers may have provided
opportunities for economic development. It was noted that
one farmer invited others to join a professional network of
local growers. In another example, one farmer had the
opportunity to speak with a South Carolina Department of
Agriculture representative about ‘‘Senior and WIC voucher
certification.’’ Both of these interactions could increase a
farmer’s capacity to continue to sell quality, affordable
produce to consumers. Sharing of supplies, including kni-
ves and tents, among farmers could also improve service
delivery at the market.
Community Ownership
Examples of community ownership illuminated community
stake in operating and sustaining the farmers’ market.
These interactions could be particularly important for
supporting the market as a stable aspect of the community.
Observers recorded that customers would invite others to
join the market; this included both inviting a friend to come
(e.g., calling a friend and asking them to meet at the
market) as well as returning to the market with a friend.
Customers also became involved in marketing; as one
observer noted, ‘‘A consumer gave recommendations about
how to better market the market to the low-income apart-
ment complex behind the market area.’’ Other examples of
community ownership include assisting with the market
(e.g., helping to set up the market or running the market)
and donating money or supplies.
Actors also participated in market activities, such as
watching a ceremony taking place at the market or actively
participating in activities. In particular, one observer noted
that ‘‘Customers got involved in [market event]. They
joined in on the dancing, and I noted groups of friends
sitting together while waiting on the door prizes. There
were laughs between friends around who was going to win
the prizes, and some people even held the tickets for those
who could not be there.’’
Farmers also supported the market through produce
sales. Specifically, interactions were identified where
farmers would sell produce in the absence of another
farmer, which helped sustain the market by way of ensur-
ing that produce, especially highly requested produce, were
available weekly. One observation noted how a farmer sold
peanuts, a highly requested produce item, in light of the
absence of another farmer: ‘‘[Farmer 1] volunteered to
provide boiled peanuts, in the absence of [Farmer 2]. He
sold out of boiled peanuts.’’
Conflict Resolution
As is typical with most community-participatory projects,
there were interactions observed in which conflict occur-
red. Conflicts observed included issues with payment or
financial exchange, produce quality, market policies, and
general conflict.
Importantly, structures in place at the market often lead
to resolution of conflict. The role of the market manager
was particularly critical to conflict resolution. For example,
one observer recorded that, ‘‘A community customer
arrived around 3:00, highly disappointed that market was
cleared. The Market Manager and remaining vendor
informed customer Market is open every Friday 10:00 to
2:00 until October.’’
Opportunities between consumers and farmers also
provided opportunities for resolving conflict. If a consumer
was displeased with the quality of produce, a farmer would
often replace the produce or compensate the customer as
noted in this example, ‘‘One customer complained that the
Am J Community Psychol
123
watermelon she ‘purchased last week wasn’t that good’.
[Farmer] replaced her watermelon free of charge with no
hesitation.’’ Another example displays how farmers
resolved conflict around payment, ‘‘One consumer tried to
get a larger amount of sweet potatoes for a smaller price,
and although she was sort of ripping off the farmer, and the
farmer knew it, he was still very friendly and let her go
ahead and place the order.’’
Discussion
The present qualitative analysis explored social interactions
taking place within a health center-based farmers’ market
located in a low-income, predominantly minority, rural
community. Findings revealed the emergence of various
social network interactions among a diverse group of human
actors and non-human facilitators to those interactions.
Forms of social interaction included camaraderie and rela-
tionship building; education; resource sharing; economic
and financial exchange; community ownership; and conflict
resolution. These interactions provided opportunities for
social networks to develop among attendees, which may
have facilitated the acquisition of resources related to health,
economic and community outcomes. Results provided
insight into the role social networks may play in mediating
the relationship between a farmers’ market environmental
intervention and improved health and community outcomes.
This study also offered an in-depth analysis of the typologies
of relationships naturally occurring within the farmers’
market space, which may inform understanding of the role of
social networks in reducing health disparities as well as
social network theory more broadly. Findings may have
important implications for intervention and policy changes
related to health disparities.
An important contribution of this study was our in-depth
examination of naturally occurring social networks that
formed in a farmers’ market located in a low income, rural
community. A range of interactions involving diverse
human actors and non-human facilitators were observed at
the health center-based farmers’ market. These interactions
provided opportunities for resources, such as relationship
development, learning, and support. Several studies have
observed similar interactions, including fellowship, finan-
cial exchanges, and sharing of information, at farmers’
markets (Alkon 2008; Alonso and O’Neill 2011; Baber and
Frongillo 2003; Gagne 2011; Gerbasi 2006). However,
limited research has examined the interactions occurring
within rural farmers’ markets located in marginalized
communities. One study compared the social constructions
of two urban farmers’ markets, one located in an affluent,
predominantly white neighborhood and one in a low-
income, predominantly African American neighborhood
(Alkon 2008). Interestingly, Alkon (2008) observed vari-
ations in these social spaces. For instance, speeches/talks
related to the history of black farmers were observed in the
low-income community whereas the affluent market tended
to focus on things such as the promotion of organic pro-
duce (Alkon 2008). Based on insights from our study along
with past research, it seems that social interactions are
salient across farmers’ markets, but the type or function of
interactions may vary by context. For example, financial
exchanges, such as bartering and marketing, seem to be
common across farmers’ markets (Alonso and O’Neill
2011; Hinrichs 2000). Alternatively, few studies, if any,
have observed deals being made for consumers using
federal food subsidies. These findings suggest that farmers’
markets may be flexible interventions that have the
potential to adapt to the needs and cultural norms of the
contexts in which they are embedded. This could be par-
ticularly important in low-resource contexts. Future
research is needed to compare social interactions embed-
ded in different contexts to enhance understanding of the
generalizability of findings.
Findings from this study shed light onto the potential
role of social networks in mediating the connection
between farmers’ market interventions and changes in
improved health and broader economic and community
outcomes. The growing popularity of farmers’ markets
presents an exciting opportunity to address health dispari-
ties in the United States (Centers for Disease Control and
Prevention 2010; United States Department of Agriculture
2012). Emerging evidence suggests that farmers’ markets
are associated with positive outcomes such as increased
food access and intake of fruits and vegetables (Freedman
et al. 2013b; Herman et al. 2006). However, the mecha-
nisms through which farmers’ market interventions influ-
ence food access and fruit and vegetable intake are unclear
(Oakes et al. 2009). Hawe et al. (2009) proposed that
interventions are events within complex systems; that is,
interventions should be viewed from a dynamic systems
perspective that explores how interventions couple with
context to influence the social networks embedded within
that setting. In line with these perspectives, findings from
this study suggest that the climate provided at the farmers’
market created a space for the development or enhance-
ment of various social networks related to fellowship,
education, financial opportunity, and community owner-
ship. A small but growing body of evidence suggests that
such social interactions are linked with food access (Smith
and Morton 2009; Wicks et al. 2006) and fruit and vege-
table intake (Kirk and Cade 2002; Krølner et al. 2011).
Thus, it is possible that the farmers’ market intervention
may have increased food access and improved diet via the
development of social networks, though these associations
were not directly tested.
Am J Community Psychol
123
This study adds to mounting evidence that social factors
are critical for understanding obesity-related health out-
comes and associated health behaviors, especially in low
income populations. Recent national priorities have
encouraged researchers to examine how social contextual
factors influence obesity-related health disparities (Com-
mission on Social Determinants of Health 2008). These
priorities emerge out of recognition that inequities are
embedded in the places people live, work and play impact
health (Commission to Build a Healthier America 2009).
Social environmental factors have been identified as
important intervention targets given that they are generally
amenable to change and are associated with a range of
health behaviors tied to obesity (Kumanyika et al. 2008).
Growing evidence from other areas of health disparities
research suggests that social relationships are directly
linked with obesity-related health behaviors, including
physical activity (McNeill et al. 2006; Whitt-Glover et al.
2013). The present study builds on this past research by
documenting the social networks in one potential setting
for reducing health disparities, farmers’ markets, and sug-
gests that these social networks may play a role in
improving health outcomes.
Exploration of the interactions occurring within the
market space also contributes to social network theory
more broadly. The analysis conducted in this study
expanded on past research by describing the typologies of
the networks within the setting, whereas previous research
has tended to focus on the topography of the networks with
less emphasis on the nature of interactions occurring
between actors in the network. Previous research has
demonstrated that social networks influence health out-
comes, including obesity (e.g., Christakis and Fowler 2007)
and physical activity (Graham et al. 2012). This research
indicates that social networks, such as those among friends
and family, are important for impacting health outcomes.
However, it does not explain what it was about the social
networks that influenced risk for obesity. It is likely that it
is not only that the actors are connected within a network
that influences outcomes, but rather that the nature of that
connection, or typology, is also critical to understand.
Examining the nature of interactions within a social net-
work could provide guidance for understanding the com-
plex relationship between social networks and individual
benefits. Such research could aid in the identification of
intervention strategies for addressing health disparities.
Future research is needed to enhance our ability to measure
network changes and typologies.
Our findings offer important intervention and policy
implications. Specifically, results provide further insight
into farmers’ markets as effective strategies for addressing
factors related to obesity in a low-income setting with
limited nutritious food access and high rates of diet-related
health disparities. A challenging yet exciting next step in
this area of research is to identify strategies for purpose-
fully targeting social networks to reduce health disparities
without making such relationships artificial. It is possible
that placing picnic tables at the market may foster social
network development by encouraging attendees to sit and
interact with one another. Alternatively, peer-led mutual
support groups are more structured approaches for culti-
vating social networks to provide tangible and emotional
support for health promotion (e.g., Dennis et al. 2002;
Vinson et al. 1996). Recently, peer-led mutual support
groups called ‘‘HOPE Circles’’ were formed among women
in North Carolina to provide health education, job skills,
and microenterprise opportunities and resulted in
improvements in fruit and vegetable intake, physical
activity, and weight loss among participants (Benedict
et al. 2007). Data from the health center-based farmers’
market study and the HOPE Circles study provide support
for interventions that both provide opportunities for infor-
mal opportunities for social interactions and more targeted
approached to promote social network formation to
improve food access.
As with any study, there are strengths and limitations.
Strengths included the timely focus on farmers’ markets as
a strategy to increase food access among marginalized
populations. The examination of social relationships was
also timely, given recent attention on the importance of the
social environment in influencing health outcomes (Com-
mission on Social Determinants of Health 2008; Saelens
et al. 2012). The observation method is both a strength and
limitation. It offered an open-ended approach to document
social interactions based on the perspectives of 22
observers, which provided opportunities for triangulating
data (i.e., multiple observers on 1 day noted the same
interactions). Some interactions, however, were undoubt-
edly missed in this process because observers were often
playing multiple roles in the market space and were unable
to be present to observe every interaction. Furthermore,
interactions could have been observed more than once by
multiple reviewers; thus, we were not able to report how
common interactions were across observations nor could
we calculate reliability of ratings. Additionally, the time
lag between the observed event and data entry, which
occurred during the evening after the market day, may have
resulted in some interactions going unrecorded. It is also
possible that the open-ended approach may have resulted in
potential biases in the data collected. Factors related to
involvement in the market, such as frequency and famil-
iarity with the market setting, personal demographic fac-
tors, and location in the market setting may have influenced
results. It is possible that biases may have contributed to
the majority positive interactions documented. However, it
is worthwhile to note that these results are consistent with
Am J Community Psychol
123
past research which has described farmers’ markets as
generally positive spaces (Ruelas et al. 2012). Finally,
observations were limited to one setting. Thus, the gener-
alizability of findings may be limited. Future research is
needed to examine these research questions in other food
environment contexts.
Conclusion
In summary, the present qualitative analysis explored
social interactions taking place within a health center-based
farmers’ market located in a low-income, predominantly
minority, rural community. Results revealed the emergence
of various interactions, including camaraderie and rela-
tionship building; education; resource sharing; economic
and financial exchange; community ownership; and con-
flict resolution, among a diverse group of actors. Findings
expanded on limited research examining farmers’ markets
in low income, rural settings and suggest that the social
networks existing in the market space may facilitate the
procurement of resources needed for overcoming health
disparities. Additionally, results provided insight into the
mediating role of social networks on linking a farmers’
market environmental intervention to improved health,
economic and community outcomes. This study adds to a
growing evidence base demonstrating the importance of
social networks in facilitating positive health behaviors.
Future social network analysis should assess the typology,
as well as topology, of networks to more fully understand
the role of social networks in improving health. Further-
more, interventions should identify strategies for purpose-
fully targeting social networks as a way to further access to
healthy and affordable foods. Such research may facilitate
reductions in diet-related health disparities among mar-
ginalized populations.
Acknowledgments This manuscript was supported by the South
Carolina Cancer Prevention and Control Research Network under
Cooperative Agreement Number 3U48DP001936-01W1 from the
Centers for Disease Control and Prevention and National Cancer
Institute. The findings and conclusions in this manuscript are those of
the authors and do not necessarily represent the official positive of the
Centers for Disease Control and Prevention or National Cancer Insti-
tute. We are thankful for our partners at Family Health Centers, Inc.
References
Alkon, A. (2008). Paradise or pavement: The social constructions of
the environment in two urban farmers’ markets and their
implications for environmental justice and sustainability. Local
Environment, 13(3), 271–289.
Alonso, A. D., & O’Neill, M. A. (2011). Investing in the social fabric of
rural and urban communities: A comparative study of two Alabama
farmers’ markets. Community Development, 42(3), 392–409.
Baber, L. M., & Frongillo, E. A. (2003). Family and seller
interactions in farmers’ markets in upstate New York. American
Journal of Alternative Agriculture, 18(02), 87–94.
Benedict, S., Campbell, M., Doolen, A., Rivera, I., Negussie, T., &
Turner-McGrievy, G. (2007). Seeds of HOPE: A model for
addressing social and economic determinants of health in a
women’s obesity prevention project in two rural communities.
Journal of Womens Health (Larchmt), 16(8), 1117–1124. doi:10.
1089/jwh.2007.CDC9.
Birch, L., Parker, L., & Burns, A. (2011). Early childhood obesity
prevention policies. Washington, DC: Institute of Medicine.
Brown, C., & Miller, S. (2008). The impacts of local markets: A
review of research on farmers markets and community supported
agriculture. American Journal of Agricultural Economics, 90(5),
1296–1302.
Centers for Disease Control and Prevention. (2010). The CDC guide
to fruit and vegetable strategies to increase access. Atlanta, GA:
Availability and Consumption.
Christakis, N., & Fowler, J. (2007). The spread of obesity in a large
social network over 32 years. The New England Journal of
Medicine, 357(4), 370–379.
Clarke, A. E. (2005). Situational analysis: Grounded theory after the
postmodern turn. Thousand Oaks, CA: Sage.
Commission on Social Determinants of Health. (2008). Closing the
gap in a generation: Health equity through action on the social
determinants of health, Final Report of the Commission on
Social Determinants of Health. In W. H. Organization (Ed.).
Geneva.
Commission to Build a Healthier America. (2009). Beyond health
care: New directions to a healthier America. Princeton, NJ:
Robert Wood Johnson Foundation.
Dedoose Version 4. (2012). Web application for managing, analyz-
ing, and presenting qualitative and mixed method research data.
Los Angeles, CA: SocioCultural Research Consultants, LLC.
www.dedoose.com.
Dennis, C. L., Hodnett, E., Gallop, R., & Chalmers, B. (2002). The
effect of peer support on breast-feeding duration among
primiparous women: A randomized controlled trial. Canadian
Medical Association Journal, 166(1), 21–28.
Dowler, E., Kneafsey, M., Cox, R., & Holloway, L. (2009). ‘Doing
food differently’: Reconnecting biological and social relation-
ships through care for food. The Sociological Review, 57(S2),
200–221.
Feagan, R. B., & Morris, D. (2009). Consumer quest for embedded-
ness: A case study of the Brantford farmers’ market. Interna-
tional Journal of Consumer Studies, 33(3), 235–243.
Freedman, D. A., & Alia, K. A. (2013). Building farmacies: A guide
for implementing a farmers’ market at a community health
center. Columbia, SC: University of South Carolina.
Freedman, D. A., Blake, C., & Liese, A. (2013a). Developing a
multicomponent model of nutritious food access and related
implications for community and policy practice. Journal of
Community Practice, 21, 379–409.
Freedman, D. A., Choi, S. K., Hurley, T., Anadu, E., & Hebert, J. R.
(2013b). A farmers’ market at a federally qualified health center
improves fruit and vegetable intake among low-income diabet-
ics. Preventive Medicine, 56(5), 288–292.
Freedman, D. A., Whiteside, Y. O., Brandt, H. M., Young, V.,
Friedman, D. B., & Hebert, J. R. (2012). Assessing readiness for
establishing a farmers’ market at a community health center.
Journal of Community Health, 37(1), 80–88.
Friedman, D. B., Freedman, D. A., Choi, S. K., Anadu, E., Brandt, H.
M., Carvalho, N., et al. (2013). Provider communication and role
modeling related to patients’ perceptions and use of a federally
qualified health center-based farmers’ market. Journal of Health
Promotion Practice. doi:10.1177/1524839913500050.
Am J Community Psychol
123
Gagne, N. O. (2011). Eating local in a US city: Reconstructing
‘‘community’’—a third place—in a global neoliberal economy.
American Ethnologist, 38(2), 281–293.
Gerbasi, G. T. (2006). Athens farmers’ market: Evolving dynamics
and hidden benefits to a southeast Ohio rural community. Focus
on Geography, 49(2), 1–6.
Graham, D. J., Bauer, K. W., Friend, S., Barr-Anderson, D. J., &
Nuemark-Sztainer, D. (2012). Personal, behavioral, and socio-
environmental correlates of physical activity among adolescent
girls: Cross-sectional and longitudinal associations. Journal of
Physical Activity and Health (Epub ahead of print).
Harry, B., Sturges, K. M., & Klingner, J. K. (2005). Mapping the
process: An exemplar of process and challenge in grounded
theory analysis. Educational Researcher, 34(2), 3–13.
Hawe, P., Shiell, A., & Riley, T. (2009). Theorising interventions as
events in systems. American Journal of Community Psychology,
43(3–4), 267–276.
Herman, D. R., Harrison, G. G., & Jenks, E. (2006). Choices made by
low-income women provided with an economic supplement for
fresh fruit and vegetable purchase. Journal of the American
Dietetic Association, 106(5), 740–744.
Hinrichs, C. C. (2000). Embeddedness and local food systems: Notes
on two types of direct agricultural market. Journal of Rural
Studies, 16(3), 295–303.
Kirk, S. F. L., & Cade, J. E. (2002). Factors affecting food choice in
relation to fruit and vegetable intake: A review. [Article].
Nutrition Research Reviews, 15(2), 373–387.
Krølner, R., Rasmussen, M., Brug, J., Klepp, K., Wind, M., & Due, P.
(2011). Determinants of fruit and vegetable consumption among
children and adolescents: A review of the literature. Part II:
Qualitative studies. The International Journal of Behavioral
Nutrition and Physical Activity, 8, 112.
Kumanyika, S. K., Obarzanek, E., Stettler, N., Bell, R., Field, A. E.,
Fortmann, S., et al. (2008). Population-based prevention of
obesity: The need for comprehensive promotion of healthful
eating, physical activity, and energy balance: A scientific
statement from American Heart Association Council on Epide-
miology and Prevention, Interdisciplinary Committee for Pre-
vention (formerly the expert panel on population and prevention
science). Circulation, 118(4), 428–464.
McNeill, L. H., Kreuter, M. W., & Subramanian, S. V. (2006). Social
environment and physical activity: A review of concepts and
evidence. Social Science and Medicine, 63(4), 1011–1022.
Morales, A. (2011). Marketplaces: Prospects for social, economic,
and political Development. Journal of Planning Literature,
26(1), 3–17.
Morse, J. M., & Richards, L. (2002). Readme first for a user’s guide
to qualitative methods. Thousand Oaks, CA: Sage Publications.
Neal, Z. (2012). The connected city: How networks are shaping the
modern metropolis. New York: Routledge.
Oakes, J. M., Masse, L. C., & Messer, L. C. (2009). Work group III:
Methodologic issues in research on the food and physical
activity environments: Addressing data complexity. American
Journal of Preventive Medicine, 36(4 Suppl), S177–S181.
Payet, J., Gilles, M., & Howat, P. (2005). Gascoyne Growers Market:
A sustainable health promotion activity developed in partnership
with the community. Australian Journal of Rural Health, 13(5),
309–314.
Prevention Institute. (2008). Promising strategies for creating healthy
eating and active living environments. Oakland, CA: Healthy
Eating Active Living Convergence Partnership.
Quatman, C., & Chelladurai, P. (2008). Social network theory and
analysis: A complementary lens for inquiry. Journal of Sport
Management, 22(3), 338–360.
Robert Wood Johnson Foundation. (2013). County health rankings.
Retrieved September 10, 2013, from http://www.countyheal
thrankings.org/.
Ruelas, V., Iverson, E., Kiekel, P., & Peters, A. (2012). The role offarmers’ markets in two low income, urban communities.
Journal of Community Health, 37(3), 554–562.
Saelens, B. E., Sallis, J. F., Frank, L. D., Couch, S. C., & Zhou, C.
(2012). Obesogenic neighborhood environments, child and
parent obesity: The Neighborhood Impact on Kids study.
American Journal of Preventive Medicine, 42(5), e57–e64.
Smith, C., & Morton, L. W. (2009). Rural food deserts: Low-income
perspectives on food access in Minnesota and Iowa. Journal of
Nutrition Education and Behavior, 41(3), 176–187.
Smithers, J. J., Joseph, A. E., & Lamarche, J. J. (2008). Unpacking the
terms of engagement with local food at the farmers’ market:
Insights from Ontario. Journal of Rural Studies, 24(3), 337–350.
United States Census Bureau. (2010a). Decennial census. Washington,
DC: U.S. Census Bureau.
United States Census Bureau. (2010b). State and county quickfacts
2010. Washington, DC: U.S. Census Bureau.
United States Department of Agriculture. (2012). Farmers’ Market
Growth: 1994–012. Washington, DC. Retrieved from http://www.
ams.usda.gov/AMSv1.0/ams.fetchTemplateData.do?template=Tem
plateS&leftNav=WholesaleandFarmersMarkets&page=WFMFar
mersMarketGrowth&description=Farmers%20Market%20Growth
&acct=frmrdirmkt.
Vinson, T., Baldry, E., & Hargreaves, J. (1996). Neighbourhoods,
networks and child abuse. British Journal of Social Work, 26(4),
523–543.
Walker, J. L., Holben, D. H., Kropf, M. L., Holcomb, J. P, Jr, &
Anderson, H. (2007). Household food insecurity is inversely
associated with social capital and health in females from special
supplemental nutrition program for women, infants, and children
households in Appalachian Ohio. Journal of the American
Dietetic Association, 107(11), 1989–1993.
Wasserman, S. (1994). Social network analysis: Methods and
applications (Vol. 8). Cambridge: Cambridge university press.
Wenger, G. C. (1991). A network typology: From theory to practice.
Journal of Aging Studies, 5(2), 147–162.
Whitt-Glover, M. C., Bennett, G., & Sallis, J. F. (2013). Introduction
to the active living research supplement: Disparities in environ-
ments and policies that support active living. Annals of
Behavioral Medicine, 45(Suppl 1), S1–S5.
Wicks, R., Trevena, L. J., & Quine, S. (2006). Experiences of food
insecurity among urban soup kitchen consumers: Insights for
improving nutrition and well-being. Journal of the American
Dietetic Association, 106(6), 921–924.
Am J Community Psychol
123
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