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 %

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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

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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

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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,

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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

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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.

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