Update on Project Activities
This last week marked the beginning of the end of our project activities as we began to draft plans for our presentation and final deliverables. We decided on a handbook format for the final product that we will hand to Priscilla. Our aim here is to provide her with a comprehensive document that outlines our recommendations (based on our methods and findings) for each component of farmers market establishment. Our recommendations will be accompanied by explicit steps that Priscilla and her team can follow as they move forward. The open office hours session on Monday was spent mapping out the sections of this handbook and allocating work to group members. The picture to the left shows our brainstorming.
In conversation with Priscilla on Wednesday, we revisited our original deliverables as they were presented in our scope of work. We wanted her to know how our scope of work had changed over time, and we wanted to make sure we were including everything she hoped to have in the end. As a result of this conversation, it was decided that we needed to do a bit of price surveying in local markets and grocery stores to provide Priscilla with a few produce price points (say that three times fast). Just today, Pete visited Foods Co., Chavez, and Sigona’s, some of the most frequently referenced grocery stores among our survey respondents, to collect price data.
Another major task leading into these last couple of weeks has been entering and analyzing our survey data. We ended survey collection with 98 surveys – 69 patients and 24 staff (5 missing clinic affiliation information).
What We’ve Learned
Our survey data hasn’t necessarily shown us anything surprising, but it has provided us with concrete numbers to help answer some of our questions. In terms of interest levels, 100% of staff who took our survey and 83% of patients who took our survey expressed interest in having a farmers market at FOHC. 95% of survey respondents said they would shop at a farmers market before or after a scheduled appointment. 82% said they would shop at a farmers market even if they didn’t have a schedule appointment, which was a promising result for us – we expected fewer people to be interested in coming to the clinic only for the purpose of visiting a farmers market. 26% of survey respondents knew that they are WIC eligible, and 21% knew that they are CalFresh eligible. The top five most desired fruits and vegetables (which were used for our price checks at grocery stores) were apples, oranges, carrots, onions, and spinach.
A snapshot of survey data
Another major learning point this week: this type of community planning takes time. Lots of it. It would be great if, at the end of Week 10, we could have a stand opening up at FOHC to sell produce to the passing patients. Realistically, this moment may be a year or two away. The work we’re putting in now is valuable in its own right, however, and must be done to help Priscilla carry out her farmers market vision in a credible and appropriate way.
The survey data also showed that 74% of survey respondents are satisfied with the produce from the stores at which they currently shop. This begs the question: even if clinic staff and patients express interest in having a farmers market at the clinic, do they really have a need for one that would motivate use and support of the market? This question, along with compiling our results and recommendations, has forced us to look back and reexamine our initial purpose and Priscilla’s initial purpose. North Fair Oaks, in many ways, is not really a food desert. But, according to Priscilla, the population they’ve seen at the clinic has been suffering from increasing rates of nutrion-related disease such as diabetes and overweight/obesity. Consequently, perhaps the biggest role a FOHC farmers market could play is not one of increasing food access or making produce more affordable but is one of tying food choice and eating into the patients’ healthcare and wellness. It is from this perspective that we will frame our final presentation, drawing from FOHC’s vision of total wellness.
Focus Groups at FOHC
This week we conducted two focus groups at Fair Oaks Health Center (FOHC). These hour-long sessions aimed at soliciting the views of clinic staff and patients of a potential FOHC farmers market. We spoke with 14 staff members who hold a variety of roles at the clinic. Six patients, including two young boys, braved the pouring rain to join us for the second session the following day.
We structured the focus groups to flesh out the patient and staff responses recorded in our ever-increasing cache of surveys. The conversations covered participants’ produce consumption habits, their visions for a FOHC farmers market, and the times and days when they’d be most likely to attend such a market.
Most participants expressed enthusiasm for the idea of a farmers market. Patient participants stressed the health benefits from eating more fresh fruits and vegetables. They suggested that the weekend would be the most convenient time since they work during the day. Staff liked the idea of having a farmers market just outside their front door and noted that a farmers market would be a natural extension of FOHC’s community health mission. Both groups said that fresh produce is often expensive, and so affordability would be an important factor in whether they shopped at the market. The picture below is from the staff focus group.
Creating Space for Creativity
Leading focus groups is hard. Even though all of the participants in our sessions attended because they are interested in our project, it’s still difficult to craft non-leading questions that encourage people to think both creatively and practically. We drew some inspiration from the examples of participatory planning that we’ve seen throughout the term. Most recently, we attended a presentation by James Rojas, founder of Place It! (http://www.placeit.org/). Mr. Rojas provides participants with a random assortment of inexpensive items – foam blocks, monopoly money, plastic Elmo figurines, cloth leaves, construction paper – and asks them to design livable urban environments. The very motley-ness of the objects frees participants to set aside any expectation that their creation might look “right” and instead focus on the act of creating.
We asked participants to draw their ideal FOHC farmers market on a blank sheet of paper. The results, one of which is shown below, fueled some great discussion.
We also provided staff participants with a map of FOHC that we had designed. We asked staff to locate their ideal market on the map. This exercise generated some helpful feedback, but it suffered from a severe problem: the maps weren’t accurate. The farmers market is unlikely to start until the old clinic that currently squats on the northern half of the FOHC parcel is demolished. The maps that we handed out included the old clinic and so didn’t help staff imagine what the space would look like once the old clinic comes down. We opted not to use the maps in the patient group.
“Lo que comes, lo que eres”
It was particularly exciting to participate in the patient focus group, which Sophie conducted entirely in Spanish. These folks made an extra effort to come out and share their thoughts with us. One participant even offered to help us create posters to help advertise the market to the community. Patients cared because their health and the health of their families matters deeply to them. As one participant noted, “Lo que comes, lo que eres” (You are what you eat.). Our interactions with patients and staff have confirmed that there is a demand for fresh, affordable produce in North Fair Oaks. Our next step is to translate the data that we’ve gathered into a form that enables FOHC to decide on the most effective way to meet that demand.
Update of Project Activities
Last Friday afternoon, I (Natalie) had the chance to meet with a different stakeholder in our project: Preet Kaur, a sophomore here at Stanford and an intern of Priscilla’s at FOHC, has officially joined the farmers market team. Priscilla’s idea for the farmers market project was one of the things that originally attracted Preet to the FOHC internship, and she has been eager to get involved. In my meeting with her, we mostly discussed logistics of the project, but I made a point of extending the conversation to overall goals and purposes. Preet’s main point of involvement for the time being is survey distribution. With strong Spanish skills and a set schedule for being at the clinic, Preet has already proven to be a huge help in growing our sample size. Just today she collected 30 responses and seemed to enjoy herself while doing it. She texted me from the clinic:
After this quarter, I’m sure Preet will play a big role in carrying the farmers market project forward. Getting to work with her at this stage is very important in terms of establishing some continuity within our project.
Another major effort within this past week has been finalizing our plans for the two focus groups we are holding next week. Our staff focus group is going to be held on Tuesday during the lunch hour, and our patient focus group will be on Wednesday evening from 5-6pm. We have already received 23 RSVPs from the staff and plan to break them up into two smaller groups to facilitate conversation. We have contact information from a few patient surveys that we can use to recruit for the patient focus group, but Priscilla is facilitating the majority of that recruitment.
Pete has recently conducted two more phone interviews with Collective Roots and the Ecology Center. The Ecology Center referred us to Phat Beets (haha), a food justice collective in Oakland, for additional support and information. Additionally, these conversations have led us to re-evaluate our initial concerns over market management. Previously, we were thinking that having FOHC staff manage the market would be infeasible, but we now feel that this idea deserves more attention.
Observations and Learnings
After collecting our first pilot round of 14 surveys, I (Natalie) sat down with them and went to work coming up with a useful way of coding the information and putting it into an Excel spreadsheet. With only 14 responses accounted for so far, it’s impossible to make any statements about trends, but there are hints of interesting things going on. For example, 12 out of 14 said they would shop at a market at FOHC, but these same people indicated that they are satisfied with the produce offered at their current grocery stores. So while people may not be opposed to the idea of a farmers market at FOHC, they may feel that it is not particularly necessary. In terms of what items they’d like to see at the market, fruits are favored over vegetables, and there is very little interest in eggs or milk. Nine out of the 14 indicated that they would shop at the market even if they didn’t have an appointment at the clinic that day. I found this to be encouraging – I imagine a future challenge to be getting people to come to the clinic for the sole purpose of purchasing food. We’re excited to log more survey data and see what we can find.
The presentations given by Dara and Eli in class on Wednesday were great supplements to the work and reflection that we’ve been putting into our project. Eli’s direct question to our group about how our farmers market would address food access issues in North Fair Oaks was particularly thought provoking. While it does seem like we are putting effort into the physical, economic, educational, and cultural components of food access, I wonder if we are doing this in a way that is specific enough to North Fair Oaks. I personally don’t feel as though I have a good handle on what the particular food access issues are or how the residents of North Fair Oaks perceive them. It seems like there are a lot of stores around, including corner stores and larger chains – so it is a price issue? A nutrition literacy issue? A lack of time? Hopefully as we move forward with our surveys and focus groups, we will be able to answer these questions more explicitly.
The healthy corner store initiative that Eli mentioned reminded me of the importance of not getting stuck in one track of thinking when other ideas are worth entertaining. While I stand behind the idea of having a farmers market at FOHC, there are many corner store and tiendas throughout North Fair Oaks. Maybe a similar corner store initiative could be applicable and effective here. It is easy to forget that there are other ways to achieve the same goals, and remembering this can be the key to making progress and implementing the most useful, appropriate strategies.
Natalie, Pete, and Sophie
Part 1: Update of Project Activities
This week, we took advantage of the extra time on Wednesday to return to the Fair Oaks Health Center and pilot our survey. Our biggest challenge of the week has been updating various drafts of the survey so that we capture all of the data that we want to review in order to assess consumer demand, while keeping the survey simple and easy to fill out. In addition, one challenge was translating the survey, while making sure the connotations of words that do not have direct translations (like farmers market) are correct. Before piloting the survey, I looked up online translations for “farmers market,” in addition to checking with multiple native Spanish speakers for how they would describe a “farmers market” in Spanish. I heard a lot of different responses (particularly because most replied with regional terms for outdoor markets, which do not necessarily just sell food or produce). We are still checking in with Priscilla to make sure we use the term she deems most appropriate, but in our pilot survey, we included the most commonly cited term from my Spanish speaking peers, and then explained the term with more context when we handed out the survey. Thus far, this has been effective at getting the message through, and we have updated a few minor aspects of the survey to make it clearer before we start our full roll-out of the survey.
In addition to the Fair Oaks Health Center visit and survey pilot, other focus areas for this week have included meeting with Patricia to learn more about incorporating GIS Business Analyst into our research of the demographics of the area, and reaching out to another Stanford volunteer who will be working at the Fair Oaks Health Center this quarter and continuing where we leave off on the farmers market project after this quarter. It sounds like she is also very busy this quarter, but we are hoping to include her (as well as possibly a few other student interns Priscilla has referred to) with our work collecting surveys at the Fair Oaks Health Center.
We are also continuing to work on scheduling focus groups with the Fair Oaks Health Center staff and patients, and sending flyers to Priscilla to publicize the focus groups. For the staff members who do not attend the focus group, we are including a link to an online version of our survey so they still have a chance to give us feedback.
We have also been working on learning more about the regulations and permits required for the farmers market. Our particular challenge is that we are not sure that the farmers market will be approved because the Fair Oaks Health Center already has limited parking (shown below), and we may not be allowed to further limit the parking spaces by blocking off spaces for a parking lot.
Our most important next step is to meet with Priscilla to discuss alternatives to this regulations challenge, and to further discuss plans for market management. We will also continue to coordinate focus groups, put to use what we learned about GIS this past week, and officially begin conducting the final version of our survey.
Part 2: What You Observed and Learned
The first time we visited the clinic, I remember being very impressed by the newness of the building, the quality of the equipment, and the excitement of the staff to be working in this new, integrated facility. After touring the Y2E2 building this past week in class, my visit to the Fair Oaks Health Center this week prompted me to reflect more on the building design in addition to the quality of equipment. One main idea I took away from the Y2E2 tour was the fact that the building was designed to encourage the faculty to cross paths, share ideas, and see sustainability as an important component of their day-to-day lives, and it seemed like the building design really has inspired faculty and students to reflect more on environmentalism and other main ideas and goals of the departments housed within Y2E2. The Fair Oaks Health Center has a different goal – promoting total wellness in families of all ages – but this also seems to be reflected in the building design. To begin with, the Fair Oaks Health Center is a combination of three former clinics. Whereas pediatric services and adults services used to occur in entirely different locations, now both are integrated into the same Fair Oaks Health Center building, which I think makes it easier to reflect on improving healthy living for one’s whole family rather than solely concentrating on improving the health of one member of the family who may be feeling ill. In addition, the waiting rooms for each floor are connected by a central lobby/ check-in area, instead of divided into isolated waiting rooms for each service, so it is easier to see the different services provided at the clinic (pediatric, adult, dental, mental health, optometry, pharmacy, WIC services), which makes the comprehensive approach of this clinic toward total wellness more apparent. Outside the door is a mural with “health” in multiple different languages (shown in part below), and above the front desk is another sign about total wellness in several languages.
All of these components serve as reminders of the importance of healthy living, rather than just the importance of curing symptoms of individual diseases. After thinking about the role a building structure plays in the inner-workings of that building during our tour of Y2E2, I realized how well designed the Fair Oaks Health Center is to promoting total health. The only thing that I might have done differently in the Fair Oaks Health Center – after touring Y2E2 – would be to move the stairs into a more immediate and obvious location. I remember how the design of the staircase in Y2E2 made people in the building much more likely to take the stairs than the elevators. Right now in the Fair Oaks Health Center, there is a staircase, but it is a little harder to find (although there is a very small sign next to the door reminding us to take the stairs to improve total health). That being said, I understand that in a health center it is particularly important to have an elevator present for people with disabilities, the elderly, and families with kids in strollers.
This week, in addition to touring the building, we also got a chance to pilot the survey, which has given us important feedback on how to update the survey before next week, and allowed us to observe and think about the logistical challenges we will face as we continue to pass out surveys. Our biggest logistical challenge is just the fact that it takes a long time to fill out the surveys. When we visited the health center, we approached individuals in the waiting areas (only one or two people at a time), and then sat with them as they filled it out so that we could answer any questions. This made it possible to clarify anything that was confusing about the survey, have a short a conversation and get some anecdotal data, and re-collect the surveys when they were complete, but it also made the process rather slow. We left campus (on our bikes) around 12:40 and got back around 3:20, but in the entire time that we were at the health center, we only collected twelve surveys. Now that we have had a chance to pilot the survey and see which parts have been unclear, we will be able to update the survey to make it easier to fill out, which might mean that we will not have to sit with each patient as they fill it out, but certainly the timing of conducting surveys at the health center is a logistical challenge we need to work out.
One other important observation we made as we conducted surveys was the fact that when we approached individuals in the waiting room, we had no idea how long it would be until they were called in to their appointments. As a result, I had just explained the survey to three different people and asked if they would like to take it, when they got called into their appointments and consequently couldn’t fill out the survey. One woman had just begun her survey when she was called in and took it with her. We did not know how long her appointment would last so after completing surveys with the rest of the patients on that floor and still not seeing the woman return from her appointment, we ended up moving back down to the first floor. The woman who had taken her survey with her actually found us on the first floor on the way out and turned it in to us there, which was great, but I realized that we had not really told her where we would be and where she should turn in the survey when she got out of her appointment, so this is something we should be more clear about in the future. We have brainstormed the idea of having a collection box on each floor near the registration counters where we could ask people to leave surveys if they took the surveys with them as they went into appointments so that this process becomes clearer and flows more smoothly in the future.
Overall, our survey pilot was useful not only for figuring out if our survey questions were clear, but also for observing existing logistical challenges, and giving us a chance to brainstorm solutions to these challenges before we return. In our most recent visit, Priscilla was absent from the health center, so we were not able to check in with her in person, but we are planning to update her on our logistical challenges and our proposed solutions and get her thoughts and ideas before we continue with the full roll-out of the surveys.
Part 3: Critical Analysis
This week was a particularly big step for us because it was our first week truly interacting with the patients at the Health Center. In our first visit to the Fair Oaks Health Center, we were focused on touring the facilities and talking to Priscilla about our updates and ideas, and her plans and thoughts on the farmers market project. Priscilla did introduce us to a number of the staff members at that point, so we had a chance to talk with them briefly about the farmers market project, and we were pleased to hear that every staff member we talked to showed enthusiasm for the idea. However, coming away from that experience, we also recognize that the patients at the clinic, compared to the staff members, tend to be more representative of the demographics of the broader North Fair Oaks community. In addition, the ultimate goal of the project – expanding access to healthy foods – is implicitly targeted at improving the accessibility of a healthy lifestyle for the patients of the health center and the surrounding community members, more than at the staff members who already may have a higher level of education around total wellness. Because of this, we recognize that while staff support is important (particularly because our contact at Collective Roots described that it has been slightly challenging to operate the East Palo Alto Farmers Market at the Ravenswood Health Clinic because staff tend to be unsupportive), it will be most important to interact with the patients and North Fair Oaks community members to assess what this population is looking for in a farmers market, and what features within a farmers market would make them most likely to attend.
As we mentioned in the last reflection, we have been slightly nervous about approaching patients because 70% of patients are monolingual Spanish speakers, which creates a substantial language barrier. I (Sophie) have taken Spanish classes in high school and at Stanford, and interacted with a variety of Spanish speakers in other programs that I work with, but I have never before approached someone who I do not know at all, and spoken with them in Spanish. After Carly’s “Brave Spaces” workshop, I also reflected on the fact that I was worried about making assumptions about which language an individual spoke, and causing a misunderstanding based on any assumptions. I am very glad that we had the opportunity to think about our assumptions in this workshop before beginning patient surveys, because it better prepared me to ask (in Spanish, since more patients speak Spanish than English) which language an individual preferred, then continue the conversation from there. As I approached multiple different patients, I was pleased to see that patients were unfazed when I asked which language they wanted to speak in, were incredibly receptive to talking with me, and were willing to fill in the survey.
I felt extremely grateful that the patients were super patient about talking to me in Spanish, and were willing to give us their time to chat a bit about the idea and fill out the survey. One of the important ideas I took from Carly’s “Brave Spaces” workshop and our larger discussions of service (such as one of our early readings on the Haas Principles of Ethical and Effective Service) is the importance of humility, of being genuine, and of working to build trust and learn together when you approach a community (particularly one that is different from your own). I felt very fortunate to have this opportunity to learn from each of the patients that I talked to, and I hope it was as apparent to them as it was to me that I was learning a ton from them, both in relation to ideas about farmers markets and in relation to speaking Spanish, as I tried to share my own understanding of the farmers market project so they could learn about it as well. I had some great conversations, including corrections to my Spanish that helped me speak more clearly with the next patients I talked to, and enjoyed the opportunity to get feedback on the survey and the farmers market project from the patients. Some patients were particularly enthusiastic, telling me what a great idea this would be, and checked the box on the survey indicating they wanted to be updated on the project in the future; I am excited about the fact that some of these initial relationships and learning will continue beyond the brief survey time at the health center.
One assumption we had talked less about before this survey pilot was the assumption that our patients could read and write. We had talked a little with Priscilla initially about the fact that the community members have various levels of comfort with literacy, and we considered including pictures on our survey to make it easy to do even without being literate. As we developed the survey, we realized some questions were too abstract for pictures to describe without any words, and decided that the pictures made the surveys seem much too long. Instead, we have one picture at the top illustrating a farmers market, and the rest of the page is comprised of short check-box or fill-in-the-blank questions. However, when I got to the clinic, I was more focused on assumptions around language, and had not thought as much about our earlier conversations about levels of literacy. One woman I approached told me she was indeed interested in this farmers market project, but when I asked her to do the survey, she told me she couldn’t write or fill it out. Instead, we went though it step-by-step as I read aloud the questions and recorded her answers. This was incredibly easy to do, and also allowed me to get a little more anecdotal from this woman since she was already willing to talk to me about the idea, instead of just marking things down on a piece of paper. I was very excited by this woman’s enthusiasm for the project, and willingness to fill out the survey together. Most importantly, this experience reminded me that I should not make the assumption that individuals can read, and should always make it an option to go through the survey verbally.
Overall, we came away from the health center excited about the information we had collected within the surveys, and ready to meet with Priscilla to work out the logistical challenges and prepare to streamline the survey process and make it as easy as possible for each patient and staff member to give us their input and make their voice heard.
Update of Project Activities
After completing our “Scope of Work” last week, we have spent this week focused on taking the foundational steps to move the project forward and preparing to truly start getting involved with the Fair Oaks Health Center and the surrounding North Fair Oaks Community.
As defined by our “Scope of Work,” our goals for Week 5 were to build our survey for the Fair Oaks Health Center patients, staff members, and North Fair Oaks community members. In addition, we wanted to plan the logistics of conducting a focus group with the Fair Oaks Health Center staff members, and work with Priscilla to set up a focus group or individualized interviews with a few patients as well so we have detailed anecdotal data to supplement the more quantitative data we receive through the survey. After conducting several drafts of the survey on our own, we have sent a version of the survey to Priscilla for her review, so that we will be prepared to start testing the survey next week. In addition, we have worked to identify times for focus groups, and are in the process of contacting Priscilla regarding the scheduling and logistics (including identifying how many patients and staff we should try to talk to, and developing a flyer and incentivizing these individuals to come) for these two sessions.
This work around the survey and focus groups was the main milestone for Week 5, but we have also been in the process of working towards other future milestones as well. We have focused on collecting more information around setting up farmers markets in low income communities, including following up with Collective Roots (after an interview conducted last Friday) about the East Palo Alto Farmers Market and the idea of a partnership between Collective Roots or another similar nonprofit organization and the Fair Oaks Health Center to guide the new farmers market management. Our contact at Collective Roots will be proposing the idea of a partnership with the Fair Oaks Health Center to the Collective Roots staff in their team meeting on Monday and getting back to us, so we will know whether or not to contact Priscilla about this idea– which is something she mentioned she would be interested in–early next week.
Our efforts to gather the necessary information to move forward with this project have also included making phone calls to the SMC Ag Commission with questions about the application and required maps, and brainstorming a list of data points we hope to collect through GIS/Business Analyst, so we are well prepared to utilize this resource and can set up an effective meeting with Patricia Carbajales.
What You Observed and Learned
This week, the most important new insights we gained came from the interviews we have done in an effort to find out more about farmers markets in similar communities. In our call to Collective Roots, our contact emphasized many of the challenges they have faced, and made it clear that the management of even a small farmers market takes a great deal of time in order to incentivize both community members and vendors to participate so that the market stays financially stable. Interesting incentive programs used by Collective Roots include a “Double Bucks” program, where Collective Roots matches dollars up to $20 per month for families who use WIC or food stamps at the farmers market and a CSA program where Collective Roots buys bundles from the vendors and sells to individuals outside of EPA with a higher purchasing power and willingness to pay to make the market worthwhile for the vendors. Although these programs do incentivize participation and insure greater revenue at the market, the administration of these programs takes a lot of work. We learned that the operation of the EPA Farmers Market (which has only 2-3 vendors) takes 20 hours a week dedicated by a Market Manager, and 12 additional hours added by other staff members working on market management, publicity, and incentive programs. Although a bit discouraging, this information will be incredibly useful when we work with Priscilla to determine the Fair Oaks Health Center’s plan for market management, since before Priscilla was unsure as to who would be responsible and how much time they would need to dedicate. In addition, Collective Roots will be getting back to us about whether they might be interested with partnering with the FOHC in the establishment of the farmers market, so we may be able to report back to Priscilla with this as an option for market management.
This interview with Collective Roots was also particularly useful in informing our survey drafts. For example, we learned that the East Palo Alto Farmers Market, which has moved several times, has been most successful at the Ravenswood Health Clinic, but Collective Roots have found that the clinic staff really haven’t participated in the market at all, so it will be important for us to make sure to ask whether each respondent is a patient or staff member so we know whether the staff are willing to support and attend this farmers market. Overall, the information we have gathered from Collective Roots, Jerry Lami the Executive Director of the West Coast Farmers Market, and the SMC Ag Commission has been very helpful in preparing us to take the next steps in our community outreach.
In class this week, our discussions and readings about Plan Bay Area tied in to our project through because North Fair Oaks is one of the locally-nominated Plan Bay Area priority development areas. We learned that North Fair Oaks has received planning funding from the Metropolitan Transportation Commission intended for funding their updated community plan. This information provided us with more context information around what resources are behind the community of North Fair Oaks currently, and the context around the inspiration for the current North Fair Oaks Community Plan, which in fact recommends a farmer’s market.
We appreciated the opportunity in class this week to reflect on our identities, the negative impact of making assumptions, and the importance of bridging differences. Following the discussion led by Carly, we found ourselves reflecting on the commonly-held assumptions that farmers markets are for wealthy people, and thought about how best to approach community members so that they feel that the farmers market would be inclusive and inviting. In negotiating how best to approach community members when we enter the health center to conduct surveys, one concern that came up was what language to address the patients in, since 70% of the patients are monolingual Spanish speakers, but we also don’t want to make assumptions (especially wrong assumptions) about what language each individual patient speaks. We are thinking that the best thing to do will be to ask if they prefer Spanish or English (in Spanish since a majority are Spanish speakers) as we approach, then go with whatever language they are most comfortable with. We appreciated the insight in class that this first contact will not be the most important part of the conversation, and that instead we need to focus on building trust and showing respect throughout the rest of the conversation, once the patient has identified what language they wish to converse in.