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.