Integrating geospatial information with clinical practice and cancer screening and health outcomes represents a paradigm shift in the way we consider cancer prevention and control and represents another way to examine racial and ethnic cancer-related health disparities. For this initiative, we provided visually appealing maps that allowed clinical partners and key stakeholders to easily identify areas of “positive” impact of the FQHCs and areas where additional intervention (in this case, increasing FQHC density) could be beneficial. The use of statistical modeling of the relationship added further credence to these visuals. Data were available that allowed for stratification by race, rurality, and areas where there are shortages of health care professionals, which enabled further elucidation of the effect among these diverse and underserved populations. The ecological design of this study limited the interpretation of these findings; however, they indicate promising directions for future study about the potential role of FQHCs in cancer prevention and control.

By using publicly available data in unique ways (ie, the MIR calculations and GIS mapping), we conducted analyses efficiently in 2 months that otherwise would have been much more cumbersome (and probably prohibitively expensive) if new surveys and participant recruitment were required. The key to the collaborative effort was the partnership with the SCPHCA. Early meetings of the research workgroup involved discussions of the data needs of FQHCs at the state and national levels. It became clear that impact evaluation results were the most important need and hence formed the basis of the goals. On the basis of our conversations with the SCPHCA and FQHC partners, we learned that FQHC staff were interested in assessing patient outcomes for FQHCs (eg, Papanicolaou tests for cervical cancer screening and laboratory prostate-specific antigen tests for prostate cancer screening) in relationship to national standards for the provision of quality primary health care. This interest became more relevant as changes occurred in the health care environment, such as the passing of the Affordable Care Act (15).

Additional analysis of local FQHC data has been conducted on the basis of feedback and recommendations from the SCPHCA and FQHC partners. In presenting the findings from these analyses, clinical partners have used results to evaluate the cancer-specific services they provide and as the foundation for potential refinement of clinical policies and procedures. Partnering with both SCPHCA and the individual health centers also permits the SC-CPCRN to develop long-lasting, sustainable community relationships that support our team’s CBPR approach and enhances the ability of the network to implement and disseminate further evidence-based research interventions.

The farmers market was strategically developed at an FQHC in an area with high rates of diet-related health conditions and low access to retailers of healthful foods, determined by using existing databases such as the Behavioral Risk Factor Surveillance System and the US Department of Agriculture Food Atlas (8,11). A CBPR approach was used that allowed stakeholder feedback to inform research efforts.

The study protocol included a prescription program that provided $1 off produce purchases made by patients redeeming their prescriptions at the farmers market. Within several weeks of the farmers market season, the participating FQHC developed their own produce prescription program that provided $5 coupons to the farmers market for patients attending diabetes management classes at the health center. Outcomes resulting from evaluations conducted at the farmers market informed future programming (eg, marketing strategies, vendor policies, additional incentive programs).

In 2011, a farmers market advisory council that included representatives from the FQHC (eg, directors of nursing, health education, facilities) was formed and still exists. This group received regular (sometimes weekly) feedback about prescription program usage, which was documented through sales receipts recorded at the farmers market. This feedback loop influenced the development of the second produce prescription program developed by the FQHC as well as an additional monetary incentive program designed for recipients of the Supplemental Nutrition Assistance Program (SNAP), a federal food assistance program that provides nutrition assistance to eligible low-income individuals and families. Data also were presented at local meetings (eg, South Carolina Farmers Market Manager Conference) and to local advocates. Ultimately, a data-informed policy was passed in South Carolina in 2013 to provide monetary incentives for SNAP recipients shopping at farmers markets (17).

This project has made emerging intervention methods and training available to researchers, stakeholders (eg, primary care clinics), and community partners. These partners include community groups interested in promoting organic farming across the state.

In March 2013, the Right Choice, Fresh Start (RCFS) team released a manual focused on forming a health center–based farmers market. The farmers market implementation manual, Building Farmacies: A Guide for Implementing a Farmers’ Market at a Community Health Center, designed for community leaders, practitioners, and researchers, is free and is being publicized through various listserves. In the manual, we describe our experiences using a community-engaged approach to develop the RCFS farmers market, from initial conceptualization to sustaining a health center–based market (16). It was disseminated by targeting existing Web-based communication channels among relevant stakeholder groups (eg, public health, nutrition, health center, farming and agriculture, social work). This information was spread to other networks, which then spread to additional networks. From July through December 2013, the manual was downloaded 271 times from the hosting website (http://cosw.sc.edu/component/rsform/form/17-manual-request-form).

The film was released in October 2011. First, from October 2011 to January 2012, 3 community film screenings took place: 2 in the rural community in which filming took place, including showings at a local university and church; and 1 in Columbia, the capital of South Carolina, at a film festival focused on food that was sponsored by an independent theater. Attendees completed evaluation forms before and after watching the film to assess their perspectives on the quality and content of the film and the influence of the film on igniting personal and collective action. Second, from December 2011 to March 2012, the documentary film was promoted online through professional organizations (via listserves) and personal contacts to increase interest in establishing similar farmers markets and share the experience of this specific farmers market. Initial access to the film required completing a pretest, and posttest evaluations were sent approximately 4 months later to assess use of the film. We recognize the limited value of a pretest–posttest survey assessment and recommend additional measures of behavioral or health outcomes in future work (eg, changes in hemoglobin A1c among people with diabetes or prediabetes).

The documentary film was shared through public screenings and distributed to individuals and organizations requesting the film. Following evaluation of initial requests online, the documentary film was posted to YouTube, Vimeo, and SC-CPCRN and SCPHCA websites for open access. Copies of the film on DVD also were distributed during presentations about the farmers market at professional and community meetings and provided to community partners. At the 2012 annual meeting of the American Public Health Association, the film was featured as part of its Film Festival (24).

Two student filmmakers, under the direction of 2 researchers, a senior filmmaker, and a market Community Advisory Council, used personal stories, community profiles, and expert interviews to describe the formation and implementation of the market in collaboration with an FQHC in rural South Carolina. The film includes live footage with various people involved with forming the farmers market (eg, farmers, health center staff, customers, researchers). Filmmakers and stakeholders worked together through each stage of the documentary’s evolution from conceptualization through to evaluation (22,23). This approach aligns with CBPR and allows for the narrative of the film to emerge from the voices of the people in the film, who were primarily members of the community.

In addition to dissemination strategies in the local community, the SC-CPCRN received over 400 national and international requests for the original documentary film. Copies of the DVD were distributed to 42 states, the District of Columbia, and 6 countries. Through the iterative process of creating and distributing the film, enhanced recognition of the role of community members in implementing and sustaining the farmers market was realized. The film served as a powerful visual means of portraying the process of engaging the community and promoting the farmers market (25).