Listening to migrant voices: focus groups on health issues in south Georgia

The Geography of Farmworker Health in Colorado: An Examination of Disease Clusters and Healthcare Accessibility

Background: Known by some as the "invisible" people because of their precarious work and low social status, migratory and seasonal farmworkers (MSFW) are a critical and underappreciated component to the agriculture industry in the United States. Despite advances in knowledge about the health needs of this population, identifying geographies of high-risk remains a challenging task for community health workers and farmworker advocacy organizations.Methods: Using patient encounter data (2011-2015) from regional Community and Migrant Health Centers (C/MHC), this study investigates the geography of farmworker chronic disease (diabetes, obesity, hypertension) and associated risk factors (anxiety, stress, depression, tobacco use) in Northeastern Colorado through the lens of Geographic Information Science (GIS).Results: Spatial scan statistics (SaTScan) identified disease cluster hot spots in 151 zip codes and chronic disease risk factor clusters in 44 zip codes. Additionally, 13487 farmworkers or 82% of the total population is found in zip codes designated as chronic disease hot spots, while 10,115 or 62% of the population reside in zip codes identified as risk factor hot spots. GIS-based Network Analysis determined that 1,269 farmworkers lived greater than 30 minutes from a C/MHC, or 7.7% of the total population in the study area (n = 16,419).Conclusions: The findings of this study confirm the need for geospatial analytics in farmworker population healthcare management. These methods, combined with multiple contextual and methodological perspectives, will inform appropriate outreach, research, and policy strategies, and further, serve to address the unique geographic challenges facing MSFW's in Northeastern Colorado.

Covariates of Identified Stress and Depression among Seasonal Farmworkers

Many noted difficulties of farmworker life result in increased risk for stress and depression. To date, limited research has focused primarily on seasonal farmworkers; much of the prior research examines migrant farmworkers or both groups collectively. This study aims to: (1) describe levels of stress and depression among a sample of seasonal farmworkers; and (2) identify if covariates (age, gender, marital status, education level, years of residency, problems obtaining healthcare due to documentation, language barriers, transportation, costs, medical insurance, and stress level) are significant predictors of depressive symptoms. Survey data were collected from 150 Latino seasonal farmworkers. A hierarchical binary logistic regression was conducted to identify significant covariates. The results indicated that the only statistically significant covariates were health insurance coverage (p = 0.025) and stress (p = 0.008). Those farmworkers without health insurance were 1.8 times more likely than those with health insurance to possess depressive symptoms, while those demonstrating higher stress levels were over 7 times more likely to demonstrate symptoms of depression. The implications of the results are discussed in the manuscript.

Breaking the Silence: Sexual Harassment of Mexican Women Farmworkers

The purpose of this study was to understand Mexican women farmworkers' perceptions of workplace sexual harassment, its related factors and consequences, and potential points of intervention. This community-based participatory research study conducted focus groups with 20 women farmworkers in rural Washington. Four coders analyzed and gleaned interpretations from verbatim transcripts. Three main themes were identified. It was learned that women farmworkers: (1) frequently experienced both quid pro quo and hostile work environment forms of sexual harassment; (2) faced employment and health consequences due to the harassment; and (3) felt that both individual- and industry-level changes could prevent the harassment. Based on these findings, the authors identified three sets of risk factors contributing to workplace sexual harassment and recommend using a multilevel approach to prevent future harassment in the agriculture industry.

Using Community-Based Participatory Research and Human-Centered Design to Address Violence-Related Health Disparities Among Latino/a Youth

High rates of exposure to violence and other adversities among Latino/a youth contribute to health disparities. The current article addresses the ways in which community-based participatory research (CBPR) and human-centered design (HCD) can help engage communities in dialogue and action. We present a project exemplifying how community forums, with researchers, practitioners, and key stakeholders, including youths and parents, integrated HCD strategies with a CBPR approach. Given the potential for power inequities among these groups, CBPR + HCD acted as a catalyst for reciprocal dialogue and generated potential opportunity areas for health promotion and change. Future directions are described.

Alcohol Use and Problem Drinking Among Male Mexican and Central American Im/migrant Laborers

This review addresses a growing concern regarding alcohol use in adult male Latino im/migrant laborers in the United States. The review draws from alcohol studies focusing on “Hispanic” populations, and from health behavior studies of Latino im/migrant laborers, research that includes alcohol use. Specifically, this review addresses (a) alcohol consumption and drinking patterns among Mexican and Central American im/migrant laborers, and (b) health and social consequences of alcohol use. After reviewing more than 200 articles, 30 studies meeting key criteria were selected for review. Survey data show lower alcohol use in Latino im/migrants as compared with U.S. Latino and non-Latino populations, but also a relation between problem drinking and acculturation. Ethnographic research reveals heavy drinking and negative health and social consequences in a significant number of Latino im/migrant laborers. How structural-environmental and culture-based factors combine to influence problem drinking in the United States is discussed along with recommendations for future research.

Hispanic Adolescent Farmworkers’ Perceptions Associated with Pesticide Exposure1

The migrant farmworker population in the United States is a vulnerable and understudied population whose characteristics are constantly shifting. The number of youth involved in agriculture work is increasing, and they, in particular, may be at increased risk for occupational hazards, such as pesticide exposure. The present study utilized an ecological framework for focus group discussions with 33 adolescent migrant farmworkers in Oregon. Adolescents’ risk perception and health beliefs associated with pesticide exposure are examined on four levels of environmental influence: microenvironment, organizational environment, social/community environment, and macroenvironment. Adolescents provided insight on such topics as perceived vulnerability of illness due to pesticide exposure, attitudes toward farmwork, influence of their boss, knowledge of occupational hazards, safety training, and barriers to occupational choice. Cultural influences on occupational safety and health are discussed and increased attention to safety training is recommended.

Health experiences of Korean immigrant women in retirement

In this focused ethnographic study, we explored the health experiences of 15 Korean immigrant women after retirement in an urban center in Western Canada. Almost all women began their lives in Canada without adequate personal finances, making their employment essential for supporting their families financially. Most women lived with more than two chronic diseases, attributed to long hours and difficult work conditions. They experienced improved psychological health after retiring, irrespective of positive or negative changes in their physical health. Spiritual faith and exercise were important strategies to maintain and enhance their health and to postpone and manage chronic diseases.

Health care access and health care workforce for immigrant workers in the agriculture, forestry, and fisheries sector in the southeastern US

BACKGROUND

The Agriculture, Forestry, and Fishery (AgFF) Sector workforce in the US is comprised primarily of Latino immigrants. Health care access for these workers is limited and increases health disparities.

METHODS

This article addresses health care access for immigrant workers in the AgFF Sector, and the workforce providing care to these workers.

CONTENTS

Immigrant workers bear a disproportionate burden of poverty and ill health and additionally face significant occupational hazards. AgFF laborers largely are uninsured, ineligible for benefits, and unable to afford health services. The new Affordable Care Act will likely not benefit such individuals. Community and Migrant Health Centers (C/MHCs) are the frontline of health care access for immigrant AgFF workers. C/MHCs offer discounted health services that are tailored to meet the special needs of their underserved clientele. C/MHCs struggle, however, with a shortage of primary care providers and staff prepared to treat occupational illness and injury among AgFF workers. A number of programs across the US aim to increase the number of primary care physicians and care givers trained in occupational health at C/MHCs. While such programs are beneficial, substantial action is needed at the national level to strengthen and expand the C/MHC system and to establish widely Medical Home models and Accountable Care Organizations. System-wide policy changes alone have the potential to reduce and eliminate the rampant health disparities experienced by the immigrant workers who sustain the vital Agricultural, Forestry, and Fishery sector in the US.

Anticipatory guidance preferences of Latina migrant farmworker mothers

INTRODUCTION

The purpose of the study was to learn preferences of Latina migrant farmworker mothers regarding the presentation of health education materials by discussing the strengths and weaknesses of numerous mixed-media samples.

METHOD

This community-based participatory study was qualitative and descriptive in design. Focus groups were conducted in Spanish in four Midwest migrant camps with a convenience sample of mothers (N = 31). Adult learning and cultural care theories guided the study. Various modes of educational materials on various topics were presented.

RESULTS

Mothers preferred comic book-style handouts, games, food replicas, text in English/Spanish, and digital video discs or digital versatile discs, but almost none of them had media-playing equipment. They did not like black-and-white photos or cartoon-like illustrations. Identified themes of importance were colored illustrations, sizes mothers could easily carry in purses, and limited verbiage on a page.

DISCUSSION

The knowledge gained in this study will be used to customize health promotion interventions that are sensitive to migrant farmworker-preferred learning styles. The findings from this study can inform other interventions with Latino populations and serve as a prototype for other populations of immigrant non-English-speaking mothers.

Female farmworkers' perceptions of heat-related illness and pregnancy health

Although agricultural workers have elevated risks of heat-related illnesses (HRI), pregnant farmworkers exposed to extreme heat face additional health risk, including poor pregnancy health and birth outcomes. Qualitative data from five focus groups with 35 female Hispanic and Haitian nursery and fernery workers provide details about the women's perceptions of HRI and pregnancy. Participants believe that heat exposure can adversely affect general, pregnancy, and fetal health, yet feel they lack control over workplace conditions and that they lack training about these specific risks. These data are being used to develop culturally appropriate educational materials emphasizing health promoting and protective behaviors during pregnancy.

A metasynthesis of qualitative studies regarding opinions and perceptions about barriers and determinants of health services' accessibility in economic migrants

Background

Access to health services is an important health determinant. New research in health equity is required, especially amongst economic migrants from developing countries. Studies conducted on the use of health services by migrant populations highlight existing gaps in understanding which factors affect access to these services from a qualitative perspective. We aim to describe the views of the migrants regarding barriers and determinants of access to health services in the international literature (1997–2011).

Methods

A systematic review was conducted for Qualitative research papers (English/Spanish) published in 13 electronic databases. A selection of articles that accomplished the inclusion criteria and a quality evaluation of the studies were carried out. The findings of the selected studies were synthesised by means of metasynthesis using different analysis categories according to Andersen’s conceptual framework of access and use of health services and by incorporating other emergent categories.

Results

We located 3,025 titles, 36 studies achieved the inclusion criteria. After quality evaluation, 28 articles were definitively synthesised. 12 studies (46.2%) were carried out in the U.S and 11 studies (42.3%) dealt with primary care services. The participating population varied depending mainly on type of host country. Barriers were described, such as the lack of communication between health services providers and migrants, due to idiomatic difficulties and cultural differences. Other barriers were linked to the economic system, the health service characteristics and the legislation in each country. This situation has consequences for the lack of health control by migrants and their social vulnerability.

Conclusions

Economic migrants faced individual and structural barriers to the health services in host countries, especially those with undocumented situation and those experimented idiomatic difficulties. Strategies to improve the structures of health systems and social policies are needed.

Female farmworkers' perceptions of pesticide exposure and pregnancy health

Occupational pesticide exposure may be hazardous to pregnant farmworkers, yet few studies have focused on the health of female farmworkers distinct from their male counterparts or on the impact of agricultural work tasks on pregnancy outcomes. In the current community-based participatory research study, researchers conducted five focus groups with female nursery and fernery workers in Central Florida to enhance knowledge of attitudes about occupational risks and pregnancy health and to gather qualitative data to help form a survey instrument. This article presents the results from questions focused on pesticide exposure and its impact on general, reproductive, pregnancy, and fetal health. Workers reported a belief that pesticide exposure could be hazardous to pregnancy health; descriptions of symptoms and health concerns believed to be related to farmwork and to pesticide exposure; and descriptions of barriers preventing them from practicing safer occupational behaviors.

Differences in methylphenidate use between immigrants and spaniards in the child population of aragon, Spain: a retrospective study

The aim of this research is to study the differences in methylphenidate use in children from different ethnic groups in the region of Aragon, Spain. Differences in the use of methylphenidate between both groups of children, immigrants and Spanish nationals, were assessed based on the total number of methylphenidate prescriptions made out for all children in Aragon in 2008 (N = 98 837). We have used defined daily doses and the defined daily doses per 1000 inhabitants per day. Defined daily doses per 1000 inhabitants per day of methylphenidate use was 18.49 in Spanish boys compared with 2.70 in immigrant boys, and 5.48 in Spanish girls versus 0.83 in immigrant girls. All differences between groups were statistically significant (P < .001). This study confirms that methylphenidate use is higher in a local population than in an immigrant population. Western European and North American children show the highest use, followed by Latin Americans and Eastern Europeans.

Impact of individual-, environmental-, and policy-level factors on health care utilization among US farmworkers

OBJECTIVES

We examined individual-, environmental-, and policy-level correlates of US farmworker health care utilization, guided by the behavioral model for vulnerable populations and the ecological model.

METHODS

The 2006 and 2007 administrations of the National Agricultural Workers Survey (n = 2884) provided the primary data. Geographic information systems, the 2005 Uniform Data System, and rurality and border proximity indices provided environmental variables. To identify factors associated with health care use, we performed logistic regression using weighted hierarchical linear modeling.

RESULTS

Approximately half (55.3%) of farmworkers utilized US health care in the previous 2 years. Several factors were independently associated with use at the individual level (gender, immigration and migrant status, English proficiency, transportation access, health status, and non-US health care utilization), the environmental level (proximity to US-Mexico border), and the policy level (insurance status and workplace payment structure). County Federally Qualified Health Center resources were not independently associated.

CONCLUSIONS

We identified farmworkers at greatest risk for poor access. We made recommendations for change to farmworker health care access at all 3 levels of influence, emphasizing Federally Qualified Health Center service delivery.

Healthcare use among California farmworkers: predisposing and enabling factors

Farmworkers are at risk for developing occupation-related health conditions, yet healthcare use is limited. National Agricultural Workers Survey data were used to test a modification of the Behavioral Model for Vulnerable Populations on use of healthcare in the past two years and type of healthcare used. Barriers to care were examined to determine associations with use and type of use. The farmworkers (N = 2,291) were primarily foreign-born Latino/Hispanic married males who reported limited ability to read and speak English. Healthcare use in the past two years was more likely among females, those with more than six years of education, who earned an annual income of more than $15,000 annually, were authorized, non-migrant, insured, and who reported living in the US for more than two years. Healthcare system barriers were most prominent. This study provides important targets for policy and health promotion initiatives to reduce health disparities in this marginalized community.

Strategies for targeting health care disparities among Hispanics

Hispanics are the largest minority group in United States and at a great risk for poor health outcomes linked to poor access to health care. Their large geographic distribution makes it critical that the underlying factors resulting in health care disparities among documented and undocumented Hispanics be addressed at local, state, and national levels. Health care systems should establish community partnership for effective strategies to address these disparities. This article presents factors identified in the literature that contribute to health care disparities among Hispanics and provides strategies for improving access to health care for health promotion.

Listening to rural Hispanic immigrants in the Midwest: a community-based participatory assessment of major barriers to health care access and use

Hispanic immigrants are increasingly residing in rural communities, including in the midwestern United States. Limitations in the ability of rural Hispanics to access and utilize health care contribute to patterns of poor health and health disparity. A conceptual model of "vulnerability" guides this community-based participatory assessment project designed to explore rural Hispanics' perceived barriers to accessing and utilizing health care. Findings from a series of 19 focus groups with 181 participants from three communities in the upper Midwest identified perceived barriers at the individual and health care system levels. The most commonly perceived barriers were the lack of and limitations in health insurance coverage, high costs of health care services, communication issues involving patients and providers, legal status/discrimination, and transportation concerns. Findings imply that these barriers could be addressed using multiple educational and health service delivery policy-related strategies that consider the vulnerable nature of this growing population.

Delivery of health services to migrant and seasonal farmworkers

Farmworkers are low-paid, uninsured employees in an extremely hazardous industry, and they provide an essential service for U.S. society. This review evaluates the delivery of health services to farmworkers. It describes the farmworker population in the United States, noting characteristics (e.g., migratory and immigration status) that limit their access to and utilization of health services. It describes the health services needs of this population, including occupational health, mental health, oral health, and chronic disease treatment. Cultural, structural, legal, financial, and geographic barriers to health services utilization are described. Existing research on health services utilization among farmworkers is discussed. Programs that have been developed to address the barriers to health services utilization among farmworkers are reviewed. Finally, research needed to improve knowledge of farmworker health services utilization is suggested. These research needs include formal evaluations of existing programs and basic research to characterize the health services utilization patterns of farmworkers.

Child Health Needs of Rural Alabama Latino Families

This article presents findings from a study that used focus group methodology to identify perceptions of Latino parents living in rural Alabama related to their children's health needs. Sixteen focus groups were held with a total of 89 parents (54 mothers and 35 fathers). The groups were led by native Spanish speakers, and group meetings were tape recorded. The main themes that emerged related to (a) what children need to be healthy, (b) common children's health problems, (c) what we do when children are ill, (d) barriers to receiving health care, (e) parenting issues and concerns, (f) experiences with children's schools, and (g) services needed. The findings can be used to guide the development of culturally appropriate, community-based programs to address the priority health needs of the growing Latino community in rural areas of the United States.

Florida Farmworkers’ Perceptions and Lay Knowledge of Occupational Pesticides

Despite federal regulations, farmworkers often lack access to basic information about pesticides applied at their worksites. Focus groups revealed that farmworkers have developed an extensive body of lay knowledge, based on personal perceptions, about pesticides and pesticide exposure including means of pesticide exposure, means of pesticide entry into the body, and the potential health effects of pesticide exposure. We describe how this lay knowledge, when combined with technical information that is required to be provided to workers by law, provides valuable data to consider before developing and implementing health interventions designed to reduce the adverse health effects of pesticide exposure.

Cross-cultural reliability of the Health Perception Index and the Health Control and Competence Index

PURPOSE

To test the reliability of two Spanish instruments to measure (a) health perceptions, and (b) health control and competence.

DESIGN

Triangulated methodology used with two different Latino populations.

METHODS

Preliminary qualitative data were collected in Mexico. Based on themes from Mexico, data were collected from 44 men (Dominican Republic, n=24 ; Peru, n=20) with two instruments, the Health Competence and Control Index and the Health Perception Index. Alpha reliability estimates were obtained.

FINDINGS

Results of the study confirmed reliability of the instruments in one of the Latino populations, consistent with understanding of the constructs found in the Mexican study. Reliability was low in the second Latino population.

CONCLUSIONS

Although results from this study are useful, further translation and research procedures are needed to address the many differences among ethnically similar groups and to further strengthen internal and external validity of instruments designed to assess Latino men's perceptions of health and their control over health.

Stakeholder analysis of Florida farmworker housing

Farmworkers, farmworker advocates, state and federal policy-makers, and researchers all consider adequate housing as central to successful migration, community building, and quality of life, including good health, among farmworkers. This study analyzes results from interviews and focus groups with stakeholders involved in Florida farmworker housing conducted with the goal of providing recommendations for future farmworker housing policy. These recommendations include considering housing needs within a life continuum and understanding how wages and housing are interconnected. The concurring perspectives of stakeholders can be considered as building blocks in developing more effective state and local housing policy.

The dynamic process of focus groups with migrant farmworkers: the Oregon experience

Focus groups with culturally diverse populations, and Latino farmworkers in particular, have been used as an effective research method. However, the specifics of planning and implementing focus groups with diverse populations have not been elaborated in the literature. Focus groups were used as part of The Reducing Pesticide Exposure in Minority Families Project to successfully elicit migrant farmworkers' views on pesticide exposure and preferences for educational method. Although attention was paid to cultural and lifestyle considerations in the planning and implementation of our focus groups, recruitment, environmental context, convener, focus group questions, and within-population differences were identified as areas that required ongoing assessment and operational change. Vigilance to the dynamics of the process resulted in more effective focus groups.

Stress Among Migrant and Seasonal Farmworkers in Rural Southeast North Carolina

CONTEXT

Although funding to enhance the delivery of health care among migrant farmworkers has primarily focused on urgent care issues within this population, the etiology of mental health risks and perceived stress is poorly understood.

PURPOSE

To identify the type and severity of stress perceived by migrant and seasonal farmworkers in rural southeast North Carolina.

METHODS

During the pre-agricultural season in 2002, 151 migrant and seasonal farmworkers completed the 39-item Migrant Farmworker Stress Inventory (MFWSI) in either English or Spanish.

FINDINGS

Fifty-one percent (n = 77) of the respondents perceived themselves at a high level of stress (mean score above 80 of "caseness") that may subsequently put them at greater risk for experiencing psychological difficulties. The stressors highly ranked (mean>2.5 in a maximum of 4, with "extremely stressful" in a 5-point Likert scale 0 to 4) were related to their mobile lifestyle, language barriers, insecure job and legal status, financial restraint, and long working hours. Also, drug and alcohol use in the migrant community was found to be one of the significant sources of stressors. Variables influencing high levels of stress include education, social support, religion, marital status, and age. Despite a relatively high level of perceived stress, the majority of respondents (71.5%) viewed their physical health as either "good" or "excellent."

CONCLUSIONS

Findings from the study suggest the availability of social support systems may provide significant insight into developing appropriate health services for migrant and seasonal farmworkers and their families.

Psychosocial stressors associated with Mexican migrant farmworkers in the midwest United States

Although estimates suggest that there are upwards of 5 million migrant farmworkers in the United States, scant research has explored the stressors associated with their lifestyle. Contrary to previous work, the present study directly explored migrant farmworkers' own perceptions of what is difficult in their lives. The purposes of the present study were to qualitatively explore, from a phenomenological standpoint, the stressors associated with living as a migrant farmworker in the Midwest United States; and to determine the stressors that were most strongly related to symptoms of anxiety and depression. The findings indicated that 18 stressors were commonly experienced by the migrant farmworkers and that the farmworkers experienced overall elevated levels of anxiety and depression. A number of stressors that were not previously reported in the literature were identified. The stressors of "rigid work demands" and "poor housing conditions" were significantly associated with higher levels of anxiety and "low family income/living in poverty" and "rigid work demands" were significantly associated with depression. Implications of findings and prevention strategies are discussed.

Primary health care for Hispanic children of migrant farm workers

Providing primary care to children of culturally diverse populations is a challenge for pediatric nurse practitioners and educators. The challenge is intensified when providing care to Hispanic children who are uprooted because their parent(s) are migrant farm workers. The creation of health-focused academic community partnerships is one unique strategy to improve primary care to these children. One such partnership is the ongoing Migrant Family Health Program in which practitioner nursing students and their faculty members provide primary health care to children who are enrolled in a summer education program for migrant children.

Listening to the quiet voices of Hispanic migrant children about health

There is a paucity of literature related to school-aged migrant children's perceptions of their own health. To best provide culturally competent care, more information is needed about migrant children's experiences. Focus-group methodology allowed the voices of migrant children to be heard by primary health care providers at a summer school program for children of migrant farm workers in south Georgia. Seventy-three children participated in 14 focus-group sessions. Six themes emerged from the data that were analyzed by using a qualitative software system. They are healthy behaviors, acculturation issues, environmental influences, health care actions, health behavior outcomes, and learning needs. Emerging patterns within each theme render insight about these migrant children. The findings suggest implications for pediatric nurses related to culturally competent care.