Digital Inclusion for Farmworkers in a Pandemic: The North Carolina Farmworker Health Program Internet Connectivity Project, 2020‒2021

Digital Leadership in Physician Assistant Education

ABSTRACT

The rapid evolution of technology offers the health industry advancement of organizational operations that directly impact clinical practice. Physician assistant (PA) educational settings have an added responsibility to set a foundation for students where they can develop comprehensive digital skills necessary for professional growth in the workforce. The challenges for PA educators of behavioral medicine fundamentals include personalizing pedagogy to all learners to equip students with the soft skills they will need in clinical practice. It is far too often that patients are unwilling to communicate their concerns or collaborate in their care plans when rapport is not well established between health care providers and their patients. Artificial intelligence applications broaden the opportunities for PA educators to create learning environments that are conducive for students with various learning styles. Physician assistant leaders in education and clinical practice have the opportunity to influence the inclusiveness of digital tools in their clinical settings and communities to better meet the needs of their patients and enhance patient outcomes. The skills developed as a result of digital integration among PA education prepares learners for all medical disciplines where adaptability is valued. Digital leadership begins in PA education and enhances the clinical practice of PAs.

Internet Devices and Internet Access Among Migrant and Seasonal Farmworkers, North Carolina, 2023

OBJECTIVES

Migrant and seasonal farmworkers work in rural areas where internet access may be limited. We assessed internet access, cost of access, and devices available to farmworkers through a statewide survey in North Carolina.

METHODS

During the 2023 agricultural season, we surveyed 1034 migrant and seasonal farmworkers during routine outreach visits in partnership with community health workers employed by 8 community health centers or by nonprofit health service agencies serving farmworkers in North Carolina. We surveyed participants aged ≥18 years by using time-venue sampling and surveyed up to 5 farmworkers at migrant housing locations. We weighted participants to the total population of farmworkers living in surveyed housing and calculated frequencies and percentages of internet access, internet speed, internet cost, available internet devices, and awareness and use of the Affordable Connectivity Program-a program that was run from 2021 through May 31, 2024, by the Federal Communications Commission to make internet access more affordable in the United States. We assessed predictors of internet access and ability to use online videos by using regression models.

RESULTS

Participants were predominantly Spanish-speaking men who lived in housing provided by farm owners. Among participants, 9.8% had internet connections with a cable or digital subscriber line, and 23.5% did not have consistent internet access. Most participants used cellular network internet (84.9%) and mobile phone devices (93.9%). Even among farmworkers who lived in their housing year-round, few had heard of (34.4%), applied to (4.8%), or used (2.0%) the Affordable Connectivity Program.

CONCLUSIONS

Interventions are needed to increase internet access and digital inclusion for migrant and seasonal farmworkers in North Carolina. Development of state and county broadband infrastructure should consider farmworker housing.

Community health worker outreach to farmworkers in rural North Carolina: Learning from adaptations to the SARS-CoV-2 pandemic

BACKGROUND

Community health workers represent a critical part of the health outreach and services for migrant and seasonal farmworkers ('farmworkers') in rural areas of the United States.

PURPOSE

We sought to identify adaptations to farmworker patient engagement and health outreach made by community health workers during the first 18 months of the COVID-19 pandemic.

METHODS

In this qualitative study, we used semi-structured interviews with community health workers from August 2020 to February 2022 (n = 21). Two coders used thematic analysis to identify three themes related to the experiences of community health workers in conducting health education and outreach to farmworkers prior to and following the onset of the pandemic.

FINDINGS

We found themes related to pre-pandemic outreach efforts to provide health education resource sharing with farmworkers and pandemic-related outreach efforts that included adoption of porch drops and distanced delivery of health education, adaptation of modes of health education and communication through technology and the internet, and taking on new roles related to COVID-19. Finally, we identified changes that reverted after the pandemic or will continue as adaptations.

CONCLUSIONS

Community health workers created practice-based innovations in outreach in response to the COVID-19 pandemic. These innovations included new COVID-19 related roles and new modes of health education and outreach, including the use of digital resources. The changes developed for emergency use in COVID-19, particularly related to internet and technology, have likely altered how community health workers conduct outreach in North Carolina going forward. Funders, community health worker training programs, and researchers should take note of these innovations.

PATIENT OR PUBLIC CONTRIBUTION

Community health workers who typically come from patient populations and provide critical navigation and connection with the health care system advised on the design and creation of this research project, including serving on an advisory board. Two authors have experience working as community health workers.