title: Reducing barriers associated with delivering health care services to migratory agricultural workers.
abstract: BACKGROUND
  Between one and two million migratory agricultural workers (MAWs), primarily from Mexico and Central America, leave their homes each year to plant, cultivate, harvest and pack fruits, vegetables, and nuts in the USA. While in the USA, most lack health insurance, a permanent residence, and a regular healthcare provider. Publications over the past two decades in the USA have reported that a majority of MAWs encounter barriers to receiving medical services. Migratory agricultural workers experience high rates of occupational illness and injury. Poor access to medical care continues to exacerbate health problems among members of this population related to their working environments. In most studies concerning healthcare access issues for this population, researchers collected their information from healthcare service providers; rarely have they included input from migratory agricultural workers. This study was different in that opinions about healthcare access issues were collected directly from MAWs. The primary purpose of this study was to describe issues related to barriers associated with the delivery of healthcare services to migratory agricultural workers. A secondary purpose was to suggest strategies for reducing these barriers.
  
  
  METHODS
  In this study, data from focus group sessions were used to develop a survey questionnaire. Four certified bilingual interpreters were trained to administer the questionnaire. A total of 157 usable questionnaires were returned from MAWs living in employer-provided camps in Northwest Ohio. The statistical analyses were primarily descriptive.
  
  
  RESULTS
  The most significant barriers hampering access to medical services among the 157 respondents were cost (n=113; 72.0%), crop demands (n=102; 65.0%), the lack of an interpreter (n=98; 62.4%), travel distance (n=88; 56.1%) and transportation (n=82; 52.2%). Approximately half (n=82; 52.2%) said that they had access to transportation for traveling to a medical clinic. As a group, respondents were willing to travel an average of 29.1 km (18.1 miles) (range 0-129 km [0-80 miles]) to obtain medical services. Female heads of households had significantly less access to transportation compared with male heads of households (t=2.35; df=74; p<0.05).
  
  
  CONCLUSIONS
  Three general categories of barriers to health care for MAWs surfaced in this study: (1) work environment; (2) migratory agricultural worker resources; and (3) healthcare clinic practices. Work environment issues relate mostly to the employers. Resources are barriers for MAWs because they are poor and have limited funds for the cost of transportation to clinics and the fees associated with accessing health care. Most of the barriers identified related to healthcare clinic practices. Some strategies to address healthcare clinic practice barriers were developed by the group conducting the study. By listening to what MAWs described as barriers to health care, providers can help improve access which can reduce the use of high cost hospital emergency room care.
authors: Bowling Green State University, Bowling Green, OH, USA. hschmal@bgsu.edu
authors: Hans D
authors: HD
authors: Schmalzried
authors: L Fleming
authors: LF
authors: Fallon
mesh_terms: D000328:Adult; D000383:Agriculture; D001291:Attitude of Health Personnel; D002489:Central America / Q000208:ethnology; D003144:Communication Barriers; D054521:Cultural Competency; D005260:Female; D017144:Focus Groups; D006293:Health Promotion / Q000379:methods; D006297:Health Services Accessibility / Q000191:economics / Q000592:standards* / Q000706:statistics & numerical data; D054625:Healthcare Disparities / Q000208:ethnology / Q000592:standards*; D006801:Humans; D008297:Male; D008800:Mexico / Q000208:ethnology; D009784:Occupational Diseases / Q000191:economics / Q000523:psychology / Q000628:therapy; D009820:Ohio; D010342:Patient Acceptance of Health Care / Q000208:ethnology / Q000523:psychology*; D011795:Surveys and Questionnaires; D013997:Time Factors; D014171:Transients and Migrants / Q000523:psychology* / Q000706:statistics & numerical data; D014186:Transportation / Q000191:economics / Q000706:statistics & numerical data; D014850:Waiting Lists; D000078329:Workforce; D016526:Workload / Q000523:psychology