title: User Perceptions of ¡Protéjase!: An Intervention Designed to Increase Protective Equipment Use Among Mexican Immigrant and Mexican American Farmworkers.
abstract: BACKGROUND
  Farmworkers' exposures to pesticides are reduced when they wear personal protective equipment (PPE), and mobile health (mHealth) platforms can potentially deliver information to farmworkers to help promote PPE use. However, little is known about the feasibility of using mHealth platforms to promote farmworkers' use of PPE.
  
  
  OBJECTIVE
  The objective of the study was to describe the development and feasibility-testing of Protect Yourself! (¡Protéjase!), an intervention designed to increase PPE use. As the vast majority of farmworkers in the United States are from Mexico, we examined the intervention in a primarily Mexican-origin farmworker population.
  
  
  METHODS
  ¡Protéjase was developed in several steps. First, we performed ethnographic observations to understand what prevents PPE use. Next, we developed program components that met the challenges uncovered in the ethnographic observations, seeking direct feedback from farmworkers on each component. Feasibility was assessed using surveys and focus groups. Material was provided in Spanish or English at the preference of the participant. Finally, we pilot tested each component of the intervention, including: (1) PPE that was provided to each worker for their personal use during the intervention trial, and (2) delivery of an application-based tool that promoted the use of PPE through daily individualized messaging.
  
  
  RESULTS
  55 farmworkers enrolled in the study, but only 41 of 55 (75%) completed the entire pilot intervention trial. Results focus on the evaluation of the intervention, and include only those who completed the entire trial. Among farmworkers who completed the entire intervention trial, all but two farmworkers were born in Mexico and were Spanish speaking. Still, all study participants self-identified as Mexican or Mexican-American. When asked what changes were needed in the intervention's messaging or delivery to increase user satisfaction, 22 out of 41 participants (54%) felt that no changes were needed. However, 16 of 41 participants (39%) suggested small changes to messaging (eg, refer to long pants as pants only) to improve their understanding of the messages. Finally, a small number (3 of 41 participants, 7%) felt that messages were difficult to read, primarily due to low literacy.
  
  
  CONCLUSIONS
  The ¡Protéjase! mHealth program demonstrated very good feasibility, satisfaction, and acceptance; potential improvements (eg, small modifications in messaging to increase farmworkers' use) were noted. Overall, the PPE provided to workers as well as the mHealth platform were both perceived as useful for promoting PPE use.
authors.affiliation: Penn State University, Department of Biobehavioral Health, University Park, PA, United States. sas84@psu.edu.
authors.forename: Shedra A
authors.identifier: http://orcid.org/0000-0001-8965-0429
authors.initials: SA
authors.lastname: Snipes
authors.forename: Francisco A
authors.identifier: http://orcid.org/0000-0002-2837-726X
authors.initials: FA
authors.lastname: Montiel-Ishino
authors.forename: Joshua M
authors.identifier: http://orcid.org/0000-0002-0904-5390
authors.initials: JM
authors.lastname: Smyth
authors.forename: Dennis J
authors.identifier: http://orcid.org/0000-0001-7396-2487
authors.initials: DJ
authors.lastname: Murphy
authors.forename: Patricia Y
authors.identifier: http://orcid.org/0000-0003-0601-4852
authors.initials: PY
authors.lastname: Miranda
authors.forename: Lisa A
authors.identifier: http://orcid.org/0000-0002-4869-4692
authors.initials: LA
authors.lastname: Davis
keywords: Hispanic; intervention study; mHealth; migrant worker; occupational safety; pesticides