title: Improving Health Care for Spanish-Speaking Rural Dairy Farm Workers.
abstract: Dartmouth Geisel Migrant Health (DGMH) is a medical student group that provides on-site health services for Spanish-speaking dairy workers in rural Vermont and New Hampshire in conjunction with a federally qualified health center (FQHC).
  
  
  
  This project was undertaken to evaluate and improve the services provided by DGMH and the FQHC and to refine understanding of the target population.
  
  
  
  We surveyed 25 workers at 6 collaborating dairy farms to identify health priorities and concerns and perceived barriers and facilitators to health care for these workers. Surveys were administered over 2 weeks in July 2015. Interpreter-mediated appointment and sliding-fee-scale data from a period 7 months that spanned survey administration were also assessed.
  
  
  
  Diabetes and hypertension were the most common health concerns. Thirty-two percent of participants reported 10 or more days of depressed mood in the past month. Insurance and language were the most common barriers to health care and employers and on-site clinics were the most common facilitators. Appointments most often addressed women's health, gastrointestinal problems, health maintenance, diabetes, and back pain. Thirty FQHC sliding-fee-scale applications were completed by workers.
  
  
  
  These Spanish-speaking dairy-farm workers have many health concerns and perceive substantial barriers to health care. Collaboration between medical students, a rural FQHC, and farm employers provides important services that facilitate health care access among this population.
authors.affiliation: From the Dartmouth Geisel School of Medicine, Hanover, NH (CB, DP); Department of Community & Family Medicine, Dartmouth Geisel School of Medicine, Hanover (AO, DJ, SG); Department of Pediatrics, Dartmouth Geisel School of Medicine, Hanover (AO). Caledonia.K.Buckheit.MED@dartmouth.edu.
authors.forename: Caledonia
authors.initials: C
authors.lastname: Buckheit
authors.affiliation: From the Dartmouth Geisel School of Medicine, Hanover, NH (CB, DP); Department of Community & Family Medicine, Dartmouth Geisel School of Medicine, Hanover (AO, DJ, SG); Department of Pediatrics, Dartmouth Geisel School of Medicine, Hanover (AO).
authors.forename: Dwan
authors.initials: D
authors.lastname: Pineros
authors.affiliation: From the Dartmouth Geisel School of Medicine, Hanover, NH (CB, DP); Department of Community & Family Medicine, Dartmouth Geisel School of Medicine, Hanover (AO, DJ, SG); Department of Pediatrics, Dartmouth Geisel School of Medicine, Hanover (AO).
authors.forename: Ardis
authors.initials: A
authors.lastname: Olson
authors.affiliation: From the Dartmouth Geisel School of Medicine, Hanover, NH (CB, DP); Department of Community & Family Medicine, Dartmouth Geisel School of Medicine, Hanover (AO, DJ, SG); Department of Pediatrics, Dartmouth Geisel School of Medicine, Hanover (AO).
authors.forename: Deborah
authors.initials: D
authors.lastname: Johnson
authors.affiliation: From the Dartmouth Geisel School of Medicine, Hanover, NH (CB, DP); Department of Community & Family Medicine, Dartmouth Geisel School of Medicine, Hanover (AO, DJ, SG); Department of Pediatrics, Dartmouth Geisel School of Medicine, Hanover (AO).
authors.forename: Stephen
authors.initials: S
authors.lastname: Genereaux
mesh_terms: D000328:Adult; D000067565:Farmers / Q000706:statistics & numerical data; D005260:Female; D006297:Health Services Accessibility / Q000191:economics / Q000706:statistics & numerical data*; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data; D006630:Hispanic or Latino / Q000706:statistics & numerical data*; D006801:Humans; D007348:Insurance, Health / Q000706:statistics & numerical data; D007802:Language; D008297:Male; D009513:New Hampshire; D058996:Quality Improvement; D011907:Rate Setting and Review; D012423:Rural Health / Q000706:statistics & numerical data*; D019035:Rural Health Services / Q000191:economics / Q000706:statistics & numerical data*; D000070319:Student Run Clinic / Q000191:economics / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires; D014707:Vermont; D055815:Young Adult
keywords: Agriculture; Depression; Diabetes Mellitus; Farmers; Health Priorities; Hispanic Americans; Hypertension