Research Aims to Improve the Health of Migrant and Seasonal Farmworkers

This article was originally published in Nov 2020

When Cheryl Holmes shops for produce at the grocery store, she doesn’t just see apples or watermelons or lettuce. She sees the faces of the migratory and seasonal agricultural workers she knows who have worked long days — often 6:00 am to 8:00 pm in all weather, six days a week — to harvest each piece.

“I think about the faces and the names of the people behind what I see. I appreciate it so much more and feel there really is a story behind each item that is there,” shares Holmes, MPA, research project director with the University of Kansas School of Social Welfare. “The farmworkers take great pride in the work they do. It’s hard work, and it requires a lot of skill.”

Likewise, Holmes and her partners are working hard to ultimately improve the health and lives of the estimated 2.4 million migratory and seasonal agricultural workers in the United States. With funding from the Patient-Centered Outcomes Research Institute’s Eugene Washington Engagement Award, Holmes is collaborating not only with numerous community and national partners, but also farmworkers themselves, to build capacity for patient-centered research, promote the allocation of funding to carry it out, and link networks of national and local agencies to support the sharing of results.

Uncovering the Health Needs of Migrant and Seasonal Farm Workers

Here’s what keeps Holmes up at night: Migrant and seasonal farmworkers face a host of threats to their health, yet don’t usually have the resources, access, and information they need to safeguard their well-being.

For example, they must work long hours doing hard physical labor in extreme temperatures, handle hazardous chemicals, and use dangerous heavy machinery. They often live in substandard, over-crowded housing. Because they are only paid when they are working, it is costly for them to take time off when they are sick or need to see a health provider. And most have limited English language proficiency, which makes navigating the health care system difficult.

“Often times they are coming into rural areas where they may not know where to access services or have time off to access them,” Holmes says. “Plus, they face barriers that are typical in a rural area, like the shortage of providers or long commutes to the nearest grocery store.”

Engaging Farmworkers in the Research Process

So far, Holmes says, little research has been conducted on the unique health care discrepancies faced by farmworkers and how to meet their health care needs. But in her patient-centered research project, the farmworkers themselves play a central role in defining the supports they need and determining the interventions that would be most beneficial to them. The immediate goals of this two-year research project, which concludes in August 2021, is to build capacity for engaging farmworkers and other key stakeholders in patient-centered research, which helps center the focus on farmworkers’ needs, preferences, and desired health outcomes

“My hope is we raise awareness of the need to involve migrant and seasonal farmworkers in a meaningful way in the research on outcomes that are important to them,” she says.

With the help of local partners who work closely with farmworkers in the target states of Kansas, Missouri, and Texas, Holmes is recruiting farmworkers as direct collaborators in the process, training them to help identify needs and solutions. The farmworkers are embracing this role, she reports, excited to play a part in improving the lives of their fellow workers. “Sometimes it’s important to have someone remind you how valuable your insights are,” Holmes adds.

In the long term, the team hopes to see more research conducted that includes farmworkers as partners, and that focuses on the needs and preferences they identify. They also want health care providers and agencies to utilize the research results, and for funders to include this approach and population in their strategic plans.

The Importance of Partners

Holmes knows it would be very difficult to gain the trust and cooperation of the farmworkers without the involvement of key partners that the workers know and trust. While the team from the KU School of Social Welfare serves as the project lead, the work would not be possible without community co-leads, the Migrant Farmworkers Assistance Fund and the National Center for Farmworker Health. A national advisory council comprised of a variety of organizations offers additional expertise and insights.

“With populations that can be harder to reach, this connection with community partners is essential,” she points out. “My access to migrant workers is because of my community partners.”

There is still a long way to go in providing migrant and seasonal farmworkers with the health care support they need and deserve. However, Holmes is excited by the progress she and her team are making. “We are working to build the capacity needed to improve outcomes important to these men and women who contribute so muchto our food system,” she says.

Research in the Time of COVID-19

When the global pandemic hit in 2020, Cheryl Holmes and her team knew COVID-19 would adversely impact migratory and seasonal farmworkers. They were thrilled to receive an additional $150,000 in COVID-19 enhancement funding from the Patient-Centered Outcomes Research Institute to find out more.

“We have been administering in-person surveys with farmworkers to obtain insights into how they obtain COVID-related information, who they trust to provide that information, and on what topics they need more information,” Holmes says. They carefully weighed their decision to conduct in-person surveys against the risk, ultimately implementing safety protocols to protect farmworkers and surveyors alike. “We knew that farmworkers living in very rural areas would be missed if we limited our methods to the use of telephone and internet alone.” The survey results, along with other content, will help inform a COVID-19 related research agenda.