"The Only Thing I Wish I Could Change Is That They Treat Us Like People and Not Like Animals": Injury and Discrimination Among Latino Farmworkers.

OBJECTIVE: This article describes how perceived discrimination shapes the way Latino farmworkers encounter injuries and seek out treatment. METHODS: After 5 months of ethnographic fieldwork, 89 open-ended, semistructured interviews were analyzed. NVivo was used to code and qualitatively organize the interviews and field notes. Finally, codes, notes, and co-occurring dynamics were used to iteratively assess the data for major themes. RESULTS: The primary source of perceived discrimination was the "boss" or farm owner. Immigrant status was also a significant influence on how farmworkers perceived the discrimination. Specifically, the ability to speak English and length of stay in the United States were related to stronger perceptions of discrimination. Finally, farm owners compelled their Latino employees to work through their injuries without treatment. CONCLUSIONS: This ethnographic account brings attention to how discrimination and lack of worksite protections are implicated in farmworkers' injury experiences and suggests the need for policies that better safeguard vulnerable workers.

User Perceptions of ¡Protéjase!: An Intervention Designed to Increase Protective Equipment Use Among Mexican Immigrant and Mexican American Farmworkers.

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.

Anthropological and psychological merge: design of a stress measure for Mexican farmworkers.

This study implements qualitative and quantitative methodologies in the development of a culturally appropriate instrument of stress for Mexican immigrant farmworkers. Focus groups were used to uncover culturally based perspectives on life stressors, definitions of stress, and stress mediators. Qualitative data were analyzed using QSR NVivo and then used to develop a 23-item stress scale. The scale was tested for reliability and validity in an independent sample and demonstrates excellent reliability (alpha = 0.9123). Test-retest coefficients of the stress scale are also strong (r = 0.8344, p = 0.0000). Qualitative analyses indicated three major sources of stress: work, family, and community. Emotional aspects of stress also emerged, demonstrating a cultural perspective of stress closely related to feelings of despair and not being able to find a way out of despairing situations. This paper reveals themes gathered from the qualitative data and identifies reliability and validity constructs associated with the scale. The stress scale developed as part of this investigation is a reliable and culturally appropriate instrument for assessing stress among Mexican immigrant farmworkers.

Methodologic advances and ongoing challenges in designing community-based health promotion programs.

Community intervention trials continue to attract researchers as potential ways to achieve widespread, long-term change in health behaviors. The first generations of community studies were somewhat unsophisticated in design and analysis, and their promise may have been overstated. As design and analysis issues were better defined, as secular trends caught up with the behaviors that researchers were trying to change, or as other unknown variables affected community studies, small effects of interventions were observed in community trials. Discussions were held in professional meetings and reported in the literature: Should community trials be discontinued? In general, the answer was a qualified no. In this paper, we briefly review some of the many advances made in community intervention trials, and address in more detail the challenges ahead.