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Lucy Sanchez

M.S. Prevention Science & Community Health

Department of Hematology and Medical Oncology, Emory University

Strategies to Increase Cultural Competentcy in Underserved Migrant and Seasonal Farm Worker Communities

Agenda

  • Public health significance and disproportionate disease burden statistics of MSFW communities

  • Underlying factors for disease burden within the MSFW community

  • Supporting behavioral theories

  • Final Thoughts

Seasonal Farmworkers in the U.S.

Public Health Significance

  • According to recent estimates by the National Center for Farmworkers Health (NCFH), there are over 3 million agricultural workers across the United States (NCFH, 2018).

  • 2013-2014 NAWS Report
  • 73% were immigrants
  • 47% were undocumented

  • 2015-2016 NAWS Report
  • 69% were born in Mexico with 83% identifying as Hispanic

  • In a 2002 data set, just 12% of MSFWs identified as women (Rosenbaum and Shin, 2005).

  • In 2013, NAWS estimated 28% of MSFWs were female.

  • In 2015, that number climbed from 4% to 32% (U.S. Department of Labor’s National Agricultural Workers Survey, 2018; Farmworkers Justice, 2019).

Data retrieved from the U.S. Census Bureau

Disease Burden

  • Within the MSFW community, the prevalence of obesity ranges from 29.2-54.5% (Matias el al, 2022).

  • Less than 50% of pregnant MSFWs received health care during their first trimester (Rosenbaum, S. & Shin, P., 2005)

  • 42.0–45.5% of participants across 3 studies looking at health outcomes for MSFWs were found to have high blood pressure (Matias el al, 2022).

  • One study “noted that HIV diagnoses increased 7.8% annually between 2003 and 2006 along the U.S.- Mexico border” (Espinoza et al, 2009).

  • Considering the mobility, stigma, and lack of stringent empirical data for these communities, preliminary research puts HIV prevalence among MSFWs somewhere between 2-13% (NCFH, 2018).

Data retrieved from the National Agricultural Workers Survey, 2019

Important Considerations

Cultural Competence

  • When identifying the causes for the chronic and infectious disease burden across the United States for these communities of MSFWs, researchers must look at more than just circumstance.

  • It is unidimensional to blame the burden of disease on farmworkers being uninsured and impoverish; MSFWs are particularly vulnerable for a number of social and environmental reasons that can make it difficult to seek medical treatment.

  • Numerous studies have highlighted the importance of using population-specific intervention techniques (Wyatt, Williams, Gupta, & Malebranche, 2012).
  • Cultural influence
  • Provides “rules and scripts about how to live and make decisions across the life course.
  • What does it really mean?

Theory of Planned Behavior

Theory Selection

  • The theory of planned behavior constitutes that behavioral beliefs (attitudes), normative beliefs (subjective norms), and control beliefs (perceived control) are the main factors that dictate the transition from intention to behavior (Ajzen, 1991).
  • Behavioral beliefs
  • Personal opinions and attitudes toward a certain behavior
  • Normative beliefs
  • Perceived expectations of others
  • Control beliefs
  • “Beliefs about the presence of factors that may facilitate or impede performance of the behavior (Ajzen, 2002
  • Each construct is a salient, informational precursors that informs the intention of a behavior.

Minority Stress Theory

Minority Stress Theory

  • Originally, it was used to assess the social component of the development of mental disorders in the LGBT+ community (Meyer 1995, 2003).
  • The minority stress theory incorporates social stress “by suggesting that conditions in the social environment, not only personal events, are sources of stress that may lead to mental and physical ill effects” (Meyer, 2003).
  • Proximal stressors and distal stressors are the main social tenets of the theory.
  • Proximal stressors include fear of rejections, rumination on past negative experiences with prejudice, and cultural betrayal.
  • Distal stressors include the actual perception of discrimination and prejudice while proximal stressors are the emotional appraisal of said prejudice.

Dual Model

  • In the diagram, just as in the original TPB model, attitudes receives input from both subjective norms and perceived behavioral control with the new addition of proximal and distal stressors posited by MST.

  • In this model, both proximal and distal stressors act as moderators for not only attitudes but subjective norms and perceived behavioral control as well.

  • Additionally, chronic distal and proximal stressors can lead to social isolation and distress.
  • This also has a moderating influence on intention and behavior
  • If an individual is partaking in the behavior, perceived social isolation can negatively impact their ability and willingness to continue

  • Under the updated model, intention and behavior have a progressive and regressive relationship where moderating factors such as proximal and distal stressors can impact the mechanism to action.

Closing Reminders

Discussion

  • What is the significance of cultural competence in your own work? How can you better cater to the socialeconomical nuances within the populations that you work with?

  • Are their subgroups within your target population that have different social inputs that researchers/physicians/policy makers should be aware of when creating a(n) intervention/treatment plan/bill?

Works Cited

References

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