Understanding Factors that Influence Health Care Utilization Among Mixtec and Zapotec Women in a Farmworker Community in California

The Health and Well-Being of Women in Farming: A Systematic Scoping Review

OBJECTIVES

Health and well-being have long been identified as key issues for investigation within agricultural communities. While myriad studies have been conducted to investigate causation, impact, outcomes and interventions among farming populations, the overall emphasis has been disproportionately weighted away from the experiences of women. This systematic scoping review determines the prevalence of topics, identifies the target populations and geographical locations of studies, outlines methodological approaches to the subject area, and summarizes the key findings and conclusions of the available literature.

METHODS

With the guidance of the Arksey and O'Malley framework for conducting a scoping review, a single database search for publications focusing on the health and well-being of women in farming (including primary farmers, members of farm households, and farmworkers), in the Global North, published between 1990 and 2023, was conducted. Data were organized, thematically coded, critically appraised and analyzed using the systematic review online tool CADIMA.

RESULTS

In total, 93 studies met the inclusion criteria for full review. The majority of studies were conducted in the United States, with the number of publications steadily increasing since the 1990s. Of studies, 68% were wholly quantitative in nature, and 23% wholly qualitative. Key findings suggest women are at particular risk from certain illnesses associated with some aspects of agricultural work and face a number of stressors (including gender-specific issues) that can lower well-being, but evidence is scarce in a number of areas. Clear gaps in research exist in relation to reproductive health, caring responsibilities, or help-seeking and support. Women primary farmer and farmworkers are particularly neglected as study cohorts.

CONCLUSION

Numbers of studies related to the health and well-being of women in farming are still relatively small in comparison with the wider body of related literature, and there exists an obvious need for further studies with a specific emphasis on particular cohorts, issues pertaining to the contemporary climate, and issues specific to women, as well as greater geographical reach. By emphasizing such research gaps, opportunities exist to improve the health and well-being situation of women in agriculture through more explicit studies with the intention of developing more effective, targeted solutions.

Barriers and facilitators for breast cancer early diagnosis in an indigenous community in Mexico: voices of otomí women

BACKGROUND

Literature on barriers and facilitators for early detection of Breast Cancer (BC) among indigenous women is very scarce. This study aimed to identify barriers and facilitators for BC early diagnosis as perceived by women of the otomí ethnic group in Mexico.

METHODS

We performed an exploratory qualitative study. Data was collected in 2021 through three focus group interviews with 19 otomí women. The interview transcripts were analyzed using the constant comparison method and guided by a conceptual framework that integrates the Social Ecological Model (SEM), the Health Belief Model and the Institute of Medicine's Healthcare Quality Framework.

RESULTS

Barriers and facilitators were identified at several levels of the SEM. Among the main barriers reported by the study participants were: beliefs about illness, cancer stigma, cultural gender norms, access barriers to medical care, and mistreatment and discrimination by health care personnel. Our participants perceived as facilitators: information provided by doctors, social support, perceived severity of the disease and perceived benefits of seeking care for breast symptoms.

CONCLUSIONS

Healthcare policies need to be responsive to the particular barriers faced by indigenous women in order to improve their participation in early detection and early help-seeking of care for breast symptoms. Measures to prevent and eradicate all forms of discrimination in healthcare are required to improve the quality of healthcare provided and the trust of the indigenous population in healthcare practitioners.

A homozygous Gly470Ala variant in PEX6 causes severe Zellweger spectrum disorder

Zellweger spectrum disorder (ZSD) is a group of autosomal recessive disorders caused by biallelic pathogenic variants in any one of the 13 PEX genes essential for peroxisomal biogenesis. We report a cohort of nine infants who presented at birth with severe neonatal features suggestive of ZSD and found to be homozygous for a variant in PEX6 (NM_000287.4:c.1409G > C[p.Gly470Ala]). All were of Mixtec ancestry and identified by the California Newborn Screening (NBS) Program to have elevated C26:0-lysophosphatidylcholine but no reportable variants in ABCD1. The clinical and biochemical features of this cohort are described within. Gly470Ala may represent a founder variant in the Mixtec population of Central California. ZSD should be considered in patients who present at birth with severe hypotonia and enlarged fontanelles, especially in the setting of an abnormal NBS, Mixtec ancestry, or family history of infant death. There is a need to further characterize the natural history of ZSD, the Gly470Ala variant, and expand upon possible genotype-phenotype correlations.

Language Accommodations for Limited English Proficient Patients in Rural Health Care

Over 25 million individuals living in America are limited English proficient, many of whom live in rural communities. Adequate language accommodations are critical to providing effective healthcare for these populations. An online questionnaire was delivered to 42 rural facilities in Washington State. It included questions about their demand for language services, modalities of interpretation, translated documentation and barriers to providing accommodations. Fifteen of 42 (35.7%) responded. Spanish, Russian, Vietnamese, Japanese, Ukrainian and Mam were encountered daily. Telephonic and virtual remote interpreter services were the most widely available. Not all facilities had vital documents translated to frequently encountered languages. Challenges to providing language access were reported by nearly all participants. The rural facilities surveyed all encountered LEP patient populations and offered oral interpretation. Overall, these facilities were meeting requirements for providing language accommodation services. Even so, many facilities reported experiencing barriers to providing these services.

Aprendiendo de La Vida (Learning from Life): Development of a Radionovela to Promote Preventive Health Care Utilization among Indigenous Farmworkers from Mexico Living in California

Mixtecs and Zapotecs, originating from the Oaxaca area in Mexico, are among the largest indigenous groups of workers in California. Many adults in this community only access the health care system when sick and as a last resort. This article describes the development of a radionovela to inform the community about the importance of preventive health care. It was developed following the Sabido Method. The methodology to develop a radionovela may be of interest to other public health practitioners who want to develop educational materials in an engaging format, especially for communities that rely on oral, not written information.

Exploring Barriers to Access Prenatal Care Among Indigenous Mexican and Guatemalan Women in Washington State

Migrant and Seasonal Agricultural Workers including indigenous women that are not of Hispanic descent face many barriers to access prenatal care. We conducted a survey in Spanish and three indigenous languages to explore knowledge, attitudes and behaviors regarding prenatal care among 82 female agricultural workers, Mixteco, Triqui and Awakateko, residing in the State of Washington. Our findings highlight the importance of collecting disaggregated data from different indigenous communities and of providing indigenous language support. Our study provides new information for developing messages to promote prenatal care that take into account the knowledge and beliefs that are prevalent in these communities.

Advancing the Health of Migrant and Seasonal Farmworkers in the United States: Identifying Gaps in the Existing Literature, 2021

There are profound health inequities for agricultural workers. We sought to assess the literature on migrant and seasonal farmworker health with an eye toward health promotion interventions, special populations, use of community health workers (CHWs), and technology. We conducted a systematic mapping review by searching five databases in March 2021. Using quantitative content analysis after establishing interrater reliability, we coded titles and abstracts to assess 13 topics and six characteristics of the research such as its focus on health promotion, use of technology, and inclusion of CHWs. We identified 1,083 records. Just 8.2% of records described or evaluated a health promotion effort to intervene in farmworker well-being and even fewer (4.2%) examined unique populations of farmworkers such as indigenous farmworkers (n = 11) or sexual minority farmworkers (n = 1). A small body of literature focused on the role of CHWs or promotores most frequently described their role in implementing health interventions. The literature on farmworker health has gaps regarding health promotion interventions, special populations, and integration of CHWs into research projects. We offer suggestions to fill in identified gaps in the literature.

Challenges, inequalities and COVID-19: Examples from indigenous Oaxaca, Mexico

COVID-19 is a challenge for indigenous communities in Mexico. Social inequalities and limited access to services combine with historical patterns of discrimination to amplify its negative impacts. Nevertheless, there are important ways in which indigenous communities organise and respond. Our paper, organised in three parts, summarises these challenges as well as the response. In the first section, we introduce indigenous Oaxaca and the challenges facing indigenous communities. In the second section, we note the ways in which indigenous communities rely on their traditions in response to the pandemic and limitations they face. In the third and concluding section, we argue that the social inequalities that define indigenous life in Oaxaca must be acknowledged in order to create an effective public health response to COVID-19.

The (in)visible victims of disaster: Understanding the vulnerability of undocumented Latino/a and indigenous immigrants

As climate change advances, communities across the United States are adapting to the increased threat of wildfires, drought, heatwaves, and infectious diseases. Such disasters are expected to become more frequent and severe. Now more than ever, it is crucial to understand how these events amplify existing inequalities, and how to lessen the resulting harms. Differences in human vulnerability to disaster stem from a range of social, economic, historical, and political factors. We argue that given their social status, undocumented Latino/a and Indigenous immigrants are particularly vulnerable to disasters and require special consideration in disaster planning. They are disproportionately affected by racial discrimination, exploitation, economic hardships, less English and Spanish proficiency, and fear of deportation in their everyday lives- their pre-disaster marginalized status. In the case of the Thomas Fire in California's Ventura and Santa Barbara counties, we show that emergency response and recovery efforts ignored their needs. Resources were directed toward privileged individuals, leaving local immigrant rights and environmental justice groups to provide essential services such as language access to emergency information in Spanish and Indigenous tongues; labor protections for farmworkers endangered in the fields; and a private disaster relief fund for undocumented immigrants ineligible for federal aid. The article concludes with preliminary participant observations from the COVID-19 pandemic response in the region, indicating how lessons from the fire have informed official actions. As governments grapple with the increasing severity of disasters, understanding the differential impacts on undocumented immigrants can help improve disaster planning to protect the most vulnerable and stigmatized populations.

Latinx Immigrant Farmworker Community Health Promotion: A Needs Assessment

The present study examined the health promotion intervention needs of Latinx immigrant farmworker families residing in Oregon. Grounded theory qualitative procedures were used to analyze the needs assessment data from 31 Latinx immigrant farmworker residents and key informant interviews as well as four focus groups with resident youth and parents. A theoretical model of how key family-based health behaviors can both confer risk for and protection against negative physical, mental, and social health outcomes among Latinx farmworking communities emerged. Six primary areas of concern emerged from these data, leading to the identification of primary health promotion intervention needs with three foci: (a) the provision of sustainable supports and resources, (b) skill development so that individuals could successfully negotiate identified challenges, and (c) greater community efficacy. Findings underscore the importance of social support and resource accessibility for Latinx immigrant populations.

Providing Health Education to Mixtec Farmworkers in California via Workshops and Radio: A Feasibility Study

Originating from one of the poorest areas in Mexico, Mixtecs are one of the largest indigenous groups of workers in California. Providing health education to this group is challenging because many do not speak English or Spanish, and indigenous languages are mainly oral, not written. We explored the feasibility of conveying health information through the radio and in promotora-led workshops. The study included an evaluation of the workshops through surveys before the workshop and 4 to 6 months later in a subsample of 96 indigenous women. The number of radio listeners averaged more than 2,000 per month, and 500 community members attended a workshop. Among women who completed pre- and postworkshop assessments (N = 75), there was a statistically significant increase in knowledge of how to get a wellness visit, where to get a free mammogram, and mammography screening guidelines. Women who ever had a mammogram or wellness visit at baseline were significantly more likely to report receipt of this service during the follow-up period than women who never had this service. Educational workshops and radio are promising and culturally appropriate strategies to provide health information in this community. However, many women need additional assistance to navigate access to health care.