Intervening to Improve Health Indicators Among Australian Farm Families

Stressors and Coping Strategies in Rural Farmers: A Qualitative Study

OBJECTIVE

Farmers in rural areas face unique lifestyle stressors which may cause physical and behavioral health issues. Because of external stressors, and often an internal drive to succeed, farmers in rural areas have high rates of prescription drug use, excessive alcohol use, depression, and suicide. These methods of coping may increase prevalence of distress and mental illness in farmers leading to poor health outcomes. Social norms within rural farming populations are influenced by culture, family, friends, and community beliefs which make it difficult to conduct research about substance use and mental health. The purpose of this study is to identify stressors in rural farmers and positive and negative coping strategies for stress in the farming population.

METHODS

In-depth interviews (35 minutes-1 hour) were conducted with full-time rural farmers (n = 15) in ten counties throughout Georgia. Using qualitative analysis, inductive coding was used to identify themes and patterns among transcribed interview recordings.

RESULTS

Stressors reported by farmers included: financial, work-life balance, physical health and disconnect from non-farming populations. Farmers described feeling misperceived by those outside of their community and feeling a distinct lack of control due to external factors. All the farmers identified alcohol use as a primary coping strategy to deal with stressors.

CONCLUSIONS

This study identifies distinct stressors associated with a farming lifestyle and socio-cultural factors that are barriers to care for mental health and substance use in rural farmers. This study can provide information to health practitioners that may lead to a better understanding of the factors influencing farmer's health outcomes.

Farmer Mental Health Interventions: A Systematic Review

The prevalence of mental health disorders and suicide amongst agricultural producers is a global problem. Community leaders, researchers, policymakers, and clinicians have mobilized to develop programs to address this issue. This study reviewed a wide range of mental health interventions targeting farmer mental health spanning over 50 years and examined their reported effectiveness and constraints. A total of ninety-two articles on farmer mental health were included in a final systematic review. Most articles were written concerning mental health literacy and peer and paraprofessional support interventions in the United States and Australia. Among the 56 studies reporting empirical evaluative data, 21 were mixed-method, 20 quantitative, 11 qualitative, and 5 literature synthesis. Non-experimental, self-reported, and qualitative data suggest efficacy of mental health literacy programs, peer and paraprofessional support, and community-based and agroecological interventions. However, most interventions were not subject to rigorous evaluation and only one intervention was evaluated using a control condition. The heterogeneity of existing studies and paucity of rigorous evaluation proscribes firm conclusions related to program-type efficacy. This review demonstrates that there is still a need for a stronger and broader evidence base in the field of farmer mental health interventions, which should focus on both holistic, multi-component programs and targeted approaches.

"Farmers Aren't into the Emotions and Things, Right?": A Qualitative Exploration of Motivations and Barriers for Mental Health Help-Seeking among Canadian Farmers

Working in agriculture has been associated with an increased prevalence of psychological distress and mental health concerns. Farmers are also less likely than non-farmers to seek-help for their mental health. Previous research examining help-seeking among farmers has focused predominantly on male farmers, and has not included many of the Canadian agricultural commodity groups or provinces. The goal of this study was to explore perceptions of farmer help-seeking for mental health amongst farmers and people who work with farmers. The study objectives were to characterize the motivations and barriers to help-seeking behaviours. Semi-structured interviews were conducted with 75 farmers and individuals who work with farmers in Ontario, Canada, between 2017 and 2018. Interviews were conducted in person, and by telephone when needed. Topics of discussion included farming stresses and their impacts; personal well-being; agricultural crises and mental health help-seeking; use of mental health supports; motivators and barriers to help-seeking; and perceived ideals for mental health supports. Thematic analysis was conducted collaboratively by three authors using inductive and deductive coding. Our analysis resulted in five themes around help-seeking motivations and barriers: 1) Accessibility of mental health supports and services; 2) Stigma around mental health in the agricultural community; 3) Anonymity and/or lack of anonymity in seeking support; 4) Farm credibility; and 5) Recommendations for implementing mental health services for the agricultural community. This study provides insights around how farming culture and the accessibility and delivery of services may influence help-seeking for mental health, and proposes strategies to break down barriers to help-seeking in this population.

Farmer Discussion Groups Create Space for Peer Learning about Safety and Health

Objectives: Occupational safety and health (OSH) interventions emphasizing regulation or education have had limited success in reducing agricultural accidents and fatalities. There is a growing interest in sociocultural approaches to OSH promotion amongst farmers, such as peer learning groups (PLGs). The level of OSH engagement within farmer PLGs (e.g. dairy discussion groups (DDGs)) is unknown. This study evaluates Irish DDG engagement with OSH in 2016 to better understand how DDGs contribute to OSH promotion.Methods: A mixed-mode (online, postal, and telephone) retrospective survey of 121 DDG representatives (i.e. chairperson or long-term member) assessed voluntary OSH engagement in 2016, including the location, frequency, duration, and content of OSH discussions.Results: Representatives of 96 DDGs participated in the survey and met the survey criteria. Most DDGs discussed OSH to some extent in 2016 (96%), including sharing personal experiences of accidents and illnesses (89%) and close calls (82%). For 76 DDGs, at least one meeting in 2016 addressed specific hazard and risk management topics. Groups were diverse with respect to discussion frequency, duration, and topics discussed.Conclusion: Farmers actively engaged with OSH in most DDGs surveyed, suggesting dairy farmers value OSH discussions. The findings illustrate the role of DDGs in OSH promotion, as a space for farmer-led, peer-to-peer knowledge-sharing. Farm advisory (extension) services and OSH professionals can strengthen OSH engagement through tailored resources that reflect contemporary OSH knowledge and popular discussion approaches (e.g. experience-sharing).

Educational Interventions to Improve Safety and Health Literacy Among Agricultural Workers: A Systematic Review

Health and safety education for farmers has the potential to increase the level of health, safety literacy, and thereby improve farmers’ health and quality of life. The aim of this paper is to provide a systematic review of the published literature documenting different educational interventions for agricultural workers that have the improvement of health and/or safety literacy as an outcome. A systematic search was conducted in PubMed, Embase, Scopus and PsycINFO databases for articles focusing on educational interventions for farmers’ health and safety. From the 3357 initial hits, 36 unduplicated records met the inclusion criteria. The articles included in the review used educational interventions for farmers with the purpose of preventing farm-induced diseases and injuries, increasing the health and well-being of farmers, and promoting good manufacturing practices. The educational approaches considered varied from lectures, videos, newsletters, games, and community fairs, to involving the community in designing the intervention and training farmers to deliver the intervention to the community. Interventions that used evidence-based theories, which took into account cultural aspects and individual factors, used biomarkers as a behavior change measurement, and involved the community in the development of the intervention had the best results in terms of behavior change. The strategies of educational interventions identified in this review that produced good results have the potential to inform future researchers and policy makers in the design and implementation of public health interventions, programs and policies to improve the health of farmers and their families.

Health Indicators of a Cohort of Midwest Farmers: Health Outcomes of Participants in the Certified Safe Farm Program

Occupational illness, injury, and fatality rates for those working in production agriculture are higher than in any other industry. A potential risk factor contributing to occupational injuries across all industries is acute or chronic co-morbidity (e.g., obesity, high blood pressure, high cholesterol), and related health issues that increase the risk for an occupational injury or illness. These chronic health conditions have been associated not only with increased risk for injuries, but also higher health-care costs, and greater absenteeism. Certified Safe Farm (CSF) is a comprehensive intervention program aimed to reduce occupational health and safety hazards and to promote general health among farmers. Prior publications have described CSF program efforts to reduce hazardous exposures, disabling injuries, organic dust toxic syndrome, occupational health-care costs, and to increase positive occupational health behaviors. This paper reports on the general health indicators of a cohort of 438 Iowa farm owner/operators enrolled in the CSF program. Overall, this study found that the farming population in Iowa has higher body mass index (BMI), but lower total cholesterol, low-density lipoprotein (LDL), and lower prevalence of hypertension compared to the general population. There was evidence that the combination of high blood pressure, cholesterol, and BMI were related to increased injury rates. Poor self-reported health status was also related to increased injuries but was not related to clinical health indicators. The CSF intervention led to improvements on health outcomes, particularly among those in the 35 to 49 age group. Little research has focused on the individual's general health status as a predictor of risk of occupational injury. This study suggests the need for additional research and interventions integrating occupational safety and health prevention along with health promotion.

Multiple-Time-Series Clinical Data Processing for Classification With Merging Algorithm and Statistical Measures

A description of patient conditions should consist of the changes in and combination of clinical measures. Traditional data-processing method and classification algorithms might cause clinical information to disappear and reduce prediction performance. To improve the accuracy of clinical-outcome prediction by using multiple measurements, a new multiple-time-series data-processing algorithm with period merging is proposed. Clinical data from 83 hepatocellular carcinoma (HCC) patients were used in this research. Their clinical reports from a defined period were merged using the proposed merging algorithm, and statistical measures were also calculated. After data processing, multiple measurements support vector machine (MMSVM) with radial basis function (RBF) kernels was used as a classification method to predict HCC recurrence. A multiple measurements random forest regression (MMRF) was also used as an additional evaluation/classification method. To evaluate the data-merging algorithm, the performance of prediction using processed multiple measurements was compared to prediction using single measurements. The results of recurrence prediction by MMSVM with RBF using multiple measurements and a period of 120 days (accuracy 0.771, balanced accuracy 0.603) were optimal, and their superiority to the results obtained using single measurements was statistically significant (accuracy 0.626, balanced accuracy 0.459, P < 0.01). In the cases of MMRF, the prediction results obtained after applying the proposed merging algorithm were also better than single-measurement results (P < 0.05). The results show that the performance of HCC-recurrence prediction was significantly improved when the proposed data-processing algorithm was used, and that multiple measurements could be of greater value than single.

Reducing psychological distress and obesity in Australian farmers by promoting physical activity

BACKGROUND

Studies have confirmed that the rate of mental illness is no higher in rural Australians than that of urban Australians. However, the rate of poor mental health outcomes, and in particular suicide, is significantly raised in rural populations. This is thought to be due to lack of early diagnosis, health service access, the distance-decay effect, poor physical health determinants and access to firearms. Research conducted by the National Centre for Farmer Health between 2004 and 2009 reveals that there is a correlation between obesity and psychological distress among the farming community where suicide rates are recognised as high. Chronic stress overstimulates the regulation of the hypothalamic-pituitary-adrenal (HPA) axis that is associated with abdominal obesity. Increasing physical activity may block negative thoughts, increase social contact, positively influence brain chemistry and improve both physical and mental health. This paper describes the design of the Farming Fit study that aims to identify the effect of physical activity on psychological distress, obesity and health behaviours such as diet patterns and smoking in farm men and women.

METHODS/DESIGN

For this quasi-experimental (convenience sample) control-intervention study, overweight (Body Mass Index ≥25 kg/m(2)) farm men and women will be recruited from Sustainable Farm Families™ (SFF) programs held across Victoria, Australia. Baseline demographic data, health data, depression anxiety stress scale (DASS) scores, dietary information, physical activity data, anthropometric data, blood pressure and biochemical analysis of plasma and salivary cortisol levels will be collected. The intervention group will receive an exercise program and regular phone coaching in order to increase their physical activity. Analysis will evaluate the impact of the intervention by longitudinal data (baseline and post intervention) comparison of intervention and control groups.

DISCUSSION

This study is designed to examine the effect of physical activity on psychological health and other co-morbidities such as obesity, impaired glucose tolerance, hypertension and dyslipidaemia within a high-risk cohort. The outcomes of this research will be relevant to further research and service delivery programs, in particular those tailored to rural communities.

TRIAL REGISTRATION

ACTRN12610000827033.