Identification of barriers to the prevention and treatment of heat-related illness in Latino farmworkers using activity-oriented, participatory rural appraisal focus group methods

Abstract

BackgroundHeat-related illness (HRI) is an important cause of non-fatal illness and death in farmworkers. We sought to identify potential barriers to HRI prevention and treatment in Latino farmworkers.MethodsWe conducted three semi-structured focus group discussions with 35 Latino farmworkers in the Central Washington, USA area using participatory rural appraisal techniques. Interviews were audio taped and transcribed in Spanish. Three researchers reviewed and coded transcripts and field notes, and investigator triangulation was used to identify relevant themes and quotes.ResultsAlthough the majority of participants in our study reported never receiving formal HRI training, most participants were aware that extreme heat can cause illness and were able to accurately describe HRI symptoms, risk factors, and certain prevention strategies. Four main observations regarding farmworkers’ HRI-relevant beliefs and attitudes were identified: 1) farmworkers subscribe to varying degrees to the belief that cooling treatments should be avoided after heat exposure, with some believing that such treatments should be avoided after heat exposure, and others encouraging the use of such treatments; 2) the desire to lose weight may be reflected in behaviors that promote increased sweating; 3) highly caffeinated energy drinks are preferred to increase work efficiency and maintain alertness; and 4) the location of drinking water at work (e.g. next to restrooms) and whether water is clean, but not necessarily chemically-treated, are important considerations in deciding whether to drink the water provided at worksites.ConclusionsWe identified potential barriers to HRI prevention and treatment related to hydration, certain HRI treatments, clothing use, and the desire to lose weight among Latino farmworkers. Strategies to address potential barriers to HRI prevention and treatment in this population may include engineering, administrative, and health education and health promotion strategies at individual, workplace, community, and societal levels. Although farmworkers in our study were able to describe HRI risk factors, reported practices were not necessarily consistent with reported knowledge. Further study of potential knowledge-behavior gaps may uncover opportunities for additional HRI prevention strategies. Farmworkers and employers should be included in the development and evaluation of interventions to prevent HRI.

Heat strain, volume depletion and kidney function in California agricultural workers

“…Under Cal-OSHA requirements, farmers are required to provide heat illness prevention training for workers and offer regular breaks to cool off and rehydrate (Cal-OSHA Heat Illness Regulation 3395). Despite research that suggests workers do not remember the information provided in the trainings and do not take recommended breaks,4 43 our estimates of heat strain indicate that workers in our sample do not experience high levels of heat strain. This may be related to the different farm tasks performed, suggesting that not all farm work is strenuous.…”

“…Other estimates of fluid intake among agricultural workers suggest that the amount of water workers drink is not sufficient to replace fluids and electrolytes lost during the work shift,6 as many do not believe they are at risk for injury and do not adequately rehydrate 5. In addition, agricultural workers often distrust water supplied by employers, and do not bring enough of their own water to adequately hydrate during the day 43. However, the lack of association of volume depletion to AKI was surprising, given the above findings.…”

Cumulative Incidence of Acute Kidney Injury in California's Agricultural Workers

“…Those who are paid by the piece may be more reluctant to take recommended breaks to rest in the shade or drink water because stopping work cuts into time that could be spent picking and may result in lower wages. 28 Therefore, those paid by the piece may inadvertently expose themselves to greater levels of occupational hazards, including heat illness and dehydration, 29 which may prove damaging to the kidneys. Fortunately, the method of paying agricultural workers is a modifiable risk factor and could be an approach to reducing incident AKI over a work-shift.…”

Heat effects among migrant and seasonal farmworkers: a case study in Colorado

“…They also identified several factors that potentially reduce heat-related illness, including increasing breaks in the shade, increasing access to medical attention, reducing soda intake or increasing access to regular breaks. Lam et al 16 interviewed 35 Hispanic farmworkers in Washington and identified several barriers to prevent them from heat-related illness. To the best of our knowledge, no studies examined heat effects among migrant and seasonal farmworkers using clinical data.…”