Catherine E. LePrevost

Introduction: Access to reliable internet is recognized as a social determinant of health, yet many migrant and seasonal farmworkers in North Carolina (NC) face barriers to connectivity due to rural housing locations and limited infrastructure. In response to these challenges, the NC Farmworker Health Program implemented a pilot program that installed ruggedized internet routers in employer-provided farmworker housing where other internet options were not available to improve digital inclusion and telehealth access. Methods: This qualitative study evaluated the program four years after implementation through interviews with Hispanic farmworkers (n=9) and farm owners (n=5), internet performance tests, and site observations at participating NC farms in 2024. Results: Findings showed that internet access fostered communication with family among Hispanic farmworkers. However, there were significant programmatic challenges, including weak or limited signal range, poor internet speed, lack of privacy, minimal cybersecurity, and low awareness of telehealth services. Farm owners supported the program but expressed concerns about sustaining it without continued funding due to performance limitations and costs. Conclusion: These findings highlight the importance of sustainable, high-quality internet in rural farmworker housing and suggest a need for expanded support, improved performance, and greater education around tools such as telehealth to address inequities that agricultural communities face.

There is a need for expanded language services in U.S. healthcare and public health systems, and preparing health providers and health educators to work with interpreters is one approach to this end. In this paper, we examine experiences of pre-health and health professions students, health promotion students, and practitioners in an independent online language interpretation training. A state-funded workforce development program provided a 40-hr online medical interpretation training to 80 participants during the 2022–23 academic year. At the close of the program, 17 individuals participated in qualitative interviews regarding their expectations for the training, perceptions of training material and delivery, barriers to participation, personal and professional impact, and reflections on their experiences. Authors coded the interviews through an iterative process and developed matrices to represent the salient themes discovered within the transcript data. Participants were mostly Latina/Hispanic women who were pre-health professions or public health undergraduate students. Participants elected to register for the training, in many cases, because of personal experience with the challenges posed by a language-inaccessible healthcare system. They valued the materials provided and the practical lessons that reinforced the information presented in lectures. Participants’ main feedback was to alter the schedule to be less intensive. There is an existing interest among future providers and educators to be ready to serve patients regardless of the patient’s primary language, but relevant programming is not always accessible to students or professionals. Curriculum developers should consider this demand and the limitations of using an extracurricular interpretation training when developing language access experiences for students.

Many agricultural producers live and work in rural areas that have been left behind in broadband internet expansion. A lack of digital inclusion of agricultural communities can stymie agricultural producers’ participation in e-commerce and marketing, use of precision agriculture, and access to infor­mation. To better understand how farm owners and managers access the internet and their digital skills, we conducted a mixed-methods research project using focus groups (N = 4) with partici­pants (n = 26) living in four North Carolina (NC) counties in 2023. We used thematic analysis to qualitatively analyze the focus group data. To quan­titatively assess emerging themes, we then con­ducted a survey of farmers (n = 113) at a statewide farm show in NC in 2024. We calculated descrip­tive statistics for the survey data, including demographics (gender, race, crops or livestock pro­duced, acreage farmed) and experience with de­vices, social media, and troubleshooting. We identi­fied three overarching themes: (1) experiences with internet and digital technologies; (2) impacts of internet access and digital technology, including farmers’ reflections on the critical need for internet connectivity for farm operations and perceptions of negative consequences of not having adequate connectivity; and (3) sentiments toward internet, specifically farmers’ frustration with the current state of connectivity options and opinions on initi­atives to improve connectivity. Findings reveal an imperative for better digital inclusion of farms and agricultural communities across NC.

Digital health services can facilitate patients’ access to healthcare. However, access to reliable internet and utilization of digital healthcare are patterned by race, ethnicity, and class in the United States. We assessed willingness, use, and challenges accessing digital healthcare platforms among farmworkers arriving in North Carolina on temporary H-2A work visas ( n = 327). We fielded a survey on digital healthcare access in English and Spanish at a central arrival hub for H-2A visa holders in 2024. We calculated descriptive statistics and assessed associations between willingness to use and uptake of digital healthcare and demographic variables. Most participants were interested in utilizing telehealth and patient portals, but few had ever used these services. Among participants who had used telehealth, 50% reported needing assistance. Older participants were less likely to utilize patient portals than younger participants. Future interventions should consider the unique context of migrant farmworkers in building digital health service models and provide digital skills training.

Digital exclusion is a challenge in rural North Carolina (NC), USA, where agriculture is the leading industry. Agricultural workers such as migrant and seasonal farmworkers (hereafter “farmworkers”) are disproportionately impacted by digital exclusion. As part of an effort to address digital exclusion, funders and state agencies in NC have promoted the development of county and regional plans for digital inclusion. From July 2023 to July 2024, we identified a total of 30 digital inclusion plans that covered 50 of NC’s 100 counties. To assess inclusion of farmworkers, we used a quantitative content analysis approach with two independent coders. No digital inclusion plans included farmworkers in their needs assessments or goals. Just 7% of digital inclusion plans included farmworker organizations in their planning and development, 13% of plans noted agriculture as a topic of interest in their needs assessments, and 40% noted agricultural technologies as a topic of interest. None included short or long-term goals related to agriculture. The general invisibility of farmworkers in plans contrasts with greater attention given to agriculture-related technologies. Additional attention must be given to ensure farmworkers are involved in future digital inclusion efforts.

Mitigating pesticide exposure among migrant and seasonal farmworkers (both referred to as “farm­workers” herein) is important for agricul­tural safety and health. Among farmworker pati­ents served by the North Carolina (NC) Farm­worker Health Program in 2021 (N = 11,518), 99% identified as Latine, 98% reported being nonfluent in English, 94% reported incomes below the federal poverty level, and 92% indicated they were uninsured. Prior community-led work in NC with farmworkers, advocates, and others working closely with farm­workers has highlighted demands for expanded employment benefits and improved living and working conditions, including pesticide protections, as well as expanded access to high-quality health care, improved visibility of farm work, and policy change for a better future (Cofie et al., 2023). Efforts to address pesticide exposure are critically important. . . .

Background: Despite the composition of the United States' agricultural workforce and the sector's reliance on Spanish‐speaking migrant labor, pesticide labels are largely available in English only. Currently, federal regulators are considering strategies to provide pesticide label information access in Spanish via a QR code or through other electronic methods on the pesticide container. Data on access to labels and the use of QR codes among agricultural workers are limited. We provide policy‐relevant findings from surveys collected at a large agricultural worker H‐2A visa arrival hub.Methods: In April and May 2024, we verbally administered Spanish‐language, in‐person surveys in North Carolina (n = 160). We asked questions about pesticide use, access to labels, and QR code use as well as age, gender, and seasons worked in the United States.Results: Descriptive analyses revealed approximately 60% of workers had not used a QR code. Among participants who had used pesticides and worked for two or more seasons (42%), approximately 30% reported not having access to the label on the container.Conclusion: The survey findings show QR‐code‐based pesticide labels will reach a subset of workers, but substantial gaps will remain.

ObjectivesThe aim of this study was to analyze how farmworkers are represented in stock photos available in commercial libraries for use in agricultural health and safety education materials.MethodsWe searched for images in five commercial stock photo libraries using the terms "farmworkers" and "women farmworkers" in April 2022. We used quantitative content analysis. We coded each image for containing a visible face, age, gender, skin tone, work activity, mechanization, presence of hazards, technology use, and protective equipment/clothing after establishing inter-coder reliability. We used descriptive statistics to characterize the available stock photos.ResultsWe identified stock photos (n = 127) in three databases (Adobe Stock Images, Canva, and Getty Images). Two databases (Microsoft Office Image Library and Pixabay) had no relevant images at the time of the search. Only half of the photos analyzed contained a face. Light skin tones and young or middle-aged adults were more common. A majority of farming activities represented in photos were manual tasks (e.g., harvesting) with few depictions of equipment, hazards, and protective equipment/clothing.ConclusionsHealth and safety professionals tasked with developing materials for education in agricultural settings face a severe lack of imagery pertinent to the realistic conditions of farmworkers in the United States. In the databases we reviewed, photos displaying human faces, photos showing a range of skin tones and ages, and photos displaying an array of different farm hazards are likely not sufficient for material development. Health and safety professionals may benefit from sharing photos from their own work with other professionals and allocating resources for professional photo shoots in their material development projects.