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.

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.

Broadband internet and the skills and devices necessary to use it for full participation in society are recognized as important aspects of digital inclusion. Historically, digital divides – now often termed digital exclusion – were well documented and patterned by position within a society. An emerging literature has explored measures or indicators of being part of a digital underclass, having second-class access, or digital distress to help policymakers target resources to address digital exclusion and close divides. In this study, we compare existing area-level measures of digital distress derived from the American Community Survey (percent of homes with a cellular data only subscription, with no internet access, relying only on mobile devices, and not owning a computing device) to results of a 2023 statewide survey of migrant and seasonal farmworkers in North Carolina, United States. We calculate prevalence ratios to show differences in digital distress metrics. Migrant and seasonal farmworkers were 8.17 and 6.51 times more likely, respectively, to rely on cellular data only for internet service than North Carolina households. Migrant and seasonal farmworkers were 8.98 and 7.72 times more likely, respectively, to rely on mobile devices than North Carolina households. In this study, we show how state- and county-level digital distress measures can mask digital distress in specific groups. Policymakers and researchers should consider if specific populations’ digital exclusion cannot be captured in area-level or whole population metrics.

BACKGROUND:Language discordance clearly matters in the production of healthcare and health disparities. Less clear is how training in medical interpretation and language justice might shape the perspectives of health professions students and practitioners in advancing language access. We sought to explore how students in health professions training programs and health practitioners engaged with and experienced a medical interpretation course presented with or without a training focused on language justice. METHODS:We implemented a standard national medical interpretation course that did not require a test of language proficiency in North Carolina, USA, during the 2022-2023 academic year. We implemented three separate offerings reaching 80 pre-health and health professions students and health professionals. For 28 individuals participating in one of the three sessions, we included an additional 4.5-hour training on language justice. We then conducted interviews with 17 individuals who had participated in one of the 3 course offerings. RESULTS:We identified four themes that (1) revealed how participants defined language justice, (2) explored participants' experiences with language [in]justice, (3) identified views on medical interpretation and its relevance to healthcare and language justice, and (4) showed how participants perceived that medical interpretation and language justice training will impact their future work. DISCUSSION:Language discordance remains important in healthcare and for consideration in health professional training programs. Our findings suggest that a medical interpretation course-with or without specific training in language justice-can advance language access and encourage efforts to better address language barriers in healthcare settings.

OBJECTIVES:Communication barriers can hinder health promotion and healthcare services. Migrant and seasonal farmworkers face substantial challenges to healthcare access. We used a mixed-methods approach to assess access to phones and use of international numbers among agricultural workers, specifically migrant and seasonal farmworkers, and to explore potential implications for healthcare, emergency services, and public health outreach. MATERIALS AND METHODS:First, we surveyed migrant and seasonal farmworkers working in North Carolina, USA, about their ability to send text messages and make phone calls at their housing, including use of international phone numbers, in 2023. A total of 1,034 farmworkers participated in the survey, which used time-venue sampling. In 2023, we also interviewed farmworkers (n = 19) about their technology use and digital literacy skills. In 2024, as part of a statewide community assessment, we conducted listening sessions (n = 19) with farmworkers (n = 146), community health workers (n = 32), and healthcare team members (n = 34). RESULTS:Among survey respondents, 19% reported being unable to consistently make phone calls at their housing, and 10% reported using a phone with a number from another country. Interviews and listening sessions revealed three themes related to farmworkers' cell phone use during the agricultural season, including use of international numbers, challenges with cell phones, and the utility of phones. CONCLUSIONS:Healthcare providers, emergency services, and public health practitioners should be aware that farmworkers may face barriers to making and receiving phone calls as well as sending text messages. Healthcare systems should consider how to ensure access to care for farmworkers using phones with numbers from their country of origin. While most farmworkers have access to phones, a meaningful minority cannot consistently make a phone call to coordinate care, report an emergency, or access health promotion services.

ABSTRACTBackgroundDespite 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.MethodsIn 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.ResultsDescriptive 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.ConclusionThe survey findings show QR‐code‐based pesticide labels will reach a subset of workers, but substantial gaps will remain.

Objective Agricultural workers such as migrant and seasonal farmworkers are a population uniquely vulnerable to the negative effects of climate-related disasters. The primary aim of this study was to assess how counties in eastern North Carolina (NC) incorporated best practices related to agricultural workers in emergency preparedness planning.Methods The authors conducted a quantitative content analysis of 47 emergency preparedness plans from 41 eastern NC counties between November 2022 and March 2023. The research team developed a codebook based on recommended best practices from the Centers for Disease Control and Prevention, Farmworker Advocacy Network, Federal Emergency Management Agency, and National Center for Farmworker Health. Best practices included having materials in Spanish language, mapping vulnerable populations, and garnering input from agricultural workers.Results Of the 47 plans evaluated, most lacked inclusion of agricultural workers in emergency preparedness planning. Furthermore, plans demonstrated few relevant best practices that address agricultural workers' specific challenges in preparation for and recovery from climate-related disasters.Conclusions Public emergency preparedness plans in eastern NC rarely include mention of recommended best practices related to agricultural workers. Local emergency preparedness officials should consider collaboration with advocacy groups, community health workers, and federal emergency management agencies to build disaster resilience.

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.

OBJECTIVES:Agricultural health and safety educators, including community health workers and Extension agents, represent an important community of practice, connecting agricultural workers (i.e. migrant and seasonal farmworkers) to health information and care. We sought to identify and evaluate existing education resources available to educators for use in health education and outreach with farmworkers. METHODS:This study used a systemized search process to identify health education materials in English and Spanish used in the United States. Two independent coders coded each material for its understandability and actionability using the Patient Educational Material Assessment Tool (PEMAT). We report descriptive statistics by type of material, topic, and publication date of the material. RESULTS:We identified farmworker health education materials (n = 602) from across the United States. The average understandability score was 86%, and the average actionability score was 76%. Materials were most commonly print material in the format of handouts, brochures, and posters. Some topic areas (e.g. musculoskeletal injuries) had considerably more resources than others (e.g. green tobacco). CONCLUSION:This research represents the first, to our knowledge, comprehensive assessment of health education materials for education and outreach to agricultural workers. While the average scores for understandability and actionability were high among materials, there is room to build a stronger set of resources in some topic areas and to modernize materials for electronic delivery. Using PEMAT tools can help the Extension and community health worker communities of practice improve the quality of materials they share with agricultural workers.

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. . . .

OBJECTIVE:This study engaged representative native freshwater mussel propagation biologists in focus group discussions to learn their views and priorities related to the development and adoption of freshwater mussel health metrics. It provides a case study on how early consultation with practitioners can better inform research questions and improve imperiled species conservation. METHODS:Two focus group discussions were conducted with freshwater mussel propagation biologists from across the United States to understand the needs of conducting mussel health assessments, current approaches, technical capacity, and where advances may be most beneficial. RESULTS:Propagation biologists identified how they currently measure freshwater mussel health, listed the largest threats to health, explained similarities among approaches, and made recommendations for future research. CONCLUSIONS:Propagation biologists called for quantitative metrics that complement current procedures that could be measured nonlethally and were reflective of health and resilience rather than presence or absence of disease. Further conservation research could benefit from early engagement with propagation biologists to better ensure adoption of research products and tools.

Migrant and seasonal farmworkers ("farmworkers") are a unique population with structural barriers to being reached in health promotion efforts. Social media platforms and communication campaigns are increasingly used in health promotion efforts with farmworkers. However, digital exclusion, sometimes referred to as the digital divide, can limit the reach of social media interventions and campaigns. It is critically important for program planners to know the potential reach of different communications channels. We conducted a secondary analysis of a time-venue convenience sample survey of farmworkers that was fielded in North Carolina (NC) in May-December 2023 at housing and clinic locations. We assessed social media use for seven platforms (Facebook, GroupMe, Instagram, Snapchat, TikTok, WhatsApp, YouTube), randomizing each participant with internet access to be asked about one platform. We calculated what percentage of farmworkers in NC would likely be missed via each platform based on use of the platform and inconsistent or no internet access. Several social media platforms (WhatsApp, Facebook, YouTube) were widely used by farmworkers in NC. However, use and access were not universal, with even the most used platforms missing approximately 1 in 10 farmworkers who had consistent internet in their housing locations. Considering use of platforms in combination with having no or inconsistent internet access in housing, platforms missed a minimum of approximately 1 in 3 farmworkers. Campaigns and interventions should consider using multiple social media platforms and other channels to maximize reach. Future research is needed to disentangle positive and negative effects of using social media to reach farmworkers.

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.

Introduction. Ineffective health communication can drive health disparities and limit the effectiveness of interventions to reduce them. Stock photo libraries are a critical tool for developers of patient education, health education, and intervention materials. It is not clear how well stock photo libraries represent communities bearing disproportionate burdens of disease. Method. We conducted a search using five popular stock image libraries (Adobe Stock Images, Canva, Getty Images, Microsoft Office Image Library, and Pixabay) in November 2021 to evaluate diversity and representation in health-related stock photos. We searched for the following five key preventive health topics: healthy eating, exercising, quitting smoking, vaccination, and pregnancy. The images ( N = 495 ) were coded for age, gender presentation, representation of perceived minoritized racial/ethnic identity, skin color using the Massey–Martin skin color scale, markers of high socioeconomic status (SES), and access costs. Results. The representation of perceived minoritized people, darker skin color, and inclusion of markers of high SES varied greatly by the search term and library. Images predominately portrayed young adults and adults, with limited representation of other age groups. Images in libraries with any paywall were significantly more likely to depict a person of perceived minoritized racial/ethnic identity and depict darker skin colors, and were significantly less likely to contain markers of high SES identity than images in libraries that were free to use. Discussion. We found that it costs more to develop culturally relevant health education materials for minoritized populations and groups that do not represent high SES populations. This may hinder the development of effective communication interventions. Keywords stock photos , patient education , representation , material development , health promotion , equity

OBJECTIVES:Migrant and seasonal farmworkers work in rural areas where internet access may be limited. We assessed internet access, cost of access, and devices available to farmworkers through a statewide survey in North Carolina. METHODS:During the 2023 agricultural season, we surveyed 1034 migrant and seasonal farmworkers during routine outreach visits in partnership with community health workers employed by 8 community health centers or by nonprofit health service agencies serving farmworkers in North Carolina. We surveyed participants aged ≥18 years by using time-venue sampling and surveyed up to 5 farmworkers at migrant housing locations. We weighted participants to the total population of farmworkers living in surveyed housing and calculated frequencies and percentages of internet access, internet speed, internet cost, available internet devices, and awareness and use of the Affordable Connectivity Program-a program that was run from 2021 through May 31, 2024, by the Federal Communications Commission to make internet access more affordable in the United States. We assessed predictors of internet access and ability to use online videos by using regression models. RESULTS:Participants were predominantly Spanish-speaking men who lived in housing provided by farm owners. Among participants, 9.8% had internet connections with a cable or digital subscriber line, and 23.5% did not have consistent internet access. Most participants used cellular network internet (84.9%) and mobile phone devices (93.9%). Even among farmworkers who lived in their housing year-round, few had heard of (34.4%), applied to (4.8%), or used (2.0%) the Affordable Connectivity Program. CONCLUSIONS:Interventions are needed to increase internet access and digital inclusion for migrant and seasonal farmworkers in North Carolina. Development of state and county broadband infrastructure should consider farmworker housing.

Community health workers are responsible for finding, processing, and transferring health information to communities with limited access to health-related resources, including farmworkers. This paper is the culmination of an undergraduate student research project to explore the learning processes and preferences of farmworker-serving community health workers in the USA. The project was designed for students from farmworker or agricultural backgrounds at two North Carolina universities and was supported by a North Carolina Department of Health and Human Services workforce development grant. Semi-structured interviews were conducted, in person and virtually, with a convenience sample of 17 current and former community health workers. The interview data were analysed thematically and identified a preference for a combination of learning styles, with visual and hands-on learning being the most preferred. Community health workers also identified the importance of learning preferences in relation to their responsibilities as health educators. This study provides librarians, along with public health and medical professionals, with useful information about learning preferences to inform the creation of new and varied learning materials for community health workers.

AbstractBackgroundCommunity health workers represent a critical part of the health outreach and services for migrant and seasonal farmworkers (‘farmworkers’) in rural areas of the United States.PurposeWe sought to identify adaptations to farmworker patient engagement and health outreach made by community health workers during the first 18 months of the COVID‐19 pandemic.MethodsIn this qualitative study, we used semi‐structured interviews with community health workers from August 2020 to February 2022 (n = 21). Two coders used thematic analysis to identify three themes related to the experiences of community health workers in conducting health education and outreach to farmworkers prior to and following the onset of the pandemic.FindingsWe found themes related to pre‐pandemic outreach efforts to provide health education resource sharing with farmworkers and pandemic‐related outreach efforts that included adoption of porch drops and distanced delivery of health education, adaptation of modes of health education and communication through technology and the internet, and taking on new roles related to COVID‐19. Finally, we identified changes that reverted after the pandemic or will continue as adaptations.ConclusionsCommunity health workers created practice‐based innovations in outreach in response to the COVID‐19 pandemic. These innovations included new COVID‐19 related roles and new modes of health education and outreach, including the use of digital resources. The changes developed for emergency use in COVID‐19, particularly related to internet and technology, have likely altered how community health workers conduct outreach in North Carolina going forward. Funders, community health worker training programs, and researchers should take note of these innovations.Patient or Public ContributionCommunity health workers who typically come from patient populations and provide critical navigation and connection with the health care system advised on the design and creation of this research project, including serving on an advisory board. Two authors have experience working as community health workers.

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.

Community health workers (CHWs) have reported a paucity of farmworker-specific education materials for use during health outreach to farmworkers. To improve our understanding of the availability of topically and culturally relevant health education materials for farmworkers, we identified 15 key health topics to examine across four major online health information services: MedlinePlus.gov, Migrant Clinicians Network, National Agricultural Safety Database, and National Center for Farmworker Health. We established inter-coder reliability and conducted coding for health education materials by topic and identified the percentage of materials specifically designed for farmworkers. The availability of materials ranged from, on the low end, accessing clinic services, having one health education material total across all four online services, to alcohol, tobacco, and other drugs, having 50 materials across the four online services. Online health information services ranged from 0.6% of the materials designed specifically for farmworkers (MedlinePlus.gov) to 42.9% (Migrant Clinicians Network). The findings from this study underscore the need to support community-based projects centering CHWs' roles as advocates and facilitators to develop educational materials for farmworker health outreach.

All US states, and many countries around the world, have waterways with environmental health advisories intended to protect individuals from harmful chemicals in fish, yet little is known about how informal science educators, even those who engage anglers along waterways, incorporate advisory information into their educational activities. This study, grounded in environmental health literacy, investigated the practices, knowledge, and beliefs of 24 informal educators housed in varied agencies and organizations in a southeastern US state. Participants described a range of educational activities and identified organizational constraints on their education about fish consumption advisories, which varied by organization type. Their knowledge of relevant environmental health concepts was incomplete, and they described health and teaching beliefs consistent with limited focus on advisory education. Local government and nonprofit educators were well positioned to educate anglers about advisories, due to their freedom to design and deliver instruction and their regular contact with anglers. Educators in wildlife agencies had more contact with anglers and were identified as potential conduits given their interactions, but organizational constraints (such as educators' ability to choose content/pedagogy and conflicting missions of agencies) would need to be addressed.