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J Community Health (2013) 38:397407

DOI 10.1007/s10900-012-9622-4

REVIEW

Delivery of Mobile Clinic Services to Migrant and Seasonal


Farmworkers: A Review of Practice Models for Community-
Academic Partnerships
John S. Luque Heide Castaneda

Published online: 29 September 2012


Springer Science+Business Media New York 2012

Abstract Farmworkers in the US are a medically usually a nursing school, and less frequently a medical
underserved group, who are largely uninsured, foreign- school. Other service partners frequently mentioned were
born, and working in a hazardous industry. This review federally-qualified Community Health Centers, Migrant
addresses the challenges of providing health services for Health Centers, and health departments. The review found
this priority population to study the numerous health access that service partnerships were characterized by collabora-
barriers that face migrant and seasonal farmworkers tion between academic institutions and community orga-
(MSFW), evaluates the services provided at mobile clinics, nizations, with a lead agency driving sustainability efforts.
summarizes practice models for community-academic
partnerships, and synthesizes the literature on effective Keywords Farmworker  Migrant labor  Hispanic health 
partnership approaches to deliver these services. Because Occupational and environmental health  Community
MSFW are a difficult group to reach and access, mobile health  Community partnership  Social responsibility
farmworker clinics provide an opportunity for unique stu-
dent training experiences, in addition to small survey and
feasibility studies. A literature search was conducted to Introduction
identify articles for the review. Out of 196 articles identi-
fied by the article databases and manual search techniques, Migrant and seasonal farmworkers (MSFW) are a medi-
18 articles were finally selected for the review based on cally underserved population in the US, characterized by
predetermined inclusion and exclusion criteria. Half of the striking health inequalities. The term MSFW is an occu-
articles were classified as case studies or descriptive studies pational category and has been used variably in the liter-
with lessons learned. Only three articles were classified as ature; however, for the purpose of this review, the term
research studies, and six articles were not classified as farmworker includes both those who temporarily work in
research studies, but rather descriptions of the clinics only. agriculture and migrate, as well as those who maintain a
Many of the partnership models were structured with the permanent residence and work in agriculture on a seasonal
lead agency as either the academic partner or an Area basis [1]. Occupational health hazards in the agricultural
Health Education Center. The academic partner was industry include both the risk of injury at the workplace
and dangerous chemical and environmental exposures.
Because farmworkers rarely receive benefits such as health
J. S. Luque (&) insurance coverage, paid time off, or workers compensa-
Jiann-Ping Hsu College of Public Health, Georgia Southern
tion insurance, seeking treatment for work-related injuries
University, P.O. Box 8015, Hendricks Hall, Statesboro,
GA 30460-8015, USA or illnesses is problematic [2]. Workers compensation is
e-mail: jluque@georgiasouthern.edu only available to MSFW in 13 states [3]. Care seeking
often translates into loss of income, especially marked
H. Castaneda
since farmworkers work either hourly for low wages or
Department of Anthropology, University of South Florida, 4202
E. Fowler Avenue, SOC 107, Tampa, FL 33620-8100, USA by piece rate. The majority of farmworkers are Latino
e-mail: hcastaneda@usf.edu (84 %), were born outside of the US, and speak Spanish;

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consequently, language is a primary barrier to health ser- [17]. Social justice frameworks can illuminate the many
vices [4]. The majority of farmworkers are young men, complex and contextual factors and patterns influencing the
who are either single or leave their families behind and health of disadvantaged groups such as MSFW. According
send remittances. Half of all farmworker families earn less to Arcury and Quandt [7], social justice for farmworkers
than $10,000 per year and are working without legal doc- includes earning a living wage, living free from racial or
uments [5]. In addition to these obstacles, other barriers to ethnic discrimination, having access to public services, and
health care include transportation, not knowing the location being in a living or work environment where health and
or hours of operation of healthcare facilities, preference for safety risks are addressed.
health care in the farmworkers native country, and fear of There have been no systematic reviews on the provision
discrimination or cultural misunderstanding by healthcare of mobile clinic outreach services to migrant farmworkers.
facility staff [6]. Community Health Centers and Migrant Some of the articles in this review describe community-
Health Centers receive federal financial support to address academic partnerships, which might provide exemplars for
the medical needs of farmworkers, but their reach is limited groups interested in pursuing these types of service rela-
and does not match the demand for services [7]. To address tionships. There are many preliminary considerations for
these multiple barriers for accessing primary health care, forming such partnerships, such as choosing the appropri-
nursing professionals, in partnership with professionals ate lead agency, securing financial support to make efforts
from medicine and allied health, have developed commu- sustainable, meeting the reporting requirements for the
nity-academic partnerships to deliver mobile clinic services various agencies involved, meeting evaluation standards,
to MSFW at farmworker camps, where they temporarily and providing research or service opportunities, as well as
reside during harvest season. This systematic review student training experiences, for the academic partners.
explores the clinical efficacy of these mobile clinics and Some of the articles identified in this review discuss suc-
summarizes effective partnership models to best facilitate cessful partnership models and positive student learning
these outreach activities. outcomes, but very few have directly addressed the chal-
There are several advantages to delivering care via lenges of conducting research in the context of mobile
mobile clinics to this population. Since farmworkers toil farmworker clinics, and whether this is ultimately a prudent
long hours and have very little free time, offering health strategy. Reviewing the reports on these mobile clinics
services in the evening hours at camps eliminates access raises additional questions. What are some of the research
barriers [8]. Such clinics also provide opportunities for and student learning opportunities in the mobile clinic
healthcare professionals and students to experience serving context? Since the ultimate goal of the mobile clinic is to
patients with a different language and culture, thus repre- increase access to care and not necessarily to conduct
senting a valuable addition to the curriculum [9]. In order research, there are also ethical implications involved with
to understand successful partnership models of providing conducting other activities that might conflict with pro-
health care to farmworkers and identify the challenges for viding services [18].
the academic and community partners, this systematic These mobile clinics provide training experiences for
review of the literature will advance understanding of health professional students. Active engagement in service
successful mobile clinic service models to meet the needs learning encounters benefit students by advancing critical
of this marginalized occupational group. Informed by the thinking and increasing accountability. However, these
Community Coalition Action Theory (CCAT) [10], this must be deliberate, planned, and include a reflection
review identifies successful partnership models to provide component in order to be successful [17]. There are salient
recommendations for practice. CCAT has been applied to issues from a social justice or health equity perspective that
understand the dynamics of community coalitions between might make participation in migrant health clinics prob-
different entities which are organized toward a common lematic from a clinical standpoint because of the uncer-
purpose [1113]. The theory operationalizes 21 constructs tainty of diagnostic resolution. Since migrant farmworkers
and related propositions to community coalition formation, might have very limited contact with the US health care
structure, and processes. Social scientists have turned their system and may move frequently, preliminary diagnoses
attention to the study of the dynamics of coalition forma- identified in the mobile clinic setting are more difficult to
tion and sustainability using multiple methods including track and continue with follow-up care. It is noteworthy
ethnography, participant observation, survey research, and that organizations such as the Migrant Clinicians Network
social network analysis [12, 1416]. This review is envi- have created a Health Network system to provide MSFW
sioned as a complement to that scholarship to understand with continuity of care for patients with chronic conditions
how such collaborative partnerships, in this case to provide such as diabetes [19]. Yet this program largely works with
healthcare services to migrant farmworkers, can be main- federally-funded Migrant Health Centers, and thus might
tained successfully and driven by social justice priorities be disconnected from mobile outreach clinic activities

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conducted by other entities that might be more sporadic by identified articles as well as the review articles and added
nature. an additional three articles which fit inclusion criteria, for a
The number of publications addressing the health needs final sample of 18 articles. We created a coding sheet
of migrant farmworkers has increased in recent years as composed of 28 items in order to abstract the most perti-
more researchers and practitioners are entering this field. nent information from the articles. First, we collected
However, there have been very few literature reviews since information about each article, such as author, publication
1990 assessing health status and access to health services name, year published, and publication type (e.g., journal
for MSFW with a few notable exceptions [1, 20, 21]. article, commentary, etc.). Next, we answered questions
Therefore, this review synthesizes what is currently known about the methods used in the article, if the article in
about providing mobile clinic services to MSFW, in question was a research report. We also collected demo-
addition to what other activities are being conducted in this graphic data on the clinic participants. If the article
context (e.g., research, student learning), to summarize described an intervention, we identified characteristics of
common partnership models and improve the health of this the intervention and the role of staff involved in the
underserved priority population. intervention, such as community health workers or nurses.
We identified the clinic staffing and model used (e.g.,
mobile clinic or stationary clinic based in the farmworker
Methodology community, excluding federally-qualified Community
Health Centers or Migrant Health Centers). Finally, we
Our inclusion criteria for the articles in this review were described the outcomes of the clinics such as measured and
that they (1) described mobile clinic services for migrant targeted outcomes, major health outcomes, partnership
farmworkers; (2) be US-based; and (3) be published either models, and research challenges or other clinic-related
in peer-reviewed articles indexed in PubMed or CINAHL challenges. After abstracting this information from each
(Cumulative Index to Nursing and Allied Health Litera- article independently, both authors entered the information
ture), or one of two migrant health newsletters (the into a spreadsheet. Next, any differences recorded on the
National Center for Farmworker Health newsletter Migrant spreadsheet were resolved, and the information was syn-
Health Newsline or the Migrant Clinicians Network thesized to report major findings of the studies and answer
newsletter Streamline). We excluded studies taking place at the research questions posed by this systematic review.
stationary clinics such as federally-qualified Community
Health Centers or Migrant Health Centers. We conducted
an extensive search of PubMed and CINAHL databases Results
using the time period of January 1, 1990 to July 24, 2012.
The following keyword combinations were used in the Mobile Clinic Characteristics
PubMed search: (farmworker AND outreach) and
(farmworker AND clinic). For the CINAHL search, We have summarized the characteristics in the final sample
we only used the keyword farmworker. The PubMed of articles (n = 18) in Table 1. The population served by
search produced 29 results. The CINAHL search produced the mobile farmworker clinics was mostly of Hispanic
167 results. We also manually searched all electronically origin (see Table 2). There was substantial variability in
available issues of the newsletters, Migrant Health News- the reporting of Hispanic patients backgrounds. Some of
line (January 1995Issue 3, 2012) and Streamline (Feb- the articles identified farmworkers attending clinics by
ruary 2001January 2012). We identified one newsletter percentage of country of origin, whereas others simply
article which satisfied inclusion criteria. After reading identified the farmworkers as the percentage of Hispanic/
through the abstracts of all the identified articles, we Latino or all Hispanic/Latino. Besides Hispanics, the other
compiled a database in reference management software ethnic groups represented in the farmworker population
containing 157 unique articles. Next, we queried the included Haitians, African Americans, and Anglo Ameri-
abstracts in the database with the keywords, mobile, cans. Of the eight articles that reported percentages of the
outreach, clinic, and screening to narrow our population served, 88 % were of Hispanic origin and 12 %
search. were of other nationalities or ethnicities. While it is true
We read through the abstracts of all of the articles that the migrant farmworker population is primarily male,
produced from the query and identified 17 articles which fit in the sample of seven articles which reported gender, the
the inclusion criteria. After reading all 17 articles, we majority of the clients were females (71.6 %) compared to
eliminated two because they were review articles and did males (28.4 %). The skewed percentage is related to the
not reference any farmworker outreach conducted by the fact that of these seven articles, four of them only included
authors. We manually searched the reference lists of the women because the clinics specifically focused on womens

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cancer screenings or prenatal care. The other 11 articles that increased access to health services, health professional
did not report gender percentages largely targeted farm- student learning outcomes, and frequency of patient diag-
worker men, but no data were presented on gender distri- noses or health problems. For the research studies, targeted
bution. Most of the articles did not report the average age of outcomes were varied. Examples of some outcomes
patients. However, the average age of adult patients was included food insecurity, cancer knowledge, access to
between 32 and 33 years old for those articles reporting age. cancer screening, and use of personal protective equip-
There were two articles that included migrant farmworker ment. The most common methodology for the research
children as part of their clinics target population, and one studies was the cross-sectional survey design. Only two of
which specifically targeted children [22]. the articles used longitudinal data [22, 31]. More specific
In terms of geographic distribution, most of the articles examples of targeted clinical outcomes are listed in
discussed mobile farmworker clinics in Georgia (n = 8; Table 3, such as identifying the most common occupa-
44.4 %), followed by Oregon (n = 3; 16.7 %) and Florida tional injuries (i.e., back strain) and increasing healthcare
(n = 2; 11.1 %). Other states in the sample included access for specific services, such as prenatal care.
Arizona, California, New York, North Carolina, and South Many of the partnership models were structured with the
Carolina. Some authors discussed the same clinics in lead agency as either the academic partner or the Area Health
multiple articles [e.g., [23, 24] (two articles in Oregon), Education Center (AHEC). The lead academic partner was
[25, 26] (two articles in Georgia), and [27, 28] (each article usually a nursing school, and less frequently a medical
referring to the same Georgia mobile clinic)]; therefore, school. Other service partners frequently mentioned were
this additional reporting added one article to the Oregon federally-qualified Community Health Centers or Migrant
sample and three articles to the Georgia sample. Regarding Health Centers, and health departments. Less common
clinic types, the majority of articles described mobile members joining mobile clinic partnerships were farms,
clinics that directly fit the inclusion criteria (i.e., mobile faith-based organizations, public school systems, local hos-
clinic traveling to the farm camps). However, four articles pitals, chambers of commerce, or academic divisions such as
described small stationary clinics located in a farmworker physical therapy, dentistry, public health, or psychology.
community or a mobile clinic parked temporarily next to a Some of the major challenges in implementing the
larger stationary clinic. mobile clinics were a lack of bilingual staff, difficulty in
tracking patients, coordination of partnership activities,
Key Features of Mobile Farmworker Clinics lack of funding for expensive diagnostic tests like mam-
mograms, literacy level of patient education materials,
Most of the identified articles described the characteristics inability of farmworkers to pay for services, clinic hours,
and functioning of the mobile clinics. However, a few and transportation barriers. In one study, most of the
articles only briefly referenced the mobile clinics and ser- patients paid the minimum payment because they lacked
vices and focused on findings from a research project or a health insurance [32]. For the few research studies in the
descriptive study [24, 27, 29, 30]. The most common ser- sample, common limitations included lack of generaliz-
vices provided included health screenings (e.g., cholesterol, ability due to selection bias from convenience sampling,
diabetes, blood pressure, BMI), adult vaccinations (e.g., Tb small sample sizes, and methodological limitations of data
booster), and health education (e.g., STDs, pesticides) (see collection methods, such as chart review studies.
Table 3). Other services provided, but with less frequency,
included dental, physical therapy, optometry, podiatry,
womens cancer screenings, pediatric services, prenatal Discussion
care, nutritional counseling, and psychological counseling.
While some of the articles were not explicit, it was implied Mobile clinics are among a number of strategies to improve
that most clinic services were either free or available at a accessibility and utilization of health services by MSFW
nominal charge. The range of services provided at the and appear to be successful based on case descriptions and
clinics was a function of the partners involved and the anecdotal reports. This review synthesized the literature
availability of students and volunteers. reporting on mobile clinics serving MSFW. Surprisingly,
The outcomes targeted can be divided into clinic out- only 18 articles since 1990 fit our inclusion criteria, which
comes and research study outcomes. Half of the articles we included publication in the peer-reviewed literature or in
classified as case studies or descriptive studies with lessons two relevant newsletters. The most common type of out-
learned. Only three articles were classified as research reach activity was a mobile clinic traveling to farm camps,
studies, and six articles were not classified as research thus designed to overcome many of the access barriers
studies, but rather descriptions of the clinics only. For the faced by MSFW and their families. Most of the articles
descriptive studies, the targeted outcomes included were case studies or descriptions of clinic activities and

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Table 1 Mobile farmworker clinics (n = 18)


Study State Services provided Partnership model Challenges

Albritton Georgia Healthcare services AHEC and medical school ND


[9] Clinical care Partnership between students, faculty,
and community, integrate cultural
issues and experiences in the
curriculum
Bechtel Georgia Health screenings ND No paid bilingual staff at
[46] Tetanus booster hospital, dept. of family and
childrens services or sheriffs
dept.
Minimal education levels of
workers limited their
understanding of health
maintenance behaviors
Brumitt Oregon Health care screenings (cholesterol, Healthcare organization and volunteer Failure to address MSS early can
[24] diabetes, blood pressure, BMI, university-affiliated healthcare affect work and worsen
vaccinations, optometric professionals condition (e.g., later need for
examinations, dental, mental health, costly treatments or surgery)
health education, PTexercise Inability to link MSS with
prescriptions, ergonomic education, physical demands of the
manual therapy) vineyard job
Not able to quantify severity of
injuries
Brumitt Oregon Health care screenings (cholesterol, Winemakers, physicians, healthcare Assessment of student learning
[23] diabetes, BP, BMI), vaccinations, providers, vineyard owners, volunteer outcomes limited to qualitative
musculoskeletal exams, optometric health care professionals, volunteer reports
exams, dental health services, mental service from university faculty and
health services, health education students
(personal health, mental health,
nutrition), stretching exercises
Connor Georgia For children: BMI, BP, vision/hearing Health professional students and faculty Finding translators from
[26] screening, hemoglobin and glucose from five colleges/universities, community
testing, physical exams, PT, dental, federally funded farmworker health Coordinator of partnership
psychology clinic, school system, AHEC, responsibilities and program
For adults: screenings for anemia, community member, schools of logistics
hypertension, diabetes, dental, nursing, PT, dental hygiene,
psychological referrals psychology
Connor Georgia Health screenings, physical exams, University partner with Migrant Health The use of the Fleisch-Kincaid
[25] treatment for illnesses, health Center could be used to improve
education, dental care, physical educational materials
therapy (back care exercises), Lack of native language
psychological assessments, improving interpreters
workplace safety
Need to follow-up for mental
health issues
Decker Oregon Medical history, PPD testing, BP, ND Primary health care is not
[47] urinalysis, hematocrit, STD a priority in the US
education, AIDS, pesticide education,
condom distribution
Goldsmith California Deliver cancer prevention info, BP, FQHC Migrant Clinic and Ag Cancer Some screened without returning
[29] vision, cholesterol, Educational Center Prevention Project vouchers
encounters (general information about
cancer; specific information about the
cervix, breasts, and reproductive
organs; specific details about breast
self-exams, clinical breast exams,
mammograms, pelvic exams, and Pap
smears; and the importance of
screening and early detection)

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Table 1 continued
Study State Services provided Partnership model Challenges

Hill [27] Georgia Healthcare services ND Convenience sampling for


enrollment may have
introduced selection bias and
limited generalizability
Multiple interpreters
administered the surveys,
potentially introducing bias
Himelick Georgia Healthcare services ND ND
[28]
Larson North Prenatal care Dept. of Maternal and Child Health at Few bilingual staff
[48] Carolina School of Public Health and Elimination of barriers (e.g.,
Community Health Center transportation) and language
barrier
Close tracking and follow-up
had positive effect on prenatal
care and pregnancy outcomes
Luque [30] Florida General medical exam, Pap test Academic institution and faith-based Limitations of chart review
clinic partnership studies described (e.g., use of
paper records)
Luque [31] Georgia Primary health care, health education, AHEC, farmworker services nonprofit, Over-reporting of hypertension
diabetes, BP, dental, PT Community Health Center, university diagnoses
health professional volunteers Underreporting of mental health
(survey)
Limitation of survey design and
sampling
Limitation of chart reviews
Meade Florida Community-based outreach, health Cancer Center, Community Health Lack of mammogram resources
[45] education, health promotion, breast Center, CDC Breast and Cervical for uninsured women, cultural,
cancer screening, navigation Cancer Prevention Program, ACS, language, socio-economic
health dept., Area Agency on Aging, lifestyle issues
Redlands Christian Migrant Assn.,
ElderMed, Judeo-Christian Center
Poss [49] New Medical, dental, social/administrative Migrant clinic, migrant ministry and Lack of ability of migrant
York (help clients obtain Medicaid) inter-community memorial hospital, farmworkers to pay, some can
ecumenical organization get Medicaid
Funding for program
Sherrill South Health screenings, immunizations, Mobile clinic funded by HRSA, led by Latino patients lack health
[32] Carolina basic health care needs, lab/ an academic nursing school, local insurance, have language
immunizations; gynecological exams, health dept. mobile unit parks next to barriers, cultural differences
physicals it, residency program (rural residency Lack of sufficient bilingual staff
program)
Stein [50] Arizona Use of vouchers for follow-up, ND ND
diagnostic tests, medication provided
on site, dental care with vouchers,
womens health, 1 time per month
Pap, CBE, STD screen, foot care
Wilson Georgia Health assessments for children, height/ Migrant Family Health Program Need for evening services at
[22] weight, hearing/vision, urine, integrated into Kellogg Community work sites
hemoglobin Partnership in Education Initiative, Need for Spanish materials
undergrad nursing students, graduate
Need for counseling services
NP students, psychology students,
health dept., County Migrant Health Need for interpretation services
Programs, AHEC, Hispanic outreach Lack of follow-up treatment for
workers, local physicians, local patients
hospitals, chamber of commerce,
farmers, local school system
ND not described

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Table 2 Mobile farmworker clinic characteristics characteristics such as ethnic/racial distribution, gender,
Mobile clinic characteristics* Sample No. (%)
language preference, country of origin, and age. For
example, language issues are emerging because of an
Population served increasing number of speakers of indigenous (non-Spanish)
Hispanic origin 10,610 (88.1 %) languages, which compounds existing language barriers
Other race/ethnicity 1,433 (11.9 %) [34].
Gender
Male 2,468 (28.4 %) Lack of Research Studies Engaged with Mobile
Female 6,231 (71.6 %) Farmworker Clinics
Study characteristics (n = 18) No. of articles (% of
total) Some articles reported on clinic outcomes, either describ-
ing the top complaints and diagnoses or reporting an
State
increase in utilization of services for specific health issues
Arizona 1 (5.5 %)
(see Table 3). A few articles presented research study
California 1 (5.5 %)
findings, generally with regard to clearly defined health
Florida 2 (11.1 %)
issues (food insecurity, cancer knowledge and screening,
Georgia 8 (44.4 %) and use of personal protective equipment). Only three
New York 1 (5.5 %) articles could be classified as research studies, in that they
North Carolina 1 (5.5 %) described a question to be investigated, detailed methods of
Oregon 3 (16.7 %) data collection (most commonly, cross-sectional survey
South Carolina 1 (5.5 %) design and in some cases longitudinal data), and reported
Clinic type original findings. The fact that only a few research studies
Mobile clinic going to farm camps 14 (77.7 %) were present in the literature indicates either the absence of
Stationary migrant clinic in farmworker 2 (11.1 %) research partnerships with these clinics or a lack of dis-
community
tribution of study findings in typical and accessible venues
Other (e.g., mobile clinic parked at 2 (11.1 %) for scholarship. In the case of the former, these missed
stationary clinic)
opportunities should be taken up by scholars in the future.
* More than half of the identified articles did not report race/ethnicity Nevertheless, there are formidable barriers to implement-
or gender of the patient population served ing research in the context of mobile clinics including:
limited window of time to talk to farmworkers after a long
outreach strategies. This leads us to conclude that there is a day of work; differences in goals of service and research
lack of systematic and rigorous evaluations of the health partners (e.g., publishing findings vs. service provision);
delivery services provided by such clinics, even though there obtaining institutional review board approval for farm-
is little question that they lower access barriers for these worker studies; and interpretation or translation challenges.
workers. Thus, this review underscores prior observations Other challenges to conducting quality research with
that formal evaluations of existing farmworker health ser- farmworker populations include constructing generalizable
vices are missing from the literature, and that there is a samples, the seasonality of farm work, obtaining informed
paucity of studies examining MSFW health service needs, consent with non-Spanish speakers, and costs involved
utilization, or satisfaction [1]. These data are sorely needed with face-to-face interviews in disparate and rural research
for public health policy and program planning to improve the sites where farmworkers live and work [35].
health of MSFW. This finding also suggests a potential role
for public health and social science researchers to partner Health Professional Student Learning Encounters: High
with clinical practice colleagues to implement rigorous Levels of Collaboration
program planning and evaluation activities.
Not surprisingly, most articles focused on Hispanic/ Many articles reported on cultural learning encounters to
Latino populations, which are most heavily represented in benefit student training in the health sciences. Notable was
US agriculture. Nonetheless, we noted the same lack of the interdisciplinary approach in most cases, indicating a
consistency in defining MSFW that is common by agencies high level of cooperation between different disciplines
and programs [33], along with a priori assumptions about including medicine, nursing, dentistry, physical therapy,
this population and its features. Few articles explicitly health education, public health, and psychology. Invest-
defined the target population, preventing accuracy in ment in collaborative relationships with community part-
identifying specific information. Reports on mobile farm- ners such as farm owners, faith-based organizations, public
worker clinics should include reporting of demographic school systems, local hospitals, and chambers of commerce

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Table 3 Key features of mobile farmworker clinics


Mobile clinic feature Description

Services provided Common services: health screenings (cholesterol, diabetes, blood pressure, BMI), vaccinations, health education
(STDs, pesticides)
Less common services: dental, physical therapy, optometry, podiatry, womens cancer screenings, pediatric
services, prenatal care, nutritional counseling, psychological counseling
Outcomes targeted Common clinical outcomes targeted: access to health services, health professional student learning outcomes,
most common diagnoses, such as musculoskeletal symptoms, acute illnesses, chronic diseases
Less common outcomes targeted: food insecurity, cancer knowledge, access to cancer screening, prenatal care,
use of safety eyewear
Highlights of some clinic Men who reported musculoskeletal symptoms (MSS) were likely to be older, but those who reported back pain
outcomes were more likely to be younger. For women, all older women were more likely to have pain. The back was the
most frequent region with MSS symptoms [24]
289 or 62.8 % of farmworkers were food insecure, and non-H-2A workers 2.9 times more like to be food insecure
than H-2A workers [27]
Improvement in the use of prenatal services rose from 35 to 51 %; Hispanic representation at the health center
increased; there were fewer pregnancies among the younger population; improved use of prenatal services; but
nonsignificant declining trend in birthweights [48]
Major farmworker diagnoses included back pain, hypertension, musculoskeletal symptoms, GI disorders, eye
problems, and dermatitis [31]
68 % of clients used the mobile clinic as their primary source of care [32]
The top 5 problems for migrant children were dental caries, URIs (otitis media, otitis externa, sinusitis,
pharyngitis, allergic rhinitis), UTIs, anemia, and dermatitis [22]
Partnership models Most common partnership models included: Area Health Education Center or health professional school (e.g.,
nursing or medical school) as the lead agency with primary partners including Migrant Health Center or
Community Health Center, and health departments
Less commonly the partnership model included: farms (e.g., vegetable farms, vineyards); faith-based
organizations; public school systems; local hospitals; chambers of commerce; and Schools of Physical Therapy,
Dentistry, Public Health, or Psychology
Primary implementation Few bilingual staff, or translators for indigenous languages
challenges Frequent movement of the migrant farmworker population makes tracking patients difficult, and lack of follow-up
Coordination of partnership responsibilities and program logistics
No funds for expensive diagnostic tests such as mammograms
Inability of farmworkers to afford to pay for services
Clinic hours and transportation barriers

was also a common theme. One successful strategy for Community Coalition Action Theory (CCAT) [10]. Some
promoting the time and location of the outreach clinics was of the characteristics of sustainable partnerships include: a
to notify the farm owners and farmworkers in advance for multiple and diverse organization membership structure; a
logistical planning purposes [25, 31]. In most cases, the history of collaboration; a lead institution-convener group;
articles that described training experiences relied upon a functioning partnership decision-making process; lead-
descriptive presentations and generalized statements about ership and staffing; member engagement; assessment and
their relationship to improving student learning outcomes planning; implementation; health and community outcome
and developing more culturally competent practitioners. changes; and increased community capacity. One example
These specific and significant experiences with mobile of a successful partnership identified in this review was the
farmworker clinics should be systematically investigated Farm Worker Family Health Program (FWFHP), which
and linked to the already robust literature on health science provides a two-week immersion experience for health
student training and service learning [3640]. professional students in southern Georgia and has been
operating since 1993 [25, 26]. The FWFHP adopts a
Program and Partnership Sustainability partnership model between academic institutions and
community organizations to create a sustainable delivery
Some of the mobile clinics had been operating for many system for the farmworker health services it provides. The
years, and the keys to sustainability of such programs can partnership is described as a School of Nursing operating
be explained by referring to some major constructs from together with a migrant health clinic, which provides

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additional local partnerships with AHEC, a summer edu- men, and especially men of color, remains a lack of data
cation program, child care centers, farms and other busi- [41], more systematic reporting on mens health is neces-
nesses. Since, during harvest season, the number of sary. These kinds of mobile clinicswhich reduce access
farmworkers exceeds the local migrant health clinic barriers known to be present in other settingscould play a
capacity, the mobile farm clinic is able to address the needs major role in advancing our knowledge of mens health.
of additional patients. The migrant health clinic takes the
lead on coordinating follow-up care and referrals. One of
Conclusions/Future Research
the keys to success of the FWFHP is the ability to provide
health care in multiple locations and at nontraditional hours
In conclusion, this set of articles suggests that there is a
to reduce access barriers. While the actual mobile clinic
coalition model that works well for these types of service
only operates for two weeks a year, the FWFHP operates as
partnerships to mature and evolve. Having an interdisci-
a year-round program to keep abreast of the needs of
plinary team of clinical partners from the university setting,
farmworkers and their families. The leadership of the
together with federally funded farmworker health clinics,
nursing school in the academic institution is one key to the
AHEC, and other community partners can produce sus-
longevity of this particular program.
tainable models for service delivery when there is a shared
Another feature of coalitions identified by CCAT is
mission and goal. It is evident that these community part-
stages of development. Such partnerships cycle through
nership models for delivering health care services fulfill a
stages including formation, implementation, maintenance,
health service need for MSFW that is not being met else-
and outcomes. To keep these partnerships active and
where. As other researchers have noted, collaboration is
engaged, new members must sometimes be recruited to re-
critical for the success of these partnerships, because suc-
energize the coalition. For example, a School of Physical
cessful collaborations consolidate expenses, develop cul-
Therapy joined an existing mobile clinic in Oregon, and
turally appropriate intervention approaches, reduce
reported positive research and student learning outcomes
duplication of effort, and share both the risks and rewards
from the addition of these services to the partnership mix
of the service partnership [45].
[23, 24]. In another example, a College of Public Health
Healthcare services partnerships to provide mobile farm-
joined an existing mobile clinic in Georgia to conduct a
worker clinics would benefit by adding academic or com-
needs assessment of farmworker health conditions and
munity partners who specialize in providing evaluation
injuries [31]. New partnerships are critical to the maturation
services to monitor processes and outcomes from these vital
of these coalitions through these stages of development.
services, as well as adding research components, such as
developing and testing interventions, where appropriate.
A Missed Opportunity for the Comprehensive Study
Future articles reporting the results of mobile clinic activities
of Mens Health
should include not only appropriate demographic data, but
longitudinal data on patient outcomes to measure if patients
Activities related to mens health were usually centered on
receive appropriate follow-up, diagnosis, and treatment over
occupational injuries. Only seven articles reported on
time. With emerging technologies and electronic medical
gender, and in these cases the majority of those served
records, it is becoming easier to track migrant patients who
were females because clinics focused on womens health
might be easily lost to follow-up in the past. Moreover, many
issues, including cancer screenings or prenatal care. As
MSFW return to the same clinics year after year, but are not
other programs to improve access to primary health care by
receiving proper case management. There are special case
the underserved have noted [41], few efforts have been
management considerations for MSFW [6]. The case manager
directed toward men, at the risk that they had become
also must encourage MSFW to take an active role in their own
invisible and their health needs neglected. While not
health care to assist in this process. While the literature on
invisible in articles reviewed hereoften because it is a
mobile farmworker clinics is limited, the studies identified in
given that men are the majority of MSFW and thus will
this review demonstrate the potential of this model to signif-
constitute the bulk of potential patientsgender is not
icantly impact the health of migrant farmworkers and form
brought into the discussion when reporting on men. Those
part of the agenda for farmworker social justice.
articles that did report on mens health focused almost
exclusively on occupational health concerns, such as
musculoskeletal conditions. Contemporary approaches to
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