Cole Donald C, McLaughlin Janet E, Hennebry Jenna L, Tew Michelle A
Occupational Health Clinic for Ontario Workers, 848 Main St E, Hamilton, ON L8M 1L9, Canada; Dalla Lana School of Public Health, University of Toronto, Health Sciences Building, 155 College St, Toronto, ON M5T3M7, Canada; and Institute for Work & Health, 481 University Ave Suite 800, Toronto, ON M5G 2E9, Canada
Health Studies, RCE 242, Wilfrid Laurier University, Brantford, Ontario N3T 2Y3, Canada; and International Migration Research Centre, Balsillie School of International Affairs, Wilfrid Laurier University, 67 Erb Street West, Waterloo, ON, Canada
Rural Remote Health. 2019 Dec;19(4):5313. doi: 10.22605/RRH5313. Epub 2019 Dec 1.
The intersecting vulnerabilities of migrant agricultural workers (MAWs) impact both their health and their access to health care in rural areas, yet rural clinicians' voices are rarely documented. The purpose of this study was to explore health professionals' perspectives on health care for MAWs in sending countries and rural Ontario, Canada.
Qualitative research design occurred over three distinct projects, using a multi-methodological approach including semi-structured interviews in Mexico, Jamaica and rural Ontario (n=43), and session field notes and questionnaires administered to healthcare providers (n=65) during knowledge exchange sessions in rural Ontario. A systematic analysis of these data was done to identify common themes, using NVivo software initially and then Microsoft Excel for application of a framework approach.
Structural challenges posed by migrant workers' context included difficulties preventing and managing work-related conditions, employers or supervisors compromising confidentiality, and MAWs' fears of loss of employment and return to countries of origin prior to completing treatments. Structural challenges related to health services included lack of adequate translation/interpretation services and information about insurance coverage and MAWs' work and living situations; scheduling conflicts between clinic hours and MAWs' availability; and difficulties in arranging follow-up tests, treatments and examinations. Intercultural challenges included language/communication barriers; cultural barriers /perceptions; and limited professional knowledge of MAWs' migration and work contexts and MAWs' knowledge of the healthcare system. Transnational challenges arose around continuity of care, MAWs leaving Canada during/prior to receiving care, and dealing with health problems acquired in Canada. A range of responses were suggested, some in place and others requiring additional organization, testing and funding.
Funding to strengthen responses to structural and intercultural challenges, including research assessing improved supports to rural health professionals serving MAWs, are needed in rural Canada and rural Mexico and Jamaica, in order to better address the structural and intersecting vulnerabilities and the care needs of this specific population.
流动农业工人面临的多重脆弱性影响着他们的健康以及在农村地区获得医疗保健的机会，然而农村临床医生的观点却鲜有记录。本研究的目的是探讨卫生专业人员对加拿大安大略省农村地区以及输出国流动农业工人医疗保健的看法。
定性研究设计涵盖三个不同项目，采用多方法途径，包括在墨西哥、牙买加和安大略省农村地区进行半结构化访谈（n = 43），以及在安大略省农村地区的知识交流会上向医疗服务提供者发放会议现场记录和问卷（n = 65）。首先使用NVivo软件对这些数据进行系统分析以确定共同主题，然后使用Microsoft Excel应用框架方法。
流动工人所处环境带来的结构性挑战包括预防和管理与工作相关疾病的困难、雇主或主管泄露机密、流动农业工人担心在完成治疗前失去工作并返回原籍国。与卫生服务相关的结构性挑战包括缺乏足够的翻译/口译服务以及有关保险覆盖范围和流动农业工人工作及生活状况的信息；诊所营业时间与流动农业工人就诊时间的冲突；以及安排后续检查、治疗和检查的困难。跨文化挑战包括语言/沟通障碍；文化障碍/观念；以及对流动农业工人移民和工作背景的专业知识有限，流动农业工人对医疗保健系统的了解也有限。跨国挑战围绕着医疗连续性、流动农业工人在接受治疗期间/之前离开加拿大以及处理在加拿大获得的健康问题。提出了一系列应对措施，有些已经实施，有些则需要更多的组织、测试和资金。
加拿大农村地区以及墨西哥和牙买加农村地区需要资金来加强应对结构性和跨文化挑战的措施，包括开展研究评估对为流动农业工人服务的农村卫生专业人员提供更好支持的情况，以便更好地应对这一特定人群的结构性和交叉脆弱性以及护理需求。
