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© 2009 American Public Health Association
DOI: 10.2105/AJPH.2009.166181
RESEARCH AND PRACTICE |
The authors are with the New York Center for Agricultural Medicine and Health, Bassett Healthcare, Cooperstown, NY.
Correspondence: Correspondence should be sent to Giulia Earle-Richardson, New York Center for Agricultural Medicine & Health, Bassett Healthcare, One Atwell Rd, Cooperstown, NY 13326 (e-mail: giulia.earle-richardson{at}bassett.org). Reprints can be ordered at http://www.ajph.org by clicking on the "Reprints/Eprints" link.
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ABSTRACT |
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 TOP ABSTRACT INTRODUCTIONMETHODSRESULTSDISCUSSIONHuman Participant ProtectionReferences |
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We conducted a process evaluation of 2 successful farmworker community-based participatory research intervention development projects (in Maine and New York State). Participant surveys measured satisfaction with the program process. We used qualitative methods to analyze free-text responses. Respondents indicated high satisfaction levels overall. The main concern was long-distance project coordination. Community-based participatory research programs in which (1) the work team defines the target health issue, (2) agricultural employers are meaningfully included, and (3) interventions are carried through to completion, warrant further study.
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INTRODUCTION |
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TOPABSTRACTINTRODUCTIONMETHODSRESULTSDISCUSSIONHuman Participant ProtectionReferences |
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The Community Collaborations for Farmworker Safety and Health Project was established in 2003 as part of the Environmental Justice Initiative. We initiated the project in Washington County, Maine, and in the Hudson Valley of New York, in collaboration with a farmworker service agency and a physician in each location. This initiative was jointly sponsored by the National Institute of Occupational Safety and Health and the National Institute for Environmental Health Sciences; its goal was to establish community-based interventions that assisted populations that had traditionally suffered health disparities as a result of occupational or environmental conditions. The program model was based on hiring a local site coordinator, who then facilitated the recruitment and training of a local work team representing the agricultural community: farmworkers, farm owners, health care providers, and agricultural and community service agency representatives.
In Maine, the coalition developed and successfully piloted an ergonomically enhanced blueberry-harvesting rake. In New York, the program targeted eye irritation caused by high levels of extremely fine dust present in the "black dirt" region, with an intervention consisting of eyewear, eyewash, and training. Both interventions were subsequently evaluated with randomized trials and were found to be effective1,2 (J. J. M., L. H., unpublished data, 2008). Regardless, understanding why the programs were successful is equally important. To answer this question, we collected process evaluation data throughout the project. Process evaluation breaks down a program into its component parts (e.g., forming a representative work team, making group decisions, and implementing the intervention) and seeks to understand how each unfolded from the point of view of the participants. It tells researchers how implementation was experienced, and if there were any unintended consequences. Process evaluation is a mechanism for systematically listening to participants and, thus, it is difficult to imagine a successful community-based participatory research (CBPR) program that does not include it.
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METHODS |
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TOPABSTRACTINTRODUCTIONMETHODSRESULTSDISCUSSIONHuman Participant ProtectionReferences |
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To evaluate participants' satisfaction and to solicit program feedback, we conducted structured interviews with work team members at the end of each of 4 program years (2004 through 2007). We aggregated responses and analyzed free-text comments for relevant themes.3,4
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RESULTS |
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TOPABSTRACTINTRODUCTIONMETHODSRESULTSDISCUSSIONHuman Participant ProtectionReferences |
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A total of 60 surveys was completed from 2004 through 2007 (n = 20; n = 13; n = 14; and n = 13, each year respectively) by farmworkers (n = 9), farm owners (n = 11), medical professionals (n = 4), farmworker or agricultural service agency representatives (n = 6), farm equipment dealers (n = 2), and health center staff (n = 28; many were former farmworkers). The mean response rate for the 4 years was 42.9%. This reflected the difficulty of reaching farmworkers to interview (16.4% farmworker participation), whereas the participation rate within the other participant categories was much higher (60%).
Work team member satisfaction increased over the course of the project, with 45% (n = 8) indicating that they were "satisfied" or "very satisfied" in year 1, and 92% indicating the same (n = 12) by year 4. Table 1 shows positive response frequencies for a range of process questions. A majority of participants also rated the dissemination positively (100%; n = 9), felt it had affected the community (79%; n = 11), and believed that the project could continue into the future (100%; n = 12).
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As shown in Table 2, the 1 theme identified throughout all 4 years of the program was that coordinating the project from a distance made it very difficult to run the project. As one participant put it: "Yes, [there were problems, missed opportunities] because your facilitators do not live in the community, it's difficult for them to build trust and community relationships, although they try. Spend more time in the community."
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DISCUSSION |
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TOPABSTRACTINTRODUCTIONMETHODSRESULTSDISCUSSIONHuman Participant ProtectionReferences |
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The process evaluation data for the Community Collaborations for Farmworker Safety and Health Project show high levels of satisfaction, particularly in later years. It is notable that some of the most critical participant respondents in the first year became enthusiastic supporters by the end. Although it is difficult to say definitively why the satisfaction ratings were high, there are some relatively unique aspects to the program model to consider. First, the agricultural health topic was chosen by the work team during the project period. This approach puts it within a relatively small group of agricultural health CBPR programs.5–7
Second, the work team included both farmworkers and agricultural employers together, and there was substantial interaction between them. In fact, the work team in New York ultimately selected a health issue that affected workers and farm owners equally, thus strengthening the coalition. As one work team member put it: "a community impact has been better understanding between all members of the work team." A few other CBPR farmworker programs5,8,9 have involved agricultural employers in their community work teams, with similarly positive results.
Third, the project progressed all the way from initial issue selection, through intervention development and implementation, to final evaluation. This provided a sense of accomplishment, and may explain increased participant ratings over time. Few CBPR health programs of this type are found in the literature.10,11 More typically, CBPR occupational health projects have focused in a limited way on such aspects as issue identification5,7 or intervention development,8,12–15 although sometimes the predetermined issue comes directly from the community.6,16,17 These 3 program aspects warrant further exploration and development.
On the qualitative side, respondents were disappointed with farmworker and physician representation on the work team. Although substantial input from farmworkers was obtained through focus groups, individual interviews, and community forums, respondents had apparently hoped to see greater roles played on the work teams. Further research into participant expectations18 is needed.
Perhaps the issue of greatest concern is the view that the projects were limited by being coordinated from a distance. The perception was that the main driver of the projects was the research project coordinator, rather than the local site coordinator. Placing more control in the hands of local staff leaves open the question of how researchers' accountability to the funding institution can be responsibly fulfilled without this control. The dilemma of accountability and control versus community ownership is a thorny one that has been raised previously.19 Resolving it will be one of the major challenges for CBPR practitioners in the coming years.
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Human Participant Protection |
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TOPABSTRACTINTRODUCTIONMETHODSRESULTSDISCUSSIONHuman Participant ProtectionReferences |
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All research and evaluation procedures were approved by the Mary Imogene Bassett Hospital institutional review board, and all study personnel were institutional review board certified.
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Footnotes |
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Peer Reviewed
G. Earle-Richardson originated and supervised the evaluation and led the writing. J. Sorensen assisted with the qualitative analysis and with writing the article. M. Brower assisted with the quantitative analysis and with writing the article. L. Hawkes coordinated the program and assisted with the evaluation analysis and with writing the article. J. J. May originated the program, led its implementation, and assisted with the analysis and with writing the article.
Accepted for publication July 2, 2009.
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References |
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TOPABSTRACTINTRODUCTIONMETHODSRESULTSDISCUSSIONHuman Participant ProtectionReferences |
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1. May J, Hawkes L, Jones A, et al.. Evaluation of a community-based effort to reduce blueberry harvesting injury. Am J Ind Med. 2008;51:307–315.[CrossRef][Web of Science][Medline]
2. Hawkes L, May J, Paap K, Santiago B, Ginley B. Identifying the occupational health needs of migrant workers. J Comm Pract. 2007;15(3):57–76.[CrossRef]
3. Aronson J. A pragmatic view of thematic analysis. Qualitative Rep, 1994;2(1). Available at: http://www.nova.edu/ssss/QR/BackIssues/QR2-1/aronson.html. Accessed March 24, 2009.
4. Boyatzis R. Transforming Qualitative Information. Thematic Analysis and Code Development . Thousand Oaks, CA: Sage Publications; 1998.
5. Crowe JL, Keifer MC, Salazar MK. Striving to provide opportunities for farm worker community participation in research. J Agric Saf Health. 2008;14:205–219.[Medline]
6. Wing S, Horton RA, Muhammad N, Grant GR, Tajik M, Thu K. Integrating epidemiology, education, and organizing for environmental justice: community health effects of industrial hog operations. Am J Public Health. 2008;98:1390–1397.
7. Farquhar S, Samples J, Ventura S, et al.. Promoting the occupational health of indigenous farmworkers. J Immigr Minor Health. 2008;10:269–280.[CrossRef][Medline]
8. McCauley LA, Beltran M, Phillips J, Lasarev M, Sticker D. The Oregon migrant farmworker community: an evolving model for participatory research. Environ Health Perspect. 2001;109(Suppl_3):449–455.[Medline]
9. Thompson B, Coronado G, Puschel K, Allen E. Identifying constituents to participate in a project to control pesticide exposure in children of farmworkers. Environ Health Perspect. 2001;109(Suppl 3):443–448.[Web of Science][Medline]
10. Helitzer D, Willging C, Hathorn G, Benally J. Building community capacity for agricultural injury prevention in a Navajo community. J Agric Saf Health. 2009;15(1):19–35.[Medline]
11. Andrews JO, Bentley G, Crawford S, Pretlow L, Tingen MS. Using community-based participatory research to develop a culturally sensitive smoking cessation intervention with public housing neighborhoods. Ethn Dis. 2007;17:331–337.[Web of Science][Medline]
12. Pehkonen I, Takala EP, Ketola R, et al.. Evaluation of a participatory ergonomic intervention process in kitchen work. Appl Ergon. 2009;40(1):115–123.[CrossRef][Web of Science][Medline]
13. Dick J, Clarke M, van Zyl H, Daniels K. Primary health care nurses implement and evaluate a community outreach approach to health care in the South African agricultural sector. Int Nurs Rev. 2007;54:383–390.[CrossRef][Web of Science][Medline]
14. Flocks J, Clarke L, Albrecht S, Bryant C, Monaghan P, Baker H. Implementing a community-based social marketing project to improve agricultural worker health. Environ Health Perspect. 2001;109(Suppl 3):461–468.[CrossRef][Web of Science][Medline]
15. Arcury TA, Austin CK, Quandt SA, Saavedra R. Enhancing community participation in intervention research: farmworkers and agricultural chemicals in North Carolina. Health Educ Behav. 1999;26:563–578.
16. Lipscomb HJ, Argue R, McDonald MA, et al.. Exploration of work and health disparities among black women employed in poultry processing in the rural south. Environ Health Perspect. 2005;113:1833–1840.[Web of Science][Medline]
17. Quigley D, Handy D, Goble R, Sanchez V, George P. Participatory research strategies in nuclear risk management for native communities. J Health Commun. 2000;5:305–331.[CrossRef][Web of Science][Medline]
18. Quandt SA, Arcury TA, Pell AI. Something for everyone? A community and academic partnership to address farmworker pesticide exposure in North Carolina. Environ Health Perspect. 2001;109(Suppl 3):435–441.[CrossRef][Web of Science][Medline]
19. Parker EA, Israel BA, Williams M, et al.. Community action against asthma: examining the partnership process of a community-based participatory research project. J Gen Intern Med. 2003;18:558–567.[CrossRef][Web of Science][Medline]
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