Assessment of health care providers' capacity to deliver services to migrant and seasonal farmworkers in East Tennessee

The purpose of this study was to assess the capacity and attitude of various types of health care providers in selected East Tennessee counties to deliver basic health care to migrant and seasonal farmworkers, and to propose strategies to deal with the perceived problems. The purpose of this study was two-fold: first, to assess the capacity of health care providers, in a 10 county area of East Tennessee, to deliver primary care to migrant and seasonal farmworkers; secondly, to examine the providers attitude toward dealing with migrants

Based on the literature review and a jury process, a survey instrument was developed and validated by the researcher. The instrument was divided in two parts. The first part was a Likert-type attitude scale (25 items), designed to examine the providers' opinion about migrants in three content areas: 1) Awareness of migrants' specific health needs, 2) Ways of delivering care, and 3) Desirability of migrants as patients. The second part was designed to gether data regarding the providers characteristics, their type of practice, the services provided, their knowledge of Spanish and whether (and how many) migrants had been treated as patients during the previous year

The population of interest consisted of all the primary care providers in 10 counties in East Tennessee, selected because they experienced a yearly, and increasing, influx of migrant and seasonal farmworkers.

Two mailings and a round of telephone calls yielded a response rate of 42.36% Of these, all but 6 were used for the study (N-80) Descriptive statistics were employed to analyze the data. A MANOVA was performed to compare the two groups (physicians and nurse practitioners/physician assistants) on the three variables (awareness, system delivery and desirability)

The great majority of physicians provided basic primary care services, though some were limited to women and children. All providers claimed to provide health education, but the majority concentrated on sexually transmitted diseases and nutrition. Very limited health education and counseling were noted in the areas of mental health, substance abuse and prevention of family violence.

Linkages and cooperation agreements between the agencies themselves, and between practices and institutions of higher leaming were found to be rather limited, the one possible exception being the collaboration between nursing schools and community/public health agencies. Finally, about one fourth of providers (staff included) had some knowledge of the Spanish language.

In terms of providers' attitude, it was found that both groups had a positive attitude toward migrant and seasonal farmworkers, with nurse practitioners/physician assistants attitude more positive than physicians However, the only statistically significant difference, relative to attitude, was noted in the third content area, Desirability, where the nurse practitioner/physician assistant group appeared to be more favorably predisposed toward migrants as patients

Both groups acknowledged not being well acquainted with migrants' specific health care needs, but were willing to learn more. In addition, they expressed an interest in donating their time, and in supporting community efforts to ameliorate migrant and seasonal farmworkers' conditions. There was a general agreement in not letting the burden of care falli entirely on public health agencies, and in extending TennCare coverage to all migrants, although a slim majority of physicians did not feel that the federal government should subsidize the care

Finally, all providers were favorably inclined toward having migrants as patients, although the nurse practitioner/physician assistant group was more willing to accommodate their working schedule to fit that of migrants, to facilitate the availability of, and accessibility to health services

In view of the findings, the following conclusions were made:1. The majority of providers had the capacity to deliver basic health care services to migrant and seasonal farmworkers.2. The level of linkages and cooperation between providers and agencies was rather minimal.3. The majority of providers exhibited a favorable attitude toward migrant and seasonal farmworkers, and were willing to lend their support in improving migrants conditions.