It’s not hyperbolic: everything you eat was touched by a farmworker. There are roughly 75,000 farmworkers in the state of North Carolina and they are as diverse as they are mobile – moving with the harvest to different crops, different counties, and different living conditions. 

One constant is the need for health services and information. Jobs in agriculture are some of the most dangerous, with occupational risks specific to this kind of work. But accessing relevant and accurate educational health resources is a constant challenge. Materials quickly become outdated and rarely do these resources consider the community specific risks that disproportionately affect farmworkers.

The onset of the pandemic and switch to telehealth and online-only materials drove this point home. Suddenly, the only way to access health information was via mobile platforms like WhatsApp and Facebook or recorded webinars via online databases, making these digital spaces the only point of contact between farmworkers and health information. 

Creating accessible and useful educational materials for diverse communities requires investment in time, resources, and relationships. Researchers at NC State have partnered with the NC Farmworker Health Program, NC State Extension Farmworker Health and Safety Team, and ECU’s Laupus Health Sciences Library to co-produce a new educational flip chart designed to help address the gap between farmworkers and useful online health information.

Flip charts are a tried and true educational resource that have been used in several settings, including farm fields and farmworker housing. The audience side of the chart contains highly visual content using minimal  text, while the back of the chart has notes, discussion points, and prompts for the presenting educators. Where powerpoints and webinars would fail, the flipchart thrives – being able to be deployed anywhere, even on the tailgate of a truck. 

“Feedback from focus groups [with community health workers] identified the need for increased digital literacy training for farmworkers, specifically digital health literacy,” says Emery Harwell, a former student and current social research specialist in applied ecology. “The flip chart is a familiar mode of delivery and this project focuses on how to use smartphones to access the various health information applications available today, like the NIOSH heat safety app and the FEMA app for emergency alerts.”

“There are many resources out there that talk about how to use a smartphone or how to download an app, but they don’t consider the specific needs of farmworkers,” says Catherine LePrevost, an associate professor and agromedicine extension specialist in applied ecology. “This addresses the emerging issue of more health services and education being available online but not yet accessible to farmworkers. We hope that this flip chart serves as a model for future digital literacy and online health trainings.”

The flip chart also intends to rectify some of the troubling results from the researchers’ recent work. The analysis found several major online health databases intended for agricultural workers had materials that were often difficult to access, outdated, or unrelated to their specific conditions. Researchers found that only 18% of all materials and 24% of materials about pesticides were tailored to farmworkers. Researchers also identified mismatches between the needs in the community and the materials present. For example, 49% of farmworker patients in NC have diabetes, yet only 7% of information about diabetes was tailored to farmworkers. Many materials were outdated and there was a lag between emerging issues and the availability of accurate materials. 

“We found that this information was by and large not tailored to the type of educational environment that farmworkers have,” says Harwell. “An in-person lecture or hour-long webinar does not work for folks who have just spent twelve-plus hours in the field.”

Limited internet access and accessibility to these databases is already a known challenge, but focus groups of community health workers identified that the materials themselves, once finally accessed, often lack utility – either because the information is dated, not relevant to farmworkers needs, or not in an appropriate format.

“This is a call to action for these particular services to ensure they have tailored materials and represent the most pressing health needs,” says LePrevost. “We should involve community health workers in the prioritization and development of these educational materials and databases.” 

“Community workers have great ideas for what works, like games or changing lyrics to popular songs,” says Harwell. “The capacity for creativity exists, but the resources to support that co-production do not.”

Their new educational flip chart is available freely online at Conectando NC: Manteniendonos Informados y Conectados Usando Nuestros Celulares (Connecting NC: Staying Informed and Connected Using Your Smartphone) here.

The article, “An Analysis of the Availability of Health Education Materials for Migrant and Seasonal Farmworkers” was published in the Journal of Agromedicine in February 2023. It was authored by Emery Harwell and Catherine LePrevost from NC State and Michael Wright, Jamie Bloss, and Joseph Lee from East Carolina University. The work was funded by the National Library of Medicine of the National Institutes of Health award #G08LM013198.