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Health Needs Assessment of Migrant and Seasonal Farmworkers in Apopka,

Florida. Steven Bright, MS-2, UCF College of Medicine

Faculty Advisor: Dr. Simms-Cendan

Research Mentor: Jeannie Economos

03/01/2011               

1. Title of Project

 

Health Needs Assessment of Migrant and Seasonal Farmworkers in Apopka, Florida. 

2. Technical Abstract

 

There are currently 3-5 million migrant and seasonal farmworkers (MSFW) in the United States with over 8,000 MSFW families in Orange County, FL. While MSFW represent a valuable labor force, they are faced with serious occupational and environmental hazards which adversely affect their health status. Furthermore, numerous factors such as language barriers, lack of health insurance, lack of transportation, fear of immigration policies, and low socioeconomic status limit MSFW access to health care. Because of their migratory patterns and marginalized status, little research has been conducted to assess the health of MSFW. The goal of this study was to determine the health status, needs, attitudes and barriers to healthcare of MSFW in Apopka, FL. In-person interviews using an adapted questionnaire were conducted with 41 MSFW or their dependents. Within the past 30-days the most common complaint was cold-like symptoms, followed by gastritis and musculoskeletal problems. 80.6% of the Hispanic MSFW were overweight or obese. 31.7% of the participants reported having received a flu shot within the last year. More than half of the participants (61%) reported receiving a routine checkup during the preceding 12 months. The most frequently reported reason not to seek health care was money. Fifteen participants (36.6%) reported having missed at least 1 day of work or usual activities within the past 30 days due to sickness. The results of this study will guide recommendations to healthcare providers on how to accurately meet the health needs and improve delivery of healthcare to MSFW of Apopka, FL.

3. Lay Abstract

 

The goal of this study was to determine the health status, needs, attitudes and barriers to healthcare of MSFW in Apopka, FL. Interviews were conducted with 41 MSFW or their family members. 80.6% of the Hispanic MSFW were overweight or obese. The most frequently reported reason not to seek health care was money. Fifteen participants (36.6%) reported having missed at least 1 day of work or usual activities within the past 30 days due to sickness. The results will guide recommendations on how to accurately meet the health needs and improve delivery of healthcare to MSFW of Apopka, FL.  

4. Central Hypothesis/Objective

 

The creation and implementation of a questionnaire will determine the health status, health needs, health attitudes and barriers to healthcare of migrant and seasonal farmworkers of Apopka, FL.  

5. Specific Aims

 a. Create and implement a questionnaire to determine the health

status, health needs, health attitudes and barriers to healthcare of migrant and seasonal farmworkers (MSFW) in the Apopka area.

b. Develop recommendations on how to improve healthcare for MSWF in the Apopka area.

 6. Background and rationale.

 

The fruits, vegetables, and various agriculture products grown on the farms of the United States rely on the work of migrant and seasonal farmworkers (MSFW). Because many MSFW are frequently in transit and possibly undocumented, the number of MSFW in the United States is difficult to determine, but is estimated to be between 3 and 5 million individuals.1, 2 While this labor force is important for the economic and nutritional health of the United States, MSFW represent a marginalized and at-risk population due to minority status, language barriers, low socioeconomic status, immigration status, exposure to environmental and occupational hazards and difficulties in accessing healthcare3.  

Most farmworkers are born outside the United States with 75% born in Mexico, 2% in Central American countries and 1% born in other countries.3 The native language of 81% MSFW is Spanish with roughly half reporting that they cannot read or speak English.3 Furthermore, the average highest grade completed by MSFW is 7th grade.3 Language barriers and poor literacy rates create obstacles when MSFW seek access to health care. In addition, these factors can jeopardize the quality of the management and prevention of chronic diseases that rely on a proper understanding of educational materials or instructions detailing the administration of medications.  

The total average family income for MSFW in 2000-2001 was $15,000-$17,499 which indicates that roughly 30% of MSFW families are below the

poverty line.3 This fragile financial status can make MSFW unwilling to seek medical services in lieu of missing work unless the need is debilitating. While housing facilities are sometimes provided by employers to ease the burden of a low income, the conditions of the labor camps may be substandard and may not meet the minimum criteria for health and safety as set by the U.S. Department of Housing and Urban Development.4, 5 Overcrowding and poor sanitation in the homes of MSFW increase the risk among farmworkers and their family members to contract and propagate infectious diseases, most notably parasites and tuberculosis.6 Considering that MSFW handle much of the food that is consumed by the general public, preventive measures should promote the maintenance of health and the eradication of infectious parasites among farmworkers.  

Jobs in the agricultural industry have the notorious reputation of exposing its workers to numerous and serious occupational and environmental health hazards, ranking among the top five most dangerous occupations7. Seventy-nine percent of farmworkers are male and more than half are less than 31 years old3. However, the average life expectancy of MSFW is 49 years compared to the national average of 75 years 8. Ailments that commonly afflict MSFW include musculoskeletal problems, respiratory conditions, dermatitis, diabetes, heat stress, mental illness, and poor oral hygiene.9-12 Furthermore, chronic pesticide exposure and insufficient pesticide safety training is a highly prevalent problem that is related to both chronic and acute conditions and generational adverse effects. 13-15 Despite the importance of the MSFW labor force and their numerous occupational and environmental hazards, MSFW suffer from poor access to healthcare for a variety of reasons such as language and cultural barriers, poor literacy, lack of transportation, low income, lack of health insurance, migratory frequency, and fear of immigration regulations.12, 16, 17

In the state of Florida the estimated number of MSFW and their household dependents is 286,000 with over 8,000 individuals in Orange County.18 Several organizations within Orange Country provide affordable healthcare to MSFW in the area including The Community Health Centers of South Apopka, The Apopka Shepherd’s Hope Health Center and the Healthcare Center for the Homeless Mobile Medical Van. However a formal survey to determine the health status, needs, attitudes and barriers to healthcare of MSFW in the Apopka region has yet to be conducted. The goal of this research is to answer these questions and to provide recommendations on how to improve appropriate delivery of healthcare to MSFW in the Apopka region.  

7. Significance

 

Much work is being conducted by the healthcare organizations of the United States to determine the health needs and improve the healthcare of agrarian communities in international countries. While providing healthcare to developing countries is necessary for the security of global health, the allure of these exotic projects can overshadow the health needs of our immediate neighbors and fellow citizens. The 3-5 million migrant and seasonal farmworkers (MSFW) who currently reside in the United States represent an important labor force that is marginalized and often exploited. However research to assess the health of these individuals is sparse.19 Increasing the number of studies of MSFW will improve the visibility of this vulnerable population and accurately address their health needs. Furthermore, identifying the barriers to healthcare and cultural differences regarding attitudes of healthcare will improve healthcare delivery to MSFW.  

8. Research Strategy and Methods

 

Setting of Human Research

The questionnaire was performed in private rooms at the Apopka office of the Farmworker Association of Florida (FWAF). This setting was chosen because it is known by the MSFW of Apopka to be a safe and trusted location. The study design, recruitment materials, questionnaire, and informed consent form has been approved by the University of Central Florida Institutional Review Board.  

Recruitment Methods

Participants were recruited at the FWAF Apopka office via word of mouth and flyers. The staff at the FWAF Apopka office was briefed on the questionnaire and its purpose and was responsible for determining if the participant was eligible for the study. Participants chose a scheduled 30-minute slot for February 7th or February 21st at which time they appeared at the FWAF Apopka office to complete the questionnaire.  

Participants received a $20 gift certificate to Bravo’s Supermarket in Apopka, FL at the conclusion of the questionnaire.  

Inclusion and Exclusion Criteria

Participants must have been employed at an agricultural establishment within the last 24 months or related to and living with an individual with such employment. Participants must have been at least 18 years old. Participants must have spoken English, Spanish, or Creole as their

primary language. This information was orally verified upon recruitment and no documentation was required.  

Procedures involved in the Human Research

The questionnaire contained 28 questions covering information regarding demographics, health status, and health attitudes. The questionnaire was conducted by a trained interviewer in English, Spanish, or Creole. Participants could choose to refer to their own hardcopy of the questionnaire during the interview. The answers given by the participant were recorded by the interviewer on the questionnaire.   

9. Results and Discussion

 

Data were analyzed in MS Office Excel 2007. The data is organized into four major categories: Demographics, General Health, Access to Healthcare, and Health Attitudes & Behaviors.  

Demographics

A total of 41 participants completed the questionnaire, consisting of 25 females and 16 males. Most of the participants (n=33) were born in Mexico. Participants classified themselves as Hispanic (n=35) or Haitian (n=6). Five of the six Haitian participants were male. The mean age for all participants was 42.4 years old (min. = 19, max = 72). See Table 1 for basic demographic information. 

General Health

Height and weight were self-reported and Body Mass Index (BMI) was calculated using the following equation:

       

The Center for Disease Control and Prevention defines the categories of underweight, healthy weight, overweight, and obese according to the following BMI ranges: 

BMI CategoryBelow 18.5 Underweight18.5 to 24.9 Healthy weight

25.0 to 29.9 Overweight30.0 or higher Obese

 

No BMI was calculated for 4 participants (1 male and 3 females) because they did not know their height. The average BMI for all participants was 28.7 with a standard deviation of 6.9. Five of six Haitian participants were within the range of a healthy weight. Eighty percent (25/31) of all Hispanic participants were either overweight or obese (see Figure 1).  

Within the past 30 days, the most common health complaint recorded was cold-like symptoms (48.8%), followed by gastritis (26.8%) and muscle and joint pain (26.8%).  Fifteen participants (36.6%) reported having missed at least 1 day of work or usual activities within the past 30 days due to sickness. Most participants reported their general health as “good” (n=16) or “fair”  (n=13). The most common medical condition reported by participants was high blood pressure (n=15). Of the 41 participants, 3 reported feeling sad or depressed for at least half of the previous month. Refer to Table 2 for the complete results. 

Access to Healthcare

Roughly half (n=21) of the respondents report having one person that they think of as their personal doctor or health care provider. Most participants (n=25) also reported having visited a doctor for a routine checkup within the past year. These findings were more common among the female and adult (age>35) participants. Thirteen of the forty-one respondents (31.7%) reported having seen a dentist or received dental care in the last year. Four of the six Haitian participants had never visited a dentist or received dental care. 68.3% of participants reported not having received a flu shot within the last year. The lack of flu shots was fairly consistent (60-70%) across male, female, young and adult populations. See Table 3.  

Approximately half (n=19) of the participants reported that they visit the Apopka Community Health Center to receive care.  

Within the past year, 15 participants have wanted to receive health care but did not. The most common reason (n=11) for not seeking medical assistance was attributed to money. See Figure 2.   

Health Attitudes & Behavior

Most participants reported a desire to receive a general health checkup once every 6 months (n=16) or once every 12 months (n=13). 43.3% of

the adult population demonstrated a desire for a general health checkup every 6 months, whereas 54.5% of the young population demonstrated a desire for a general health checkup every 12 months. Most participants (n=31) reported that it was “extremely important” to receive regular health care, with 10 participants reporting that it is “important”. No participants responded that receiving regular health care was “not very important” or “unimportant”. See Table 4 

80.5% of the participants reported no current or previous cigarette smoking. 78% of the participants reported no current or previous habitual alcohol use. 50% of males reported some current or previous habitual alcohol consumption, with 3 males in the range of greater than or equal to 3-4 drinks per day.  

Discussion 

This study aimed to determine the health status, health needs, health attitudes and barriers to healthcare of migrant and seasonal farmworkers in the Apopka area. The data gathered in this study will be compared to similar data of statewide and nationwide questionnaires and surveys. The demographic characteristics of this study are very limited and may differ greatly from those of nationwide and statewide studies. This holds true for Hispanic populations which can include individuals who are from Central & South America, Cuba, Puerto Rico, and other countries. The participants from this study who classified themselves as Hispanic are almost exclusively of a Mexican origin. 

Health Status

Sixteen of the 41 participants (39.0%) reported their health status as “fair” (n=13) or “poor” (n=3). In a review of the data from the 2006 Behavioral Risk Factor Surveillance System (BRFSS), the prevalence of adults of Orange County who reported a “fair” or “poor” health status was 14.5% (95% CI 10.6%-18.4%)20. The percentage of Hispanic participants with an overweight or obese BMI was 80.6%. This is higher than nationwide reports of overweight and obese BMI’s of 64.0%-67.4%21, 22. In the state of Florida, Hispanics have a slightly higher prevalence of overweight and obese BMI’s (65.7%) than the general Florida population (63.4%)21.  

Among the major or chronic medical conditions affecting participants, high blood pressure was most commonly reported (36.6%). Likely risk factors among MSFW for hypertension include an overweight or obese BMI, increased dietary intake of sodium, or persistently elevated levels of cortisol due to chronic stress23.  

Several determinants may contribute to an individual’s tendency to become overweight, obese, or hypertensive. These include racial/ethnic, socioeconomic, behavioral, and environmental factors.  A 2007 study suggests food insecurity among MSFW may contribute to increasing rates of obesity and poorer health outcomes 24.This may be due to an increased reliance upon cheap foods that are nutritionally-poor and high in sugar, sodium, and calories. Because hypertension and obesity put individuals at risk for other chronic diseases such as cardiovascular complications and diabetes, respectively, future efforts may focus on community-wide promotions of behavioral modification strategies, appropriate long-term management plans, and culturally-sensitive nutritional guidance. 

Nearly half (48.8%) of the participants reported experiencing cold-like symptoms within the past 30 days. In addition, gastritis was reported among 26.8% of the responders. These illnesses represent common infectious diseases that are associated with poor hygiene and sanitation – conditions that are commonplace among the workplaces and overcrowded households of MSFW4-6. During the free-response section of the questionnaire, three separate comments were recorded regarding the need to improve the “filthy conditions” of the restrooms at the workplace. Community outreach programs may investigate the potential to provide the supplies and collaborative volunteer efforts to help improve the living and working conditions of MSFW.  

Health Needs

For many MSFW, the exposure to livestock, crowded living conditions, poor sanitary and hygienic habits, and a general lack of resources places this group at particular risk to initiate or propagate an influenza pandemic25. However, 31.7% of the participants reported having received a flu shot within the last year. Data from the CDC demonstrates that the percentage of the general population who received influenza vaccinations within the past 12 months is more than twice that of Hispanics nationwide22. Several factors could contribute to this discrepancy including a lack of education, language barriers, cultural beliefs, or an inability to access the appropriate resources. The determinants of why MSFW fail to receive an annual influenza vaccination has yet to be studied.  

While more than half of the participants (61%) reported receiving a routine checkup during the preceding 12 months, this percentage falls below data gathered across Florida (73.2%, CI [95%] 71.9%-74.5%) and in Orange County(77.7%, CI [95%] 72.5%-83.4%)21. Most participants who did not receive a routine checkup within the last year were young (<35 years old) or male. This suggests a need to target this demographic group to improve their habits of seeking regular medical care.  

A paucity of dental care has been commonly reported among MSFW and their dependents26, 27. Thirteen of the 41 participants (31.7%) reported having visited a dentist or received dental care within the last year. However, four of the six Haitian participants reported having no history of dental care. The provision of dental care offers community outreach efforts with an opportunity to provide additional services such as various health screenings, lifestyle interventions, and educational program thereby reinforcing the practice of appropriate health maintenance. The data suggests that the need to improve access to dental services for MSFW, especially for the Haitian subpopulation, is still relevant.  

Health Attitudes & Barriers to health care

There was a general trend among participants to value regular health care highly. Twenty-nine (70.7%) of the participants expressed a desire to receive health checkups at least once per year. All of the participants felt that receiving regular health care was “important” or “extremely important”. This data suggests that poor health outcomes among MSFW may not be due to a lack of interest in receiving health care. 

The most frequently reported reason not to seek health care was money. Although MSFW are engaged in one of the top five most dangerous occupations7, they earn incomes just above the poverty line3.  MSFW typically have a high threshold to miss work for fear of lost income or losing their job12. However, fifteen participants (36.6%) reported having missed at least 1 day of work or usual activities within the past 30 days due to sickness. The inability to receive consistent, affordable care while being exposed to multiple occupational hazards may cause a cyclic effect whereby loss of income due to illness precludes the ability to receive necessary health care. Furthermore, citizenship status or difficulties in navigating the health care system may be an additional barrier to accessing the free or low-cost health care options. The barriers to health care are an important element to develop the complete picture of the health status and needs of a MSFW community and can be elaborated in future studies. 

Limitations & Future Studies:

While this study provided a brief look into the health needs of MSFW, it was limited in scope due to several factors. Migrant and seasonal farmworkers are represented by numerous races and ethnicities, each with their unique health needs and barriers to care. This study was composed mostly of Hispanics with only a handful of Haitian participants. Furthermore, several studies of MSFW demonstrate an emerging population of indigenous Mexican from the state of Oaxaca6, 28 This demographic classification was not addressed in the current study. Future

studies may benefit by increasing the number of participants to gather a more representative sample of MSFW. If a large study is not possible, narrowing the inclusion criteria to focus on one particular demographic of MSFW may improve the accuracy of the data and thereby more effectively guide future recommendations.  

This study focused solely on MSFW who are 18 years or older. Information about the first-generation Mexican-Americans, all of whom should qualify as U.S. citizens, may help researchers delineate health problems that are related to citizenship status.

This study was also limited by the number and type of questions used in the survey. More time, funds, and more bilingual interviewers would have permitted a lengthier survey.  

Certain topics may benefit from discussions generated in focus groups. For example, the barriers to health care are most likely numerous and interdependent. Gathering qualitative information from community members about this topic would greatly improve the identification and strategies to improve breaking down these barriers. Furthermore, while the current study determined that MSFW are not receiving flu shots, there was no opportunity in the survey to determine why.                               

        

10.Literature Cited

 

1. Larson A, Plascencia L. Migrant Enumeration Study. Washington DC: Office of Minority Health; 1993.

2. "An Atlas of State Profiles Which Estimate Number of Migrant and Seasonal Farmworkers and Members of Their Families". Rockville, MD. US Department of Health and Human Services.

3. Carroll D, Samardick R, Bernard S, Gabbard S, Hernandez T. Findings from the National Agricultural Workers Survey (NAWS) 2001-2002. Labor USDo, ed.; 2005.

4. Early J, Davis SW, Quandt SA, Rao P, Snively BM, Arcury TA. Housing characteristics of farmworker families in North Carolina. J Immigr Minor Health 2006;8:173-84.

5. Gentry AL, Grzywacz JG, Quandt SA, Davis SW, Arcury TA. Housing quality among North Carolina farmworker families. J Agric Saf Health 2007;13:323-37.

6. Villarejo D. The health of U.S. hired farm workers. Annu Rev Public Health 2003;24:175-93.

7. Bureau of Labor Statistics. 2009 Census of Fatal Occupational Injuries: Occupation by event or exposure. 2009.

8. Sandhaus S. Migrant health: a harvest of poverty. Am J Nurs 1998;98:52-4.

9. Mobed K, Gold EB, Schenker MB. Occupational health problems among migrant and seasonal farm workers. West J Med 1992;157:367-73.

10. Irby CE, Yentzer BA, Vallejos QM, Arcury TA, Quandt SA, Feldman SR. The prevalence and possible causes of contact dermatitis in farmworkers. Int J Dermatol 2009;48:1166-70.

11. Fraser CE, Smith KB, Judd F, Humphreys JS, Fragar LJ, Henderson A. Farming and mental health problems and mental illness. Int J Soc Psychiatry 2005;51:340-9.

12. Hansen E, Donohoe M. Health issues of migrant and seasonal farmworkers. J Health Care Poor Underserved 2003;14:153-64.

13. Whalley LE, Grzywacz JG, Quandt SA, et al. Migrant farmworker field and camp safety and sanitation in eastern North Carolina. J Agromedicine 2009;14:421-36.

14. McCauley LA, Anger WK, Keifer M, Langley R, Robson MG, Rohlman D. Studying health outcomes in farmworker populations exposed to pesticides. Environ Health Perspect 2006;114:953-60.

15. Das R, Steege A, Baron S, Beckman J, Harrison R. Pesticide-related illness among migrant farm workers in the United States. Int J Occup Environ Health 2001;7:303-12.

16. Arcury TA, Quandt SA. Delivery of health services to migrant and seasonal farmworkers. Annu Rev Public Health 2007;28:345-63.

17. Gwyther ME, Jenkins M. Migrant farmworker children: health status, barriers to care, and nursing innovations in health care delivery. J Pediatr Health Care 1998;12:60-6.

18. Larson A. Migrant and Seasonal Farmworker Enumberation Profiles Study: Florida. In: Migrant Health Program Bureau of Primary Health Care, Health Resources and Services Administration; 2000.

19. Berman S. Health care research on migrant farm worker children: why has it not had a higher priority? Pediatrics 2003;111:1106-7.

20. Kilmer G, Roberts H, Hughes E, et al. Surveillance of certain health behaviors and conditions among states and selected local areas--Behavioral Risk Factor Surveillance System (BRFSS), United States, 2006. MMWR Surveill Summ 2008;57:1-188.

21. Centers for Disease Control and Prevention (CDC). Behavioral Risk Factor Surveillance System Survey Data. Atlanta, Georgia: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, 2009.

22. Centers for Disease Control and Prevention. National Center for Health Statistics. Health Data Interactive. www.cdc.gov/nchs/hdi.htm. 2011.

23. Esler M, Eikelis N, Schlaich M, et al. Chronic mental stress is a cause of essential hypertension: presence of biological markers of stress. Clin Exp Pharmacol Physiol 2008;35:498-502.

24. Weigel MM, Armijos RX, Hall YP, Ramirez Y, Orozco R. The household food insecurity and health outcomes of U.S.-Mexico border migrant and seasonal farmworkers. J Immigr Minor Health 2007;9:157-69.

25. Steege AL, Baron S, Davis S, Torres-Kilgore J, Sweeney MH. Pandemic influenza and farmworkers: the effects of employment, social, and economic factors. Am J Public Health 2009;99 Suppl 2:S308-15.

26. Lukes SM, Miller FY. Oral health issues among migrant farmworkers. J Dent Hyg 2002;76:134-40.

27. Nurko C, Aponte-Merced L, Bradley EL, Fox L. Dental caries prevalence and dental health care of Mexican-American workers' children. ASDC J Dent Child 1998;65:65-72.

28. Breaking Down the Barriers; A National Needs Assessment on Farmworker Health Outreach. 4th Ed. Health Outreach Partners. 2010. 

                             

   

Appendix 1: Tables        

  

  Male (n=16) Female (n=25)  

  Count (%) Count (%) TotalCountry of Origin          

Mexico 10 (62.5) 23 (92.0) 33

Haiti 5 (31.3) 1 (4.0) 6

Guatemala 0 (0.0) 1 (4.0) 1

USA 1 (6.3) 0 (0.0) 1           

Classification          

Hispanic 11 (68.8) 24 (96.0) 35

Haitian 5 (31.3) 1 (4.0) 6           

Primary Language          

Spanish 11 (68.8) 23 (92.0) 34

Creole 5 (31.3) 1 (4.0) 6

English 0 (0.0) 1 (4.0) 1           

Age, y (SD) 45.8 (14.4) 40.2 (13.4)  

         

              

  

   Health Problems Within the Past 30 Days  Cold Gastritis Muscle or Joint Fever Headaches Bronchitis

Count 20 11 11 6 3 3(%) 48.8% 26.8% 26.8% 14.6% 7.3% 7.3%

               Self-reported Major Health Problems  High Blood Pressure Diabetes Asthma Heart Attack Heart Disease Stroke

Count 15 3 3 2 1 1

(%) 36.6% 7.3% 7.3% 4.9% 2.4% 2.4%

               Would you say that your general health is:    Excellent Very good Good Fair Poor  Count 4 5 16 13 3  (%) 9.8% 12.2% 39.0% 31.7% 7.3%                 During the past 30 days, for about how many days did feeling sick keep you from doing your usual activities, such as work, recreation, or

taking care of yourself or your family?

  None 1-2 days 3-4 days 5-6 days 7-8 days 8+ days

Count 26 7 4 0 2 2*

(%) 63.4% 17.1% 9.8% 0.0% 4.9% 4.9%

           

               Male Female Young (≤35 years)      Count % Count % Count %Last checkup   < 1 year ago 8 50.0% 17 68.0% 4 36.4%

  < 2 years ago 3 18.8% 2 8.0% 1 9.1%  < 5 years ago 0 0.0% 3 12.0% 2 18.2%  > 5 years ago 4 25.0% 2 8.0% 4 36.4%  Never 1 6.3% 1 4.0% 0 0.0%

                 

Personal provider   Yes 5 31.3% 16 64.0% 4 36.4%  No 11 68.8% 9 36.0% 7 63.6%

                 

Last dental care   < 1 year ago 4 25.0% 9 36.0% 5 45.5%  < 2 years ago 1 6.3% 6 24.0% 1 9.1%  < 5 years ago 3 18.8% 6 24.0% 1 9.1%  > 5 years ago 3 18.8% 4 16.0% 4 36.4%  Never 5 31.3% 0 0.0% 0 0.0%

                 

flu shot in past year   Yes 4 25.0% 8 32.0% 3 27.3%  No 11 68.8% 17 68.0% 7 63.6%  Don't know 1 6.3% 0 0.0% 100.0% 9.1%

 

              

     

         

      Male Female Young (≤35 years)

      Count % Count % Count %

Desired Frequency of checkups Every Month 1 6.3% 1 4.0% 0 0.0%Every 3 Months 3 18.8% 3 12.0% 2 18.2%Every 6 Months 6 37.5% 10 40.0% 3 27.3%Every 12 Months 4 25.0% 9 36.0% 6 54.5%Less than once a year 1 4.0% 0 0% 0 0.0%Only when sick 1 6.3% 2 8.0% 0 0.0%

                 Importance of receiving regular health care Extremely  Important 10 62.5% 21 84.0% 10 90.9%

Important 6 37.5% 4 16.0% 1 9.1%Not very important 0 0.0% 0 0.0% 0 0.0%Unimportant 0 0.0% 0 0.0% 0 0.0%

                

      Appendix 2: Figures     

  

          

                 

Appendix 3  

Needs Assessment Questionnaire1

Demographics

1. Primary language: __________ 

 2. Age: _______

 3. Sex: _______

 4. Country of birth: ________

 5. How do you classify yourself?

a. Hispanic/Latinob. Not Hispanic/Latino

 6. How do you classify yourself? 

a. ___Black/African Americanb. ___Whitec. ___Native Hawaiian/Pacific Islanderd. ___Asian e. ___American Indian/Alaska nativef. ___Some other group (please specify)____________________

 

General Health

7. How much do you weigh?: _________ pounds□     kilograms□

 8. How tall are you?: _________ inches□          centimeters□

 9. Would you say that your general health is

a. ___Excellentb. ___Very goodc. ___Goodd. ___Faire. ___Poor

 10. During the past 30 days, for about how many days did feeling sick keep you from 

doing your usual activities, such as work, recreation, or taking care of yourself or your family?

a. ___Noneb. ___1-2 daysc. ___3-4 daysd. ___5-6 dayse. ___7-8 daysf. ___8+ days (please specify) _____

11. During the past 30 days, what health problems have you had and for how long? (ask the following if not indicated)

a. ___Cold symptoms: A sore throat, runny nose, sinus congestionb. ___Bronchitis symptoms: severe cough (sometimes with 

phlegm/mucous)c. ___Gastritis symptoms: stomach-aches, diarrhea, gasd. ___Muscle or joint paine. ___Skin rash (itching)f. ___Fever

g. ___Heat Strokeh. ___Vomiting

 12. Has you ever been told by a doctor, nurse, or medical provider that you have:

a. ___Diabetesb. ___Heart attack (also called a myocardial infarction)c. ___Heart diseased. ___A strokee. ___Asthmaf. ___Tuberculosisg. ___High blood pressure

 

Access to Health Care

13. Do you have one person you think of as your personal doctor or health care provider?

a. ___Yesb. ___No

 14. When was the last time you visited a doctor for a routine checkup? A routine 

checkup is a general physical exam, not an exam for a specific injury, illness, or condition?

a. ___Within past year b. ___Within past 2 yearsc. ___Within past 5 yearsd. ___5 or more years agoe. ___Never

          

15. Where  do you go to receive health care? How many times in the last year?a. Community health center

i. ___Apopka. Number of times ____ii. ___Zellwood. Number of times _____iii. ___Winter Garden. Number of times ____

iv. ___Other CHC____________________. Number of times ____b. ___Emergency Room. Number of times ____c. ___Mobile Health Van. Number of times ____d. ___Shepherds Hope. Number of times ____e. ___Healer. Number of times___f. ___Other__________________________. Number of times ____

 16. Within the last year, have you wanted to visit a community health clinic or an 

emergency room but did not? If yes, how many times did this occur?a. ___Nob. ___ Yes, 1-2 timesc. ___ Yes, 3-4 timesd. ___ Yes, 5-6 timese. ___ Yes, 7-8 timesf. ___ Yes, 8+ times (please specify) _____

 17. If you responded “Yes”  to the previous question, what were the most common 

reasons for not seeking medical assistance? (Check up to 3)a. ___Transportationb. ___Work (job duties)c. ___Clinic or healthcare facility was not opend. ___Moneye. ___Medical assistance was not necessaryf. ___Distance to medical assistanceg. ___Fear of medical careh. ___Fear of immigration officersi. ___Too busy with personal or family issues

 18. How many times a year would you like to receive a general health checkup?

a. ___Every month (12 times a year)b. ___Every 3 months (4 times a year)c. ___Every 6 months (2 times a year)d. ___Every 12 months (1 time a year)e. ___Only when I’m sickf. ___Fewer than once a year

  

19. How important do you think it is to receive regular health care?a. ___Extremely importantb. ___Importantc. ___Not very important

d. ___Unimportant

 20. Are you aware of any programs or clinics in the area that provide free or 

affordable medical services?a. ___Yes . PLEASE NAME: _______b. ___No

 

Dental Health

21. When was the last time you visited a dentist or received any type of dental care?a. ___Within past yearb. ___Within past 2 yearsc. ___Within past 5 yearsd. ___5 or more years agoe. ___Never 

Alcohol and Tobacco use

22. How many cigarettes do you smoke a day?a. ___None

i. ___but I did smoke in the past ___ years ago for ___ years (quantify how many packs per day below)

b. ___Less than 5 cigarettes per dayc. ___½ pack per dayd. ___1 pack per daye. ___2 packs per dayf. ___More than 2 packs per day

 23. How many alcoholic beverages do you have a day?

a. ___Nonei. ___but I did drink in the past ___ years ago for ___ years (quantify 

how many drinks per day below)b. ___Less than 1 alcoholic beverage per dayc. ___1-2 alcoholic beverages per dayd. ___3-4 alcoholic beverages per daye. ___More than 4 alcoholic beverages per day

    

Preventive Health

24. During the past 12 months have you had a seasonal flu shot?a. ___Yes (please specify the month and the year__________)b. ___Noc. ___Don’t know/Not sure

 

Mental Health

25. During the past 30 days, for about how many days have you felt sad, blue or depressed? ____

 

Occupational Health

26. Are you experiencing any health problems that you feel are due to your current occupation? Please write below and include as much detail as you would like. If you are not experiencing any health problems please write “No current problems.”

         

27. What would you need to have better health? If there is nothing you would need, please write “Nothing needed”.