Community partnership leads to successful study on the effects of environmental toxicants in Yuma farmworkers
Exposure to environmental toxicants is a crucial health equity issue for the approximately 30,000 farmworkers from Yuma and nearby Mexico who work on farmland in the county, which totals around 230,000 acres.
To address this long term health concern for underserved farmworkers, leading community health experts from the Yuma Regional Medical Center (YRMC), the Regional Center for Border Health, Inc. (RCBH) and Campesinos Sin Fronteras (CSF) partnered with five NAU researchers to conduct a joint study that examined the health impacts of environmental toxicants on this crucial workforce.
A key finding of the project was that, in order to conduct vital research and to create a change in health equity, researchers must join with established experts in community health organizations. The team documented their experiences –both successes and challenges–in “A Community-Engaged Approach to Environmental Health Research: Process and Lessons Learned” in Progress in Community Health Partnerships: Research, Education, and Action, a peer-reviewed medical journal published by Johns Hopkins University Press in January 2022.
The publication authors included Regents’ Professor Julie A. Baldwin, Center for Health Equity Research (CHER) director; Regents’ Professor Robert T. Trotter II, professor emeritus in NAU’s Department of Anthropology; Mark Remiker, CHER senior research coordinator; C. Loren Buck, professor, NAU’s Department of Biological Sciences; Amanda Aguirre, president and chief executive officer of Regional Center for Border Health, Inc.; Trudie Milner, chief operating officer of Yuma Regional Medical Center; Emma Torres, executive director of Campesinos Sin Fronteras; and Frank A. von Hippel, professor of environmental health sciences in the Mel & Enid Zuckerman College of Public Health at University of Arizona.
“We firmly believed that community-engaged research would be the best approach for this project because it focuses on relationships between researchers and communities, and it aims to achieve a balance between research and action,” Remiker said. “With trust, communication, and a shared vision, involvement by community partners in the research process can expedite and enhance participant recruitment, increase study quality and lead to future collaborative efforts.”
In “A Community-Engaged Approach to Environmental Health Research: Process and Lessons Learned,” the authors discuss factors that influence partnerships, including:
- The historical context of trust between universities and communities.
- The importance of the health issue to the community.
- The capacity and readiness of the organization to engage in a project.
Partners provide primary healthcare options for Yuma farmworkers
During long and rigorous days, farmworkers are continually exposed to pesticides and other agrochemicals. As minimum wage workers, they have limited access to healthcare resources, which may predispose them to health complications.
For health issues, farmworkers in the county typically access Yuma Regional Medical Center, the Regional Center for Border Health, Inc. and Campesinos Sin Fronteras, according to the investigators in the publication.
Yuma Regional Medical Center is a general medical and surgical hospital that serves mainly rural, agricultural populations. The Regional Center for Border Health, Inc., operates health clinics in Yuma County communities. Their patients are usually the underserved, predominantly Hispanic and rural population of south Yuma County.
Campesinos Sin Fronteras is an advocacy organization that promotes self-sustainability to farmworkers by offering access to health care, social services, housing, rehabilitation, counseling, education, and workforce development. After seeing the effects of exposure to environmental toxicants in their patients, family and community members, leaders in the three health organizations saw the value of the study.
“I thought that this might be something good for our community, this might be something good we can find out about how to better protect the health of our population…it resonated with our mission,” Torres said in the publication. “Having information about what really is happening, and having information that is scientific, will empower us.”
Partner community health organizations are invaluable in training partners, conducting the study and disseminating the results Researchers and community partners worked together to develop a daylong training at each of the organizations’ facilities for approximately 20 community partner staff who conducted the study. The sessions were offered in Spanish and English.
The training covered how to educate participants about informed consent and how to administer surveys. Only the medical centers, which had the existing infrastructure and licensed personnel to support sample collection, collected biological samples to analyze endocrine function and environmental contaminant concentrations in patients with documented thyroid problems.
“The NAU partnership is very important and improves our organization’s capacity to engage in research,” Milner said in the publication.
Staff from the community partner organizations with research experience worked together to develop culturally sensitive study materials and implement recruitment scripts and survey questions.
In addition to developing study materials, community partners translated all written materials, such as recruitment posters, consent forms, and questionnaires into Spanish to accommodate non-English-speaking participants.
“We are very committed to continue collaborative work. It has a strong value to the community, but it’s not easy to do,” Aguirre said in the report.
Lessons learned from community-based participatory research
The study resulted in a highly successful recruitment rate for a difficult-to-reach population, which the authors attribute to the community partners’ leadership.
- According to the report findings, partnering with community organizations:
- Improves recruitment and retention of study participants.
- Increases likelihood that participants will adopt public health guidelines.
- Enhances translation of research findings for community and policy change.
- Increases the likelihood that the project results are meaningful at the local level.
Following their study, researchers wanted to know how community partners judged the study’s success in five areas:
- Interest and relevance of the topic
- Effectiveness of training
- Involvement in project development and implementation
- Potential for impact on local policy
- Recommendations for future research
Some of the recommendations from the community partners were: to train more community partners who could assist with the study; to extend the length of the study administration training for people with less research experience; and to determine the level of the technological abilities of community partners prior to the training.
Community partners felt that the project had the potential to improve the health of individuals in the community, but they were somewhat frustrated by the length of time it took to analyze and disseminate results.
The partners also suggested developing a joint dissemination plan before beginning the study that discusses best approaches to relaying results back to the community so they would not alarm people about environmental contaminants and possible exposure.
“Listening to each other and respecting each other as equal partners and valuing the information that each brings makes a big difference,” Torres said.
This research received funding from the Flinn Foundation and the Southwest Health Equity Research Collaborative at Northern Arizona University (U54MD012388), which is sponsored by the National Institute on Minority Health and Health Disparities (NIMHD).