Date of Award


Degree Name

PhD Nursing

Dissertation Committee

Ruth A. Bush, PhD, MPH, FAMIA Chairperson; Mary K. Barger, PhD, MPH, RN, CNM, FACNM, Committee Member; George J. Chiang, MD, Committee Member


Health Services Utilization, Healthcare, Health Care Access, Access to Care, Farmworkers


Background: Agriculture industry has the highest fatality rate among all United States industries. Farmworkers experience high rates of occupational injury, illness, and mortality, yet have limited access to health care. Implementation of the Patient Protection and Affordable Care Act (ACA) of 2010 increased health care accessibility and broadened farmworker eligibility for health insurance, yet no study has measured the impact of the ACA upon U.S. farmworkers.

Purpose: The purpose of this research was to examine health care access and health care services utilization among U.S. farmworkers following the implementation of the ACA in 2010.

Specific Aims:

1. Apply the Behavioral Model for Vulnerable Populations (BMVP) with a national sample of U.S. farmworkers to describe the predisposing, enabling, and need factors, with U.S. health care utilization.

2. Describe the predisposing, enabling, and need factors independently associated with U.S. health care utilization.

3. Determine the odds of U.S. health care utilization as accounted for by the BMVP predisposing, enabling, and need factors.

Method: A retrospective cross-sectional design was employed using secondary data from the 2011 – 2014 National Agricultural Workers Survey (NAWS). Respondents of the NAWS include U.S. hired farmworkers who labor for a U.S. agricultural employer for crop-related production (n=7260). Data analysis examined the relationships between BMVP factors and U.S. health care utilization among U.S. farmworkers.

Results: More than half (60%) of farmworkers utilized U.S. health care. All predisposing (age, education, ethnicity, country of origin, gender, legal status, marital status, English speaking and reading proficiency), enabling (access to transportation, income, insurance status, Medicaid), and need (barriers to care, health status) factors were independently associated with U.S. health care utilization when analyzed for the full sample (p

Implications: Nurses play an important role in mitigating barriers to health care for farmworker families. Understanding the many barriers and influencing factors of health care utilization can inform nurse-led outreach efforts, community programs, and health policies to improve health care service delivery for this underserved group.

Document Type

Dissertation: Open Access