Project FRESCO

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NCFH has developed an educational farmworker safety program, titled Promoviendo Farmworker Safety (Project FRESCO). The FRESCO Program is a community health worker-delivered heat and sun safety educational intervention for farmworkers. Project FRESCO was funded by the National Institute for Health and Safety (NIOSH) in collaboration with the Southwest Center for Agricultural Health, Injury Prevention and Education.  


 

Farmworkers are at high risk for heat and sun illnesses because they work for long hours outdoors during the hottest and sunniest time of the year. In fact, farmworkers are 20 times more likely than the general workforce to die from working in the heat, and evidence suggests that undiagnosed heat-related illnesses among field workers are widespread. The consequences of this hidden health problem include everything from headaches and fatigue to painful cramping, kidney disease, decreased work productivity, and increased on-the-job accidents. For these reasons, heat and sun safety were selected as the focus of this intervention.


Program Development
Formative research was conducted to identify specific farm safety behaviors and environmental conditions impacting farmworker health, to identify factors influencing farm safety behavior among migrant and seasonal farmworkers, and to develop an educational intervention to increase sun safety behavior among farmworkers. An initial literature review was conducted as well as a series of four focus groups with farmworkers and lay health workers in Texas to explore occupational safety and health issues and concerns among farmworkers. The primary areas of concern identified included: exposure to pesticides, heat and sun related illnesses, and acute musculoskeletal injuries.  A review of existing education programs for farmworkers on each of these topics revealed various culturally tailored programs on pesticides and musculoskeletal issues, but not on heat and sun.  Therefore, the development team decided to focus on developing a heat and sun related illness prevention program specifically for the farmworker population.  We then carried out a focused literature review and a series of four focus groups with farmworkers in Arizona and Texas to identify 1) risk factors for farmworkers heat and sun illnesses, 2) determinants of farmworkers heat and sun safety behaviors, and 3) appropriate health education methods and strategies to include in the intervention. 

The formative work revealed that farmworkers do not consistently practice heat and sun safety behaviors and that the primary determinants of these behaviors included low levels of knowledge concerning risks and preventive practices, low self-efficacy and skills, and perceived organizational barriers.  Following formative work, the program team carried out a pilot test of the materials and full implementation of the program in New Mexico with 100 farmworkers.  The findings from this pilot study can be used to better understand farmworker heat and sun safety behaviors and practices.  The findings indicate that the intervention was effective in increasing lay health worker competencies for delivering the program and farmworker safety behavior.  Specifically, the program effectively prepared lay health workers to effectively deliver the program by increasing their knowledge, self-efficacy, and attitudes about the importance of heat and sun safety and most importantly, the general core competencies and heat and sun safety specific competencies. The study also showed that the intervention not only increased knowledge, attitudes, self-efficacy and intention among farmworkers, but that it also increased sun and heat safety practices.  

Intervention Description

Intervention Mapping, a framework to help program planners develop successful health promotion programs, was used in the development and piloting of FRESCO.  A comprehensive curriculum to train promotoras how to carry out the program was developed to assure the program’s effectiveness and sustainability. Trained promotoras will use the FRESCO educational tools to conduct education sessions with farmworkers.  The goal of the educational sessions is to impact farmworkers’ knowledge, attitudes, and self-efficacy and to motivate them to practice the following target behaviors:  
  • drink water often
  • take breaks in the shade (if possible)
  • limit alcohol and caffeine
  • wear sun protective clothing, hats, and sunglasses
  • use sunscreen  
Organizations that adopt FRESCO will be provided with technical assistance on program planning, implementation, management, and evaluation.   

Educational Materials

The FRESCO materials are available in both English and Spanish and include:

  • a 11X17 low literacy flipchart with teaching notes on the back of each page
  • a low literacy photo novella and teaching guide
  • a lesson plan guide     
Promotora Training Curriculum 

The training curriculum provides promotores with the skills and knowledge to effectively use the FRESCO materials to encourage farmworkers to make simple, practical, and lasting changes to protect themselves from heat and sun while they work in the field.  The full training is two days in length.  

Methods include structured learning activities (presentations, group discussions, group work, role plays, practical exercises, etc.) to engage the promotores and give them a chance to practice. Promotores will have the opportunity to expand and reinforce the basic promotor competencies through critical thinking and hands-on activities.  The curriculum materials include:

  • an instructor’s guide
  • a student workbook
  • a PowerPoint presentation
  • program coordinator resources and tips  
*This curriculum has been certified by the Texas Department of State Health Services, Community Health Worker Certification Program.   

To learn more about Project FRESCO, training opportunities, and educational materials, please contact Alicia Gonzales, Consulting & Professional Services Director at gonzales@ncfh.org.