































   Advancements in Agricultural Development 
  Volume 4, Issue 3, 2023 
  agdevresearch.org 

1. John Diaz, Associate Professor and Extension Specialist, University of Florida, 1200 N. Park Rd, Plant City, FL 33563, john.diaz@ufl.edu,  

 https://orcid.org/0000-0002-2787-8759 
2. Laura Warner, Associate Professor and Extension Specialist, University of Florida, 407 Rolfs Hall, Gainesville, FL 32611, 

lsanagorski@ufl.edu,  https://orcid.org/0000-0003-2784-6666 
3. Lara Vargas, Student, University of Florida, 2708 SW Archer Rd, Gainesville, FL 32608, lvargasalvarez@ufl.edu,  

 https://orcid.org/0009-0004-5502-1842 
4. Isabel Taboada, Student, University of Florida, 2708 SW Archer Rd, Gainesville, FL 32608, isabeltaboada@ufl.edu,                                        

 https://orcid.org/009-0008-2554-3163 
5. Cody Gusto, Post-doctoral Scholar, University of Florida, 1200 N. Park Rd, Plant City, FL 33563, cgusto@ufl.edu,                                                  

 https://orcid.org/0000-0003-0008-0533 
6. Adriana Abreu, Student, University of Florida, 2708 SW Archer Rd, Gainesville, FL 32608, adriana.abreu@surgery.ufl.edu,                          

 https://orcid.org/0009-0009-8258-1032 
7. Kati Lawson, County Extension Director and 4-H Agent, University of Florida, 4509 George Blvd Sebring, FL 33875, kmcwaters@ufl.edu, 

 https://orcid.org/0000-0001-6271-8120 
8. Norman Beatty, Assistant Professor, University of Florida,  1600 SW Archer Road, D2-39 - Gainesville, FL 32608, 

norman.beatty@medicine.ufl.edu,  https://orcid.org/0000-0002-3032-5741  
158 

Achieving Farmworker Health Equity in Colombia: A 
Participatory Approach to Identifying Needs and Strategies 

 
J. Diaz1, L. Warner2, L. Vargas3, I. Taboada4, C. Gusto5, A. Abreu6, K. Lawson7, N. Beatty8 

 
 

Article History 
Received: May 2, 2023 
Accepted: August 21, 2023 
Published: September 12, 2023 
 
 
Keywords 
Delphi technique; health care access; 
quality of health care; community-
based participatory action research; 
health disparities 
  

Abstract 
Farmworkers, who are essential to the global food supply chain, are often 
exposed to a range of occupational hazards that can have negative 
impacts on their health. Hazards include exposure to pesticides, long 
working hours, and physical strain, among others. Unfortunately, 
farmworkers, particularly those in low- and middle-income countries, 
often lack access to basic healthcare services and face numerous health 
inequities. Colombia is no exception. The country's agricultural sector is 
an important part of its economy, but farmworkers in Colombia face 
significant health challenges. Many work long hours in difficult conditions 
and lack access to basic healthcare services. To address such challenges, 
there is a need for greater awareness and action targeting global 
farmworker health inequities, specifically in Colombia. The study’s 
purpose was to reach consensus among community health workers who 
serve farmworkers in Colombia on the most pervasive barriers to 
healthcare access and quality of care, as well as on effective strategies 
linked to those barriers. Using the Delphi technique, seven barriers and 
five strategies achieved consensus. The results provide insights for key 
stakeholders such as extension educators to consider in the development 
of policy and practice intended to overcome relevant barriers and 
advance health equity among farmworkers.   

mailto:john.diaz@ufl.edu
https://orcid.org/0000-0002-2787-8759
mailto:lsanagorski@ufl.edu
https://orcid.org/0000-0003-2784-6666
mailto:lvargasalvarez@ufl.edu
https://orcid.org/0009-0004-5502-1842
mailto:isabeltaboada@ufl.edu
https://orcid.org/009-0008-2554-3163
mailto:cgusto@ufl.edu
https://orcid.org/0000-0003-0008-0533
mailto:adriana.abreu@surgery.ufl.edu
https://orcid.org/0009-0009-8258-1032
mailto:kmcwaters@ufl.edu
https://orcid.org/0000-0001-6271-8120
mailto:norman.beatty@medicine.ufl.edu
https://orcid.org/0000-0002-3032-5741


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Introduction and Problem Statement 
 
Farmworkers represent an especially vulnerable population that often experience considerable 
health inequities due to poor working conditions, low wages, and limited access to healthcare 
(Arcury et al., 2018; Arcury et al., 2019; Castillo et al.., 2021; El Khayat et al.., 2022; Molina-
Guzmán & Ríos-Osorio, 2020). These inequities are particularly prevalent among farmworkers 
in Latin America (El Khayat et al.., 2022; López & Valdés, 2000; Mejía-Mejía et al.., 2007). 
Colombia specifically represents a troubling case as it has a high percentage of rural 
populations engaged in agriculture, which makes the issue of farmworker health a major public 
health concern (Lopez & Valdez, 2000; Mejia-Mejia et al., 2007; Ministerio de Salud y 
Protección Social, 2021). Farmworkers in Colombia often experience limited access to 
healthcare due to their remote locations, geographic isolation, lack of transportation, limited 
financial resources, lack of education and knowledge about health risks and preventive 
measures, discrimination, language barriers, and economic disadvantage (Castillo et al., 2021; 
Lopez & Valdez, 2000; Mejia-Mejia et al., 2007; Ministerio de Salud y Protección Social, 2021).  

Efforts have been made to address the critical issue of health inequities among farmworkers in 
Antioquia, the sixth largest department of Colombia, such as the provision of free healthcare 
services and the development of educational campaigns to raise awareness about health risks 
and preventive measures (Ministerio de Salud y Protección Social, 2021; Quartucci, 2022). 
Unfortunately, farmworkers in Antioquia also have limited access to these health education and 
prevention programs that can help improve their health outcomes. There is an opportunity for 
extension educators in Colombia to assist in overcoming these challenges by creating 
community-based approaches to identifying farmworker health needs and culturally responsive 
strategies (Burton et al., 2021).  

Theoretical and Conceptual Framework 
 
The Cooperative Extension Health Equity Framework (CEHEF) is a comprehensive approach to 
addressing health disparities in underserved communities (e.g., farmworkers; Burton et al., 
2021). Health equity refers to the absence of avoidable and unfair differences in health 
outcomes among individuals or groups due to social, economic, and environmental factors 
(Office of Health Equity, 2023). CEHEF is a guide developed by the Cooperative Extension 
System (CES) to help extension professionals understand and address health equity issues in 
their work. The framework is based on a social determinants of health (SDOH) approach that 
acknowledges the role of social, economic, and environmental factors in shaping health 
outcomes.  

SDOH are defined as “the conditions in which people are born, grow, live, work and age” 
(World Health Organization, 2021, p. 2). The National Academies of Sciences, Engineering, and 
Medicine (2017) cite nine SDOH that fundamentally influence health outcomes at the 
community level including education, income and wealth, employment, health systems and 
services, housing, the physical environment, transportation, the social environment, and public 
safety. For example, poverty is a significant social determinant of health among farmworkers, 

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with many living below the poverty line. According to a study by Villarejo et al. (2012), 62% of 
farmworkers surveyed had an annual income below the poverty line, and 72% of workers did 
not have health insurance. This lack of financial resources can result in limited access to 
healthcare services, inadequate nutrition, and inadequate housing conditions, which have 
significant implications for farmworker health and well-being.  

By leveraging the SDOH model, the CEHEF fundamentally recognizes that addressing health 
disparities requires a multi-level, multi-sector approach to effectively addresses these 
underlying factors. The CEHEF identifies three key overarching strategies for achieving this: (a) 
understanding the community context, (b) identifying and addressing disparities, and (c) 
building capacity for change (Burton et al., 2021). The framework further advances six targeted 
key strategies that can be implemented at the individual, community, and policy levels. The six 
strategies include: (a) building community capacity, (b) promoting healthy behaviors and 
environments, (c) improving access to care, (d) addressing SDOH, (e) building partnerships and 
coalitions, and (f) using data and evaluation to guide action (Burton et al., 2021).  

The CEHEF emphasizes the need for community engagement and collaboration between 
different stakeholders to identify and address SDOH that contribute to health disparities. This 
requires an understanding of the unique needs and challenges faced by underserved 
communities, as well as a commitment to cultural sensitivity and equity (Burton et al., 2021). 
One strategy for integrating and delivering a CEHEF into a community is to use a community-
based participatory research (CBPR) approach. CBPR is a collaborative approach to research 
that involves community members as equal partners in the research process (Wallerstein et al., 
2017). This approach recognizes the importance of community knowledge and expertise in 
identifying and addressing health disparities. It also helps to empower and engage communities 
in the policy development process that is important for achieving changes to policies, systems, 
and environments to advance farmworker health equity. 

Purpose 
 
The purpose of this study was to identify consensus on the most pervasive barriers and 
effective strategies to healthcare access and quality of care among Farmworkers in Antioquia, 
Colombia. To achieve this purpose, the following objectives guided our inquiry: 
1. Determine primary barriers to health care access and quality of care for farmworkers.  
2. Determine the most effective strategies to advance health care access and quality of care 

for farmworkers.  
 
This research study was developed to inform collaborative efforts between government 
agencies and officials in Antioquia, university partners, community non-profit organizations that 
serve farmworkers and community leaders. The results of this study will be used to inform 
policies and practices that advance farmworker health equity, including insights into the role of 
extension education.  

 

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Methods 
 
We utilized a modified, two-round Delphi technique in this study. A Delphi technique involves a 
series of iterative rounds of anonymous questionnaires or surveys with the goal of identifying 
consensus among expert panelists in the areas of policy, practice, or organizational decision-
making in a relatively short period of time (Brady, 2015; Hasson et al., 2000). While Delphi 
studies can range in rounds, “the essence of good Delphi surveys is an iterative process and 
controlled feedback to generate consensus,” with a “closing criteria in most of the Delphi 
studies include consensus achieved after a prefixed (usually two) rounds” (Nasa et al., 2021; p. 
120). The study was launched in the fall of 2022 and completed in the spring of 2023, and all 
verbal and written materials were presented in Spanish.  

The panel for this study included a purposive sample of 16 community health workers (i.e., 
promotoras) who lived and worked in the poorest areas of Antioquia, Colombia (i.e., comunas) 
and who serve farmworker communities. The promotoras were solicited for inclusion not only 
because of their familiarity with the communities of interest and their associated health care 
needs, but also because of their own expertise in public health and health care. In many of the 
cases of the panelists, this familiarity stemmed not only from living in the communities but also 
from working as farmworkers in these communities. Interestingly, more than half of the group 
not only were farmworkers but were part of a group called “Agricologas,” which was a peer-to-
peer learning group focused on educating and serving the agroecology communities of rural 
Antioquia.  

The Delphi technique was adapted to include the minimum of two rounds, because starting 
collaborative efforts from a point of consensus was important but the authors understand that 
the panel members had limited availability because of rough realities of their poor home life 
and extensive work responsibilities in agricultural production and community health. To 
accommodate for the respondent reality and allow for more response time, two months were 
allocated for data collection for each round. Antioquia was chosen because it represents one of 
the most productive agricultural regions in Latin America with some of the most prevalent 
health inequities in Colombia. A community-based approach (Hacker, 2013) was used to select 
the panelists, eliciting recommendations from key community leaders and non-profits. As part 
of the community-based approach, an implementation workgroup that represented a subset of 
the panel (n = 5) was convened to guide various aspects of the process, including a post-study 
review and synthesis of findings. 

Data Collection and Analysis 
In the first round of the two-round Delphi, panellists were invited to provide their perspectives 
on four open-ended prompts through an online survey. The prompts asked panellists to address 
the most significant barriers, challenges, and obstacles to quality farmworker health care 
access, and strategies believed to hold the most promise for improving access to quality health 
care for farmworkers. Prior to data collection, we administered the survey to a group of 
Colombian clientele and extension educators in Florida among Colombians who provided their 
feedback related to survey readability and understanding. We used a group of Colombians, 

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specifically, so the pilot would evaluate these tenets based on Colombian Spanish dialect and 
cultural norms.  

To analyze the open-ended responses, we used a three-step thematic analysis process (Braun & 
Clark, 2012). First, two of the co-authors extracted the text that related to our research 
questions from the respondents’ full responses to each of the prompts. Next, they grouped 
similar text together within each of the areas of interest (i.e., barriers and strategies). Once the 
text was organized, the authors provided a new thematic label to the group of items that tied 
them all together. Upon completion, the co-authors that analyzed the data put together a peer-
debrief memo and spreadsheet that explained the process and provided the outcomes to the 
rest of the author team and an external member to elicit feedback. Once feedback was 
collected, it was used to re-analyze data. This process continued until all authors agreed upon 
the created themes.  

We utilized the second round to identify the panel’s level of agreement (i.e., consensus) on the 
extent of the identified barrier and the effectiveness of each identified strategy. For barriers, 
we asked participants to rate the extent of the barrier using a 4-point scale, (1 = Not a barrier; 2 
= Somewhat a barrier; 3 = Moderate barrier; 4= Major barrier).  Following Delphi best practices, 
we utilized an a priori definition of consensus (Diamond et al., 2014) specified as 2/3 of the 
panel selecting “Major barrier.” For the strategies, we asked participants to rate the 
effectiveness of each strategy using a five-point scale (1 = Not effective at all; 2 = Somewhat 
effective; 3 = Effective; 4 = Very effective; 5 = Extremely effective). For this scale, we utilized the 
a priori definition of consensus to be 2/3 of the panel selecting “Extremely effective.”  There 
was also an open-ended question at the end of each list asking panellists to input additional 
barriers or strategies for consideration.  

We achieved a 100% (N = 16) response rate in round one and an 81% (N = 13) response rate in 
round two. Round two’s response was reduced due to two panellists being unable to complete 
the survey in the given time and another panellist passing away. Even though respondents had 
two months to complete the round 2 survey, complexities and difficulties in their personal lives 
prevented their response. 

Findings 
 
Following the completion of round two, the principal investigator reviewed the results with the 
implementation workgroup and solicited feedback. Each workgroup member received a copy of 
the results and was asked to provide feedback through a short, facilitated discussion. The 
principal investigator used four simple prompts to promote reflection, identify any perceived 
omissions, pinpoint any items that needed to be adapted, and collectively plan the next steps 
for utilizing the data. The workgroup members all had positive perspectives related to the 
results and did not identify any omissions or discrepancies. They also identified a set of next 
steps, which included meeting with the Secretary of Health in Antioquia to discuss the results.  

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Open-ended responses from the first round generated 12 barriers to healthcare access, five 
barriers to quality of care, six strategies to advance healthcare access, and nine strategies to 
enhance the quality of care (see Table 1).  

Table 1 

Barriers and strategies themes synthesized from round 1 responses 
Barriers to Health Care Access Strategies to Improve Health Care Access 
• Insufficient resources for medical emergencies 
• Insufficient financial resources 
• Lack of appropriate communication 

between medical professionals and patients 
• Lack of medical education in the communities 
• Lack of transportation resources for people 

with disabilities 
• Lack of trust towards medical professionals 
• Lack medical professionals 
• Lack of digital literacy 
• Lack of medical insurance 
• Limited access to professional advisors to 

navigate paperwork related to the healthcare 
system 

• Long distances to be traveled to receive medical 
attention due to lack of local centers 

• Transportation issues 

• Create local healthcare centers with a permanent 
medical team  

• Create stable transportation to increase mobility 
for health purposes and in case of emergencies 

• Education and promotion of preemptive health 
• Have a team of medical specialists go to the rural 

areas periodically  
• Professional advisor for public resources 
• Telemedicine (virtual resources) 

Barriers to Quality of Care Strategies to Improve Quality of Care 
• Inadequate infrastructure 
• Lack of appropriately trained medical professionals 

for the farmworker community 
• Limited access to medical specialists 
• Limited access to professionals that can help 

navigate healthcare system costs 
• Self-diagnostic and self-medication practices 

• Construction of more local healthcare centers 
• Create a medical program that focuses on 

preemptive care 
• First aid training for community members 

(emergency births, minor injury treatments, etc.) 
• Have access to a professional advisor to help 

navigate the bureaucratic side of healthcare 
• Have healthcare professionals visit the 

communities so they can plan a more 
comprehensive medical plan 

• Have routine technical audits in rural medical 
centers 

• Have the adequate medical resources for 
emergency treatment 

• More access to medical specialists to reduce the 
wait time for appointments 

• Technical and economic support for the 
development and commercialization of healthy 
foods 

 
Data analysis for round two resulted in group consensus for four barriers to health care access, 
three barriers to quality of care, three strategies for improving health care access, and two 
strategies for improving quality of care. Additionally, no items were added based on the open-

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ended prompts by panelists for either barriers or strategies. The items that are bolded in the 
first columns of Tables 2 and 3 exhibited consensus based on our a priori definition of 
consensus. The items bolded in the second column in both tables did not achieve consensus 
based on our definition but did exhibit significant agreement (i.e., 2/3 moderate or principal 
barrier; 2/3 extremely or very effective). We believe that this agreement warrants 
consideration when evaluating the results of this study.  

 Table 2 
 
 Summary of responses for barriers to health care access and quality of care 
Barrier to Access % of panelists 

identified as 
a principal 

barrier  

% of panelists 
identified as a 
moderate OR 

principal barrier 
Long distances to be traveled to receive 
medical attention due to lack of local centers 

79.92 (10) 100 (13) 

Lack medical professionals 79.92 (10) 92.30 (12) 
Insuficient financial resources 69.23 (9) 100 (13) 
Lack of transportation resources for people 
with disabilities 

69.23 (9) 100 (13) 

Lack of medical insurance 53.85 (7) 92.30 (12) 
Insufficient resources for medical emergencies 53.85 (7) 84.62 (11) 

Transportation issues 53.85 (7) 84.62 (11) 
Limited access to professional advisors to 
navigate paperwork related to the healthcare system 

46.15 (6) 76.92 (10) 

Lack of digital literacy 46.15 (6) 69.23 (9) 
Lack of medical education in the communities 23.08 (3) 92.30 (12) 
Lack of appropriate communication between medical 
professionals and patients 

23.08 (3)  46.15 (6) 

Lack of trust towards medical professionals 15.38 (2) 23.08 (3) 
Barrier to Quality of Care 

Limited access to medical specialists 84.62 (11) 92.30 (12) 
Lack of appropriately trained medical professionals 
for the farmworker community 

76.92 (10) 76.92 (10) 

Inadequate infrastructure 76.92 (10) 92.30 (12) 
Autodiagnostic and automedication practices 61.54 (8) 76.92 (10) 
Limited access to professionals that can help navigate 
healthcare system costs 

30.77 (4) 76.92 (10) 

 
 

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 Table 3 
 
Summary of Responses for Strategies to Health Care Access and Quality of Care 
Strategy to Access % of panelists identified 

as an extremely 
effective strategy 

% of panelists identified as 
an extremely OR very 

effective strategy 
Create stable transportation 
to increase mobility for health 
purposes and in case of emergencies 

76.92 (10) 92.30 (12) 

Have a team of medical specialists 
go to the rural areas periodically  

76.92 (10) 100 (13) 

Education and promotion 
of preventative health 

69.23 (9) 100 (13) 

Create local healthcare centers with 
a permanent medical team 

53.85 (7) 100 (13) 

Telemedicine (virtual resources) 38.46 (5) 69.23 (9) 
Professional advisor for 
public resources 

23.08 (3) 76.92 (10) 

Strategy to Quality of Care 
Have healthcare professionals visit 
the communities so they can plan a 
more comprehensive medical plan 

76.92 (10) 92.31 (12) 

Construction of more local 
healthcare centers 

76.92 (10) 84.62 (11) 

More access to medical specialists to 
reduce the wait time for 
appointments 

61.54 (8) 100 (13) 

First aid training for community 
members (emergency births, minor 
injury treatments, etc.) 

61.54 (8) 100 (13) 

Have adequate medical resources for 
emergency treatment 

61.54 (8) 100 (13) 

Create a medical program that 
focuses on preemptive care 

53.85 (7) 100 (13) 

Technical and economic support for 
the development and 
commercialization of healthy foods 

53.85 (7) 100 (13) 

Have access to a professional advisor 
to help navigate the bureaucratic 
side of healthcare 

7.69 (1) 76.92 (10) 

Have routine technical audits in rural 
medical centers 

23.08 (3) 84.62 (11) 

 

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Finally, the five-member implementation workgroup vocalized agreement with the results from 
round two. Additionally, the workgroup identified the opportunity to use virtual resources (i.e., 
video conferencing) to conduct trainings and educational workshops in the areas to build the 
capacities of the farmworkers, their community and the community health workers alike. This 
implementation workgroup felt that this approach served as a meaningful intervention to 
connect university partners to these communities on a more regular basis to conduct 
community capacity efforts while policy discussions to construct additional local health centers 
and develop new health professionals in the area would take some time. They believed that 
virtual approaches to capacity development would help to alleviate issues of distance and lack 
of access to educational opportunities for the remote, farmworker communities.  

Barriers 
The panel agreed upon four barriers to healthcare access for farmworkers, including long 
distances to receive medical attention, lack of medical professionals in the area, insufficient 
financial resources, and lack of transportation resources for people with disabilities. When it 
comes to quality of care, the panel agreed upon three primary barriers to quality of care, 
including: limited access to medical specialists, lack of trained medical professionals, and 
inadequate infrastructure. The barriers align with previous literature and the conundrum that is 
rural health (Burton et al., 2021). Study results reveal the challenges in providing quality health 
care for rural communities and the farmworkers in Antioquia, Colombia are no different.  

Strategies 
The panel reached consensus on three strategies that would be extremely effective in 
addressing the barriers to healthcare access, including: creating a stable transportation 
infrastructure to increase mobility for health purposes and emergencies, a team of medical 
specialists that go out to rural areas, and education and promotion of preventative health. The 
panel also agreed upon two strategies that they viewed to be extremely effective for improving 
the quality of care, including: having healthcare professionals visit the communities so they can 
plan a more comprehensive medical plan and the construction of more local healthcare 
centers. Both strategies focus on bringing more medical resources into farmworker 
communities.  

Conclusions, Discussion, and Recommendations 
 
This study found local health centers can play a critical role in addressing health equity for 
farmworker communities, serving as a hub for healthcare services, outreach, and education; 
housing medical professionals; and providing a range of resources that can improve the health 
and well-being of farmworkers including access to primary care services. Local health centers 
can also serve as a resource for community outreach and engagement, a component which is 
critical to addressing the health disparities that affect farmworker communities (HHS, 2020). By 
partnering with community organizations and extension educators, local health centers can 
help identify and address the unique health needs of farmworker communities. Responses to 
these needs may include providing transportation to medical appointments, conducting 

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outreach campaigns to raise awareness about health issues, and working with local employers 
to improve working conditions.  

The panelists identified three strategies that could address barriers to healthcare access for 
farmworkers; creating a stable transportation infrastructure to increase mobility for health 
purposes and emergencies, a team of medical specialists that go out to rural areas, and 
education and promotion of preventative health. Since transportation and geographic isolation 
are significant barriers, developing policies to advance new transportation development will 
help to alleviate existing inadequacies and impediments towards health equity (Ministerio de 
Salud y Protección Social, 2021). Providing and promoting education on preventative health 
was a strategy that panelists agreed could improve healthcare access, which aligns with current 
approaches in Colombia (Quartucci, 2022). This avenue represents an opportunity for 
agricultural extensionists to partner with health extension educators and other health 
professionals to couple occupational health and safety training with general health screening 
and education.  

While the health care and transportation systems continue to evolve, a focus on preventative 
care will reduce farmworkers’ need to use either. By providing basic health services such as 
screenings, vaccinations, and preventive care, local health centers can improve health 
outcomes and reduce disparities among farmworkers by helping farmworkers manage chronic 
conditions, avoid illnesses, and establish overall health and well-being (HHS, 2020).  

Finally, based on community-based implementation workgroup feedback, there is the 
opportunity to develop and utilize virtual resources to bolster the reach and impacts of 
community capacity development efforts as additional centers are constructed. Online training 
have been documented as viable and effective option for reaching rural communities and 
increasing their access to educational opportunities (Burton et al., 2021). This strategy would 
not be without its own inherent challenges, including the lack of information technology 
resources like those experienced in rural areas of Colombia. The digital divide between urban 
and rural areas is a well-known problem globally, and Colombia is no exception, where only 
23% of rural households in Colombia have access to the internet, compared to 58% of urban 
households (OECD, 2022). So, community members, key stakeholders and extension 
professionals may need to advocate for policy, system and environmental change to increase 
rural online access.  

Beyond the implementation of the identified strategies to address health inequities for 
farmworkers, it is important to evaluate their impacts. This task represents an additional role 
for extension, as they are well-equipped and frequently engaged in such efforts. These 
evaluation data will help to tailor the existing approaches as they are implemented and inform 
other CEHEF-informed extension efforts as stakeholders work toward achieving health equity. 

 
 
 

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Acknowledgements 
 
J. Diaz - conceptualization, methodology, validation, formal analysis, investigation, writing-
original draft, writing-review & editing, supervision, project administration; L. Warner -
methodology, validation, formal analysis, writing-original draft, writing-review & editing; L. 
Vargas - methodology, validation, formal analysis, writing-original draft, writing-review & 
editing; I. Taboada - methodology, validation, formal analysis, writing-original draft, writing-
review & editing; C. Gusto - validation, formal analysis, writing-original draft, writing-review & 
editing; A. Abreu - validation, formal analysis, writing-original draft, writing-review & editing; K. 
Lawson - formal analysis, writing-original draft, writing-review & editing; N. Beatty - formal 
analysis, writing-original draft, writing-review & editing. 

References 
 
Arcury, T. A., Arnold, T. J., Sandberg, J. C., Quandt, S. A., Talton, J. W., Malki, A., & Daniel, S. S. 

(2019). Latinx child farmworkers in North Carolina: Study design and participant baseline 
characteristics. American Journal of Industrial Medicine, 62(2), 156-167. 
https://doi.org/10.1002/ajim.22938 

Arcury, T. A., Sandberg, J. C., Talton, J. W., Laurienti, P. J., Daniel, S. S., & Quandt, S. A. (2018). 
Mental health among Latina farmworkers and other employed Latinas in North Carolina. 
Journal of Rural Mental Health, 42(2), 89–101. https://doi.org/10.1037/rmh0000091 

Brady, S. R. (2015). Utilizing and adapting the Delphi method for use in qualitative research. 
International Journal of Qualitative Methods, 14(5). 
https://doi.org/10.1177/1609406915621381.  

Braun, V., & Clarke, V. (2012). Thematic analysis. In H. Cooper, P. M. Camic, D. L. Long, A. T. 
Panter, D. Rindskopf, & K. J. Sher (Eds.), APA handbook of research methods in 
psychology, Vol. 2. Research designs: Quantitative, qualitative, neuropsychological, and 
biological (pp. 57–71). American Psychological Association. 
https://doi.org/10.1037/13620-004  

Burton, D., Canto, A., Coon, T., Eschbach, C., Gutter, M., Jones, M., Kennedy, L., Martin, K., 
Mitchell, A., O’Neal, L., Rennekamp, R., Rodgers, M., Stluka, S., Trautman, K., Yelland, E., 
& York, D. (2021). Cooperative extension’s national framework for health equity and 
well-being [Report of the Health Innovation Task Force]. Extension Committee on 
Organization and Policy Health Innovation Task Force. https://www.aplu.org/wp-
content/uploads/202120EquityHealth20Sum.pdf 

Castillo, F., Mora, A. M., Kayser, G. L., Vanos, J., Hyland, C., Yang, A. R., & Eskenazi, B. (2021). 
Environmental health threats to Latino migrant farmworkers. Annual Review of Public 
Health, 42, 257-276. https://www.annualreviews.org/doi/10.1146/annurev-publhealth-
012420-105014  

https://doi.org/10.37433/aad.v4i3.337
https://doi.org/10.1002/ajim.22938
https://doi.org/10.1037/rmh0000091
https://doi.org/10.1177/1609406915621381
https://psycnet.apa.org/doi/10.1037/13620-004
https://www.aplu.org/wp-content/uploads/202120EquityHealth20Sum.pdf
https://www.aplu.org/wp-content/uploads/202120EquityHealth20Sum.pdf
https://www.annualreviews.org/doi/10.1146/annurev-publhealth-012420-105014
https://www.annualreviews.org/doi/10.1146/annurev-publhealth-012420-105014


Diaz et al.  Advancements in Agricultural Development 
 

https://doi.org/10.37433/aad.v4i3.337   169 
 

Diamond, I. R., Grant, R. C., Feldman, B. M., Ling, S. C., Moore, A. M., & Wales, P. W. (2014). 
Defining consensus: A systematic review recommends methodologic criteria for 
reporting of Delphi studies. Journal of Clinical Epidemiology, 67(4), 401-409. 
https://doi.org/10.1016/j.jclinepi.2013.12.002 

El Khayat, M., Halwani, D. A., Hneiny, L., Alameddine, I., Haidar, M. A., & Habib, R. R. (2022). 
Impacts of climate change and heat stress on farmworkers' health: A scoping review. 
Frontiers in Public Health, 10, 71. https://doi.org/10.3389/fpubh.2022.782811 

Hacker, K. (2013). Community-based participatory research. SAGE Publications. 
https://doi.org/10.4135/9781452244181.  

Hasson, F., Keeney, S., & McKenna, H. (2000). Research guidelines for the Delphi survey 
technique. Journal of Advanced Nursing, 32(4), 1008-1015. 
https://doi.org/10.1046/j.1365-2648.2000.t01-1-01567.x 

López, R., & Valdés, A. (2000). Fighting rural poverty in Latin America: New evidence and policy. 
In: López, R., Valdés, A. (Eds.) Rural poverty in Latin America (pp. 1-31). Springer. 
https://doi.org/10.1057/9780333977798.  

Mejía-Mejía, A., Sánchez-Gandur, A. F., & Tamayo-Ramírez, J. C. (2007). Equity in access to 
health-services in Antioquia, Colombia. Revista de Salud Pública, 9(1), 26-38. 
http://www.scielo.org.co/pdf/rsap/v9n1/v9n1a05.pdf 

 Ministerio de Salud y Protección Social [Ministry of Health and Social Protection]. (2021). 
Análisis de Situación de Salud (ASIS) Colombia, 2021 [Health Situation Analysis (ASIS) 
Colombia, 2021]. 
https://www.minsalud.gov.co/sites/rid/Lists/BibliotecaDigital/RIDE/VS/ED/PSP/analisis-
situacion-salud-colombia-2021.pdf 

Molina-Guzmán, L. P., & Ríos-Osorio, L. A. (2020). Occupational health and safety in agriculture. 
A systematic review. Revista de la Facultad de Medicina, 68(4), 625-638.  
https://doi.org/10.15446/revfacmed.v68n4.76519  

Nasa, P., Jain, R., & Juneja, D. (2021). Delphi methodology in healthcare research: How to 
decide its appropriateness. World Journal of Methodology, 11(4), 116. 
https://doi.org/10.5662%2Fwjm.v11.i4.116  

National Academies of Sciences, Engineering, and Medicine. (2017). Communities in action: 
Pathways to health equity. The National Academies Press. 
https://www.ncbi.nlm.nih.gov/books/NBK425848/  

Office of Health Equity. (2023, April 20). Minority health. Centers for Disease Control and 
Prevention. https://www.cdc.gov/minorityhealth/index.html  

https://doi.org/10.37433/aad.v4i3.337
https://doi.org/10.1016/j.jclinepi.2013.12.002
https://doi.org/10.3389/fpubh.2022.782811
https://doi.org/10.4135/9781452244181
https://doi.org/10.1046/j.1365-2648.2000.t01-1-01567.x
https://doi.org/10.1057/9780333977798
http://www.scielo.org.co/pdf/rsap/v9n1/v9n1a05.pdf
https://www.minsalud.gov.co/sites/rid/Lists/BibliotecaDigital/RIDE/VS/ED/PSP/analisis-situacion-salud-colombia-2021.pdf
https://www.minsalud.gov.co/sites/rid/Lists/BibliotecaDigital/RIDE/VS/ED/PSP/analisis-situacion-salud-colombia-2021.pdf
https://doi.org/10.15446/revfacmed.v68n4.76519
https://doi.org/10.5662%2Fwjm.v11.i4.116
https://www.ncbi.nlm.nih.gov/books/NBK425848/
https://www.cdc.gov/minorityhealth/index.html


Diaz et al.  Advancements in Agricultural Development 
 

https://doi.org/10.37433/aad.v4i3.337   170 
 

OECD. (2022). National urban policy review of Colombia. OECD Urban Studies, OECD 
Publishing., https://doi.org/10.1787/9ca1caae-en  

Quartucci, S. (2022, November 7). Colombia Launches National Preventive Health Initiative. 
Latina Republic. https://latinarepublic.com/2022/11/07/colombia-launches-national-
preventive-health-initiative/   

Villarejo, D., McCurdy, S. A., Bade, B., Samuels, S., Lighthall, D., & Williams, D. (2012). The 
health of California's immigrant hired farmworkers. American Journal of Industrial 
Medicine, 55(5), 387-395. https://doi.org/10.1002/ajim.20796 

Wallerstein, N., Duran, B., Oetzel, J. G., & Minkler, M. (Eds.). (2017). Community-based 
participatory research for health: Advancing social and health equity (3rd ed.). Jossey-
Bass. 

World Health Organization. (2021). Health equity. https://www.who.int/health-topics/health-
equity#tab=tab_1 

 
 
 
© 2023 by authors. This article is an open access article distributed under the terms and conditions of 
the Creative Commons Attribution license (http://creativecommons.org/licenses/by/4.0/). 
 

https://doi.org/10.37433/aad.v4i3.337
https://doi.org/10.1787/9ca1caae-en
https://latinarepublic.com/2022/11/07/colombia-launches-national-preventive-health-initiative/
https://latinarepublic.com/2022/11/07/colombia-launches-national-preventive-health-initiative/
https://doi.org/10.1002/ajim.20796
https://www.who.int/health-topics/health-equity#tab=tab_1
https://www.who.int/health-topics/health-equity#tab=tab_1

