Migrant Farmworkers' Acceptability of Health Services in Spain: Barriers and Facilitators Identified by Professionals

Seasonal migrant farmworkers (SMF) make up a significant part of Spain's agricultural labour force. Due to precarious labour conditions, housing insecurity and factors related to migration, SMF are at risk of specific health issues and occupational accidents. In addition, migrants in Spain face barriers when accessing healthcare services. This study explores factors that influence the acceptability of healthcare services among SMF in Spain from the point of view of professionals working with this population.

Semi-structured interviews were conducted among 92 professionals working with SMF in four regions of Spain, including NGO workers, healthcare workers, employees of worker unions, public social services and governmental institutions. A thematic content analysis was performed using Atlas.ti.

Professionals identified several barriers and facilitators that influence the acceptability of healthcare services among SMF. The main identified barriers were language, different perceptions of health and healthcare between SMF and Spanish professionals, a limited understanding of the Spanish healthcare system, and precarious working and living conditions. The main identified facilitators were professionals taking time to explain healthcare procedures and rights to SMF and support and information from friends, family and other community members.

To overcome barriers, the use of translational services and cultural mediators should be increased. In addition, educational interventions are needed for migrants to better understand the Spanish healthcare system and for healthcare workers to provide culturally appropriate care to migrant patients. Finally, it needs to be considered that inequalities in health and healthcare between SMF and the Spanish native-born population reach beyond healthcare institutions. They are rooted in structural factors, which include their living and working conditions, social exclusion, and discrimination.

As this study, which is part of a bigger project, aimed to focus on healthcare access mainly from the healthcare system perspective, patients and service users were not involved in this part. Another sub-study within the project will focus on the experience of SMF. Caregivers were included as study participants and despite not having been directly included in the study design, the open-ended questions used in this study allowed them to bring up the topics they considered important in the context of this study.