Barriers to the prevention and treatment of heat-related illness in adult outdoor crop workers

Background and Objectives: Heat-related illness (HRI) is an important cause of non-fatal illness and death in agricultural workers. We sought to identify beliefs and attitudes that may serve as barriers to HRI prevention and treatment in crop workers, who are largely foreign-born, Spanish-speaking, seasonal workers in the US. Methods: We conducted three semi-structured focus group interviews in a purposive convenience sample of 35 crop workers in Yakima Valley, WA, using participatory rural appraisal techniques. Interviews were audio taped and transcribed in Spanish. Three researchers reviewed and coded transcripts and field notes, and investigator triangulation was used to identify relevant themes and quotes. Results: Four major themes regarding crop workers' HRI-relevant beliefs and attitudes were identified: 1) crop workers subscribe, to varying degrees, to beliefs that cooling treatments should be avoided after heat exposure; 2) the desire to lose weight by increased sweating is reflected in behaviors of wearing multiple layers of clothing and slimming/support braces in hot conditions; 3) highly caffeinated energy drinks are used widely to increase work efficiency and maintain alertness; and 4) the location of water at work (e.g. near restrooms) and whether water is fresh, but not treated, are important considerations in deciding whether to drink water provided at worksites. Conclusions: We identified crop worker beliefs and attitudes about hydration, clothing use, and health that may serve as barriers to HRI prevention and treatment. These results should be incorporated into the development of culturally appropriate interventions aimed at reducing the risk of HRI in agricultural workers.