UC Merced

Introduction: Previous studies on healthcare utilization among California agricultural workers California report low usage despite high vulnerability. Many studies are outdated with limited scope, and do not reflect the impact of recent policy changes. This study examines the effects of distance, socioeconomic, structural, and cultural factors on healthcare access with the actual and intended healthcare utilization patterns under the current policy framework. Digital health interventions rapidly expanded during the COVID-19 pandemic and can help overcome many obstacles. This study further examines digital access and utilization patterns among workers, the perspectives of providers and advocates on their usage, and proposes delivery models that might enhance care integration.Methods: UCM FWHS was used to examine the patterns and predictors of delay in seeking services, actual and intended healthcare utilization through Chi-square tests, linear and logistic regressions. Additionally, NAWS 2018 digital access supplement and CHIS 2021-22 surveys were used to study digital access and utilization. Thirty-eight semi-structured interviews were also conducted with healthcare providers, employers, and advocates to understand their perspectives on the barriers to access and utilization. Subsequently, 20 semi-structured interviews were conducted with providers and advocates to seek their views on digital health utilization and recommendations for health integration for state agricultural workers. Results: Cost, transportation, distrust, inconvenience, and lack of culturally competent care had a more significant impact on healthcare utilization than distance. Workers without health insurance and lower health literacy were less likely to use healthcare services. They had high digital inclusion, but lower health-related utilization, compared with the general population of California. Models for digital health integration include a hybrid model engaging Promotoras through home visits or telehealth access points, creating a separate healthcare system, or binational plans with digitally integrated services. Conclusions: A multimodal approach is needed to address healthcare needs among agricultural workers in California that incorporates the provision of affordable, convenient, high-quality, culturally competent services. Policy implications: Expanding health insurance coverage, using culturally competent health education programs, including digital outreach, and implementing pilot projects using hybrid models of digital health integration incorporating financial incentives for providers and trained Promotoras can improve healthcare utilization among workers.