J Community Health (2013) 38:397407
DOI 10.1007/s10900-012-9622-4
REVIEW
Delivery of Mobile Clinic Services to Migrant and Seasonal
Farmworkers: A Review of Practice Models for Community-
Academic Partnerships
John S. Luque Heide Castaneda
Published online: 29 September 2012
Springer Science+Business Media New York 2012
Abstract Farmworkers in the US are a medically
underserved group, who are largely uninsured, foreign-
born, and working in a hazardous industry. This review
addresses the challenges of providing health services for
this priority population to study the numerous health access
barriers that face migrant and seasonal farmworkers
(MSFW), evaluates the services provided at mobile clinics,
summarizes practice models for community-academic
partnerships, and synthesizes the literature on effective
partnership approaches to deliver these services. Because
MSFW are a difficult group to reach and access, mobile
farmworker clinics provide an opportunity for unique stu-
dent training experiences, in addition to small survey and
feasibility studies. A literature search was conducted to
identify articles for the review. Out of 196 articles identi-
fied by the article databases and manual search techniques,
18 articles were finally selected for the review based on
predetermined inclusion and exclusion criteria. Half of the
articles were classified as case studies or descriptive studies
with lessons learned. Only three articles were classified as
research studies, and six articles were not classified as
research studies, but rather descriptions of the clinics only.
Many of the partnership models were structured with the
lead agency as either the academic partner or an Area
Health Education Center. The academic partner was
J. S. Luque (&)
Jiann-Ping Hsu College of Public Health, Georgia Southern
University, P.O. Box 8015, Hendricks Hall, Statesboro,
GA 30460-8015, USA
e-mail: jluque@georgiasouthern.edu
H. Castaneda
Department of Anthropology, University of South Florida, 4202
E. Fowler Avenue, SOC 107, Tampa, FL 33620-8100, USA
e-mail: hcastaneda@usf.edu
usually a nursing school, and less frequently a medical
school. Other service partners frequently mentioned were
federally-qualified Community Health Centers, Migrant
Health Centers, and health departments. The review found
that service partnerships were characterized by collabora-
tion between academic institutions and community orga-
nizations, with a lead agency driving sustainability efforts.
Keywords Farmworker
Migrant labor
Hispanic health

Occupational and environmental health
Community
health
Community partnership
Social responsibility
Introduction
Migrant and seasonal farmworkers (MSFW) are a medi-
cally underserved population in the US, characterized by
striking health inequalities. The term MSFW is an occu-
pational category and has been used variably in the liter-
ature; however, for the purpose of this review, the term
farmworker includes both those who temporarily work in
agriculture and migrate, as well as those who maintain a
permanent residence and work in agriculture on a seasonal
basis [1]. Occupational health hazards in the agricultural
industry include both the risk of injury at the workplace
and dangerous chemical and environmental exposures.
Because farmworkers rarely receive benefits such as health
insurance coverage, paid time off, or workers compensa-
tion insurance, seeking treatment for work-related injuries
or illnesses is problematic [2]. Workers compensation is
only available to MSFW in 13 states [3]. Care seeking
often translates into loss of income, especially marked
since farmworkers work either hourly for low wages or
by piece rate. The majority of farmworkers are Latino
(84 %), were born outside of the US, and speak Spanish;
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consequently, language is a primary barrier to health ser-
vices [4]. The majority of farmworkers are young men,
who are either single or leave their families behind and
send remittances. Half of all farmworker families earn less
than $10,000 per year and are working without legal doc-
uments [5]. In addition to these obstacles, other barriers to
health care include transportation, not knowing the location
or hours of operation of healthcare facilities, preference for
health care in the farmworkers native country, and fear of
discrimination or cultural misunderstanding by healthcare
facility staff [6]. Community Health Centers and Migrant
Health Centers receive federal financial support to address
the medical needs of farmworkers, but their reach is limited
and does not match the demand for services [7]. To address
these multiple barriers for accessing primary health care,
nursing professionals, in partnership with professionals
from medicine and allied health, have developed commu-
nity-academic partnerships to deliver mobile clinic services
to MSFW at farmworker camps, where they temporarily
reside during harvest season. This systematic review
explores the clinical efficacy of these mobile clinics and
summarizes effective partnership models to best facilitate
these outreach activities.
There are several advantages to delivering care via
mobile clinics to this population. Since farmworkers toil
long hours and have very little free time, offering health
services in the evening hours at camps eliminates access
barriers [8]. Such clinics also provide opportunities for
healthcare professionals and students to experience serving
patients with a different language and culture, thus repre-
senting a valuable addition to the curriculum [9]. In order
to understand successful partnership models of providing
health care to farmworkers and identify the challenges for
the academic and community partners, this systematic
review of the literature will advance understanding of
successful mobile clinic service models to meet the needs
of this marginalized occupational group. Informed by the
Community Coalition Action Theory (CCAT) [10], this
review identifies successful partnership models to provide
recommendations for practice. CCAT has been applied to
understand the dynamics of community coalitions between
different entities which are organized toward a common
purpose [1113]. The theory operationalizes 21 constructs
and related propositions to community coalition formation,
structure, and processes. Social scientists have turned their
attention to the study of the dynamics of coalition forma-
tion and sustainability using multiple methods including
ethnography, participant observation, survey research, and
social network analysis [12, 1416]. This review is envi-
sioned as a complement to that scholarship to understand
how such collaborative partnerships, in this case to provide
healthcare services to migrant farmworkers, can be main-
tained successfully and driven by social justice priorities
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[17]. Social justice frameworks can illuminate the many
complex and contextual factors and patterns influencing the
health of disadvantaged groups such as MSFW. According
to Arcury and Quandt [7], social justice for farmworkers
includes earning a living wage, living free from racial or
ethnic discrimination, having access to public services, and
being in a living or work environment where health and
safety risks are addressed.
There have been no systematic reviews on the provision
of mobile clinic outreach services to migrant farmworkers.
Some of the articles in this review describe community-
academic partnerships, which might provide exemplars for
groups interested in pursuing these types of service rela-
tionships. There are many preliminary considerations for
forming such partnerships, such as choosing the appropri-
ate lead agency, securing financial support to make efforts
sustainable, meeting the reporting requirements for the
various agencies involved, meeting evaluation standards,
and providing research or service opportunities, as well as
student training experiences, for the academic partners.
Some of the articles identified in this review discuss suc-
cessful partnership models and positive student learning
outcomes, but very few have directly addressed the chal-
lenges of conducting research in the context of mobile
farmworker clinics, and whether this is ultimately a prudent
strategy. Reviewing the reports on these mobile clinics
raises additional questions. What are some of the research
and student learning opportunities in the mobile clinic
context? Since the ultimate goal of the mobile clinic is to
increase access to care and not necessarily to conduct
research, there are also ethical implications involved with
conducting other activities that might conflict with pro-
viding services [18].
These mobile clinics provide training experiences for
health professional students. Active engagement in service
learning encounters benefit students by advancing critical
thinking and increasing accountability. However, these
must be deliberate, planned, and include a reflection
component in order to be successful [17]. There are salient
issues from a social justice or health equity perspective that
might make participation in migrant health clinics prob-
lematic from a clinical standpoint because of the uncer-
tainty of diagnostic resolution. Since migrant farmworkers
might have very limited contact with the US health care
system and may move frequently, preliminary diagnoses
identified in the mobile clinic setting are more difficult to
track and continue with follow-up care. It is noteworthy
that organizations such as the Migrant Clinicians Network
have created a Health Network system to provide MSFW
with continuity of care for patients with chronic conditions
such as diabetes [19]. Yet this program largely works with
federally-funded Migrant Health Centers, and thus might
be disconnected from mobile outreach clinic activities
J Community Health (2013) 38:397407
conducted by other entities that might be more sporadic by
nature.
The number of publications addressing the health needs
of migrant farmworkers has increased in recent years as
more researchers and practitioners are entering this field.
However, there have been very few literature reviews since
1990 assessing health status and access to health services
for MSFW with a few notable exceptions [1, 20, 21].
Therefore, this review synthesizes what is currently known
about providing mobile clinic services to MSFW, in
addition to what other activities are being conducted in this
context (e.g., research, student learning), to summarize
common partnership models and improve the health of this
underserved priority population.
Methodology
Our inclusion criteria for the articles in this review were
that they (1) described mobile clinic services for migrant
farmworkers; (2) be US-based; and (3) be published either
in peer-reviewed articles indexed in PubMed or CINAHL
(Cumulative Index to Nursing and Allied Health Litera-
ture), or one of two migrant health newsletters (the
National Center for Farmworker Health newsletter Migrant
Health Newsline or the Migrant Clinicians Network
newsletter Streamline). We excluded studies taking place at
stationary clinics such as federally-qualified Community
Health Centers or Migrant Health Centers. We conducted
an extensive search of PubMed and CINAHL databases
using the time period of January 1, 1990 to July 24, 2012.
The following keyword combinations were used in the
PubMed search: (farmworker AND outreach) and
(farmworker AND clinic). For the CINAHL search, We have summarized the characteristics in the final sample
we only used the keyword farmworker. The PubMed
search produced 29 results. The CINAHL search produced
167 results. We also manually searched all electronically
available issues of the newsletters, Migrant Health News-
line (January 1995Issue 3, 2012) and Streamline (Feb-
ruary 2001January 2012). We identified one newsletter
article which satisfied inclusion criteria. After reading
through the abstracts of all the identified articles, we
compiled a database in reference management software
containing 157 unique articles. Next, we queried the
abstracts in the database with the keywords, mobile,
outreach, clinic, and screening to narrow our population served, 88 % were of Hispanic origin and 12 %
search.
We read through the abstracts of all of the articles
produced from the query and identified 17 articles which fit
the inclusion criteria. After reading all 17 articles, we
eliminated two because they were review articles and did
not reference any farmworker outreach conducted by the
authors. We manually searched the reference lists of the
399
identified articles as well as the review articles and added
an additional three articles which fit inclusion criteria, for a
final sample of 18 articles. We created a coding sheet
composed of 28 items in order to abstract the most perti-
nent information from the articles. First, we collected
information about each article, such as author, publication
name, year published, and publication type (e.g., journal
article, commentary, etc.). Next, we answered questions
about the methods used in the article, if the article in
question was a research report. We also collected demo-
graphic data on the clinic participants. If the article
described an intervention, we identified characteristics of
the intervention and the role of staff involved in the
intervention, such as community health workers or nurses.
We identified the clinic staffing and model used (e.g.,
mobile clinic or stationary clinic based in the farmworker
community, excluding federally-qualified Community
Health Centers or Migrant Health Centers). Finally, we
described the outcomes of the clinics such as measured and
targeted outcomes, major health outcomes, partnership
models, and research challenges or other clinic-related
challenges. After abstracting this information from each
article independently, both authors entered the information
into a spreadsheet. Next, any differences recorded on the
spreadsheet were resolved, and the information was syn-
thesized to report major findings of the studies and answer
the research questions posed by this systematic review.
Results
Mobile Clinic Characteristics
of articles (n = 18) in Table 1. The population served by
the mobile farmworker clinics was mostly of Hispanic
origin (see Table 2). There was substantial variability in
the reporting of Hispanic patients backgrounds. Some of
the articles identified farmworkers attending clinics by
percentage of country of origin, whereas others simply
identified the farmworkers as the percentage of Hispanic/
Latino or all Hispanic/Latino. Besides Hispanics, the other
ethnic groups represented in the farmworker population
included Haitians, African Americans, and Anglo Ameri-
cans. Of the eight articles that reported percentages of the
were of other nationalities or ethnicities. While it is true
that the migrant farmworker population is primarily male,
in the sample of seven articles which reported gender, the
majority of the clients were females (71.6 %) compared to
males (28.4 %). The skewed percentage is related to the
fact that of these seven articles, four of them only included
women because the clinics specifically focused on womens
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cancer screenings or prenatal care. The other 11 articles that
did not report gender percentages largely targeted farm-
worker men, but no data were presented on gender distri-
bution. Most of the articles did not report the average age of
patients. However, the average age of adult patients was
between 32 and 33 years old for those articles reporting age.
There were two articles that included migrant farmworker
children as part of their clinics target population, and one
which specifically targeted children [22].
In terms of geographic distribution, most of the articles
discussed mobile farmworker clinics in Georgia (n = 8;
44.4 %), followed by Oregon (n = 3; 16.7 %) and Florida
(n = 2; 11.1 %). Other states in the sample included
Arizona, California, New York, North Carolina, and South
Carolina. Some authors discussed the same clinics in
multiple articles [e.g., [23, 24] (two articles in Oregon),
[25, 26] (two articles in Georgia), and [27, 28] (each article
referring to the same Georgia mobile clinic)]; therefore,
this additional reporting added one article to the Oregon
sample and three articles to the Georgia sample. Regarding
clinic types, the majority of articles described mobile
clinics that directly fit the inclusion criteria (i.e., mobile
clinic traveling to the farm camps). However, four articles
described small stationary clinics located in a farmworker
community or a mobile clinic parked temporarily next to a
larger stationary clinic.
Key Features of Mobile Farmworker Clinics
Most of the identified articles described the characteristics
and functioning of the mobile clinics. However, a few
articles only briefly referenced the mobile clinics and ser-
vices and focused on findings from a research project or a
descriptive study [24, 27, 29, 30]. The most common ser-
vices provided included health screenings (e.g., cholesterol,
diabetes, blood pressure, BMI), adult vaccinations (e.g., Tb
booster), and health education (e.g., STDs, pesticides) (see
Table 3). Other services provided, but with less frequency,
included dental, physical therapy, optometry, podiatry,
womens cancer screenings, pediatric services, prenatal
care, nutritional counseling, and psychological counseling.
While some of the articles were not explicit, it was implied
that most clinic services were either free or available at a
nominal charge. The range of services provided at the
clinics was a function of the partners involved and the
availability of students and volunteers.
The outcomes targeted can be divided into clinic out-
comes and research study outcomes. Half of the articles we
classified as case studies or descriptive studies with lessons
learned. Only three articles were classified as research
studies, and six articles were not classified as research
studies, but rather descriptions of the clinics only. For the
descriptive studies, the targeted outcomes included
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J Community Health (2013) 38:397407
increased access to health services, health professional
student learning outcomes, and frequency of patient diag-
noses or health problems. For the research studies, targeted
outcomes were varied. Examples of some outcomes
included food insecurity, cancer knowledge, access to
cancer screening, and use of personal protective equip-
ment. The most common methodology for the research
studies was the cross-sectional survey design. Only two of
the articles used longitudinal data [22, 31]. More specific
examples of targeted clinical outcomes are listed in
Table 3, such as identifying the most common occupa-
tional injuries (i.e., back strain) and increasing healthcare
access for specific services, such as prenatal care.
Many of the partnership models were structured with the
lead agency as either the academic partner or the Area Health
Education Center (AHEC). The lead academic partner was
usually a nursing school, and less frequently a medical
school. Other service partners frequently mentioned were
federally-qualified Community Health Centers or Migrant
Health Centers, and health departments. Less common
members joining mobile clinic partnerships were farms,
faith-based organizations, public school systems, local hos-
pitals, chambers of commerce, or academic divisions such as
physical therapy, dentistry, public health, or psychology.
Some of the major challenges in implementing the
mobile clinics were a lack of bilingual staff, difficulty in
tracking patients, coordination of partnership activities,
lack of funding for expensive diagnostic tests like mam-
mograms, literacy level of patient education materials,
inability of farmworkers to pay for services, clinic hours,
and transportation barriers. In one study, most of the
patients paid the minimum payment because they lacked
health insurance [32]. For the few research studies in the
sample, common limitations included lack of generaliz-
ability due to selection bias from convenience sampling,
small sample sizes, and methodological limitations of data
collection methods, such as chart review studies.
Discussion
Mobile clinics are among a number of strategies to improve
accessibility and utilization of health services by MSFW
and appear to be successful based on case descriptions and
anecdotal reports. This review synthesized the literature
reporting on mobile clinics serving MSFW. Surprisingly,
only 18 articles since 1990 fit our inclusion criteria, which
included publication in the peer-reviewed literature or in
two relevant newsletters. The most common type of out-
reach activity was a mobile clinic traveling to farm camps,
thus designed to overcome many of the access barriers
faced by MSFW and their families. Most of the articles
were case studies or descriptions of clinic activities and
J Community Health (2013) 38:397407
Table 1 Mobile farmworker clinics (n = 18)
Study State Services provided
Albritton Georgia Healthcare services
[9] Clinical care
Bechtel Georgia Health screenings
[46] Tetanus booster
Brumitt Oregon Health care screenings (cholesterol,
[24] diabetes, blood pressure, BMI,
vaccinations, optometric
examinations, dental, mental health,
health education, PTexercise
prescriptions, ergonomic education,
manual therapy)
Brumitt Oregon Health care screenings (cholesterol,
[23] diabetes, BP, BMI), vaccinations,
musculoskeletal exams, optometric
exams, dental health services, mental
health services, health education
(personal health, mental health,
nutrition), stretching exercises
Connor Georgia For children: BMI, BP, vision/hearing
[26] screening, hemoglobin and glucose
testing, physical exams, PT, dental,
psychology
For adults: screenings for anemia,
hypertension, diabetes, dental,
psychological referrals
Connor Georgia Health screenings, physical exams,
[25] treatment for illnesses, health
education, dental care, physical
therapy (back care exercises),
psychological assessments, improving
workplace safety
Decker Oregon Medical history, PPD testing, BP,
[47] urinalysis, hematocrit, STD
education, AIDS, pesticide education,
condom distribution
Goldsmith California Deliver cancer prevention info, BP,
[29] vision, cholesterol, Educational
encounters (general information about
cancer; specific information about the
cervix, breasts, and reproductive
organs; specific details about breast
self-exams, clinical breast exams,
mammograms, pelvic exams, and Pap
smears; and the importance of
screening and early detection)
Partnership model
AHEC and medical school
Partnership between students, faculty,
and community, integrate cultural
issues and experiences in the
curriculum
ND
Healthcare organization and volunteer
university-affiliated healthcare
professionals
Inability to link MSS with
Winemakers, physicians, healthcare
providers, vineyard owners, volunteer
health care professionals, volunteer
service from university faculty and
students
Health professional students and faculty
from five colleges/universities,
federally funded farmworker health
clinic, school system, AHEC,
community member, schools of
nursing, PT, dental hygiene,
psychology
University partner with Migrant Health
Center
ND
FQHC Migrant Clinic and Ag Cancer
Center Prevention Project
401
Challenges
ND
No paid bilingual staff at
hospital, dept. of family and
childrens services or sheriffs
dept.
Minimal education levels of
workers limited their
understanding of health
maintenance behaviors
Failure to address MSS early can
affect work and worsen
condition (e.g., later need for
costly treatments or surgery)
physical demands of the
vineyard job
Not able to quantify severity of
injuries
Assessment of student learning
outcomes limited to qualitative
reports
Finding translators from
community
Coordinator of partnership
responsibilities and program
logistics
The use of the Fleisch-Kincaid
could be used to improve
educational materials
Lack of native language
interpreters
Need to follow-up for mental
health issues
Primary health care is not
a priority in the US
Some screened without returning
vouchers
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Table 1 continued
Study State Services provided Partnership model Challenges

Hill [27] Georgia Healthcare services ND Convenience sampling for

enrollment may have
introduced selection bias and
limited generalizability
Multiple interpreters
administered the surveys,
potentially introducing bias
Himelick Georgia Healthcare services ND ND
[28]
Larson North Prenatal care Dept. of Maternal and Child Health at Few bilingual staff
[48] Carolina School of Public Health and Elimination of barriers (e.g.,
Community Health Center transportation) and language
barrier
Close tracking and follow-up
had positive effect on prenatal
care and pregnancy outcomes
Luque [30] Florida General medical exam, Pap test Academic institution and faith-based Limitations of chart review
clinic partnership studies described (e.g., use of
paper records)
Luque [31] Georgia Primary health care, health education, AHEC, farmworker services nonprofit, Over-reporting of hypertension
diabetes, BP, dental, PT Community Health Center, university diagnoses
health professional volunteers Underreporting of mental health
(survey)
Limitation of survey design and
sampling
Limitation of chart reviews
Meade Florida Community-based outreach, health Cancer Center, Community Health Lack of mammogram resources
[45] education, health promotion, breast Center, CDC Breast and Cervical for uninsured women, cultural,
cancer screening, navigation Cancer Prevention Program, ACS, language, socio-economic
health dept., Area Agency on Aging, lifestyle issues
Redlands Christian Migrant Assn.,
ElderMed, Judeo-Christian Center
Poss [49] New Medical, dental, social/administrative Migrant clinic, migrant ministry and Lack of ability of migrant
York (help clients obtain Medicaid) inter-community memorial hospital, farmworkers to pay, some can
ecumenical organization get Medicaid
Funding for program
Sherrill South Health screenings, immunizations, Mobile clinic funded by HRSA, led by Latino patients lack health
[32] Carolina basic health care needs, lab/ an academic nursing school, local insurance, have language
immunizations; gynecological exams, health dept. mobile unit parks next to barriers, cultural differences
physicals it, residency program (rural residency Lack of sufficient bilingual staff
program)
Stein [50] Arizona Use of vouchers for follow-up, ND ND
diagnostic tests, medication provided
on site, dental care with vouchers,
womens health, 1 time per month
Pap, CBE, STD screen, foot care
Wilson Georgia Health assessments for children, height/ Migrant Family Health Program Need for evening services at
[22] weight, hearing/vision, urine, integrated into Kellogg Community work sites
hemoglobin Partnership in Education Initiative, Need for Spanish materials
undergrad nursing students, graduate
Need for counseling services
NP students, psychology students,
health dept., County Migrant Health Need for interpretation services
Programs, AHEC, Hispanic outreach Lack of follow-up treatment for
workers, local physicians, local patients
hospitals, chamber of commerce,
farmers, local school system
ND not described

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Table 2 Mobile farmworker clinic characteristics characteristics such as ethnic/racial distribution, gender,
Mobile clinic characteristics* Sample No. (%)
language preference, country of origin, and age. For
example, language issues are emerging because of an
Population served increasing number of speakers of indigenous (non-Spanish)
Hispanic origin 10,610 (88.1 %) languages, which compounds existing language barriers
Other race/ethnicity 1,433 (11.9 %) [34].
Gender
Male 2,468 (28.4 %) Lack of Research Studies Engaged with Mobile
Female 6,231 (71.6 %) Farmworker Clinics
Study characteristics (n = 18) No. of articles (% of
total) Some articles reported on clinic outcomes, either describ-
ing the top complaints and diagnoses or reporting an
State
increase in utilization of services for specific health issues
Arizona 1 (5.5 %)
(see Table 3). A few articles presented research study
California 1 (5.5 %)
findings, generally with regard to clearly defined health
Florida 2 (11.1 %)
issues (food insecurity, cancer knowledge and screening,
Georgia 8 (44.4 %) and use of personal protective equipment). Only three
New York 1 (5.5 %) articles could be classified as research studies, in that they
North Carolina 1 (5.5 %) described a question to be investigated, detailed methods of
Oregon 3 (16.7 %) data collection (most commonly, cross-sectional survey
South Carolina 1 (5.5 %) design and in some cases longitudinal data), and reported
Clinic type original findings. The fact that only a few research studies
Mobile clinic going to farm camps 14 (77.7 %) were present in the literature indicates either the absence of
Stationary migrant clinic in farmworker 2 (11.1 %) research partnerships with these clinics or a lack of dis-
community
tribution of study findings in typical and accessible venues
Other (e.g., mobile clinic parked at 2 (11.1 %) for scholarship. In the case of the former, these missed
stationary clinic)
opportunities should be taken up by scholars in the future.
* More than half of the identified articles did not report race/ethnicity Nevertheless, there are formidable barriers to implement-
or gender of the patient population served ing research in the context of mobile clinics including:
limited window of time to talk to farmworkers after a long
outreach strategies. This leads us to conclude that there is a day of work; differences in goals of service and research
lack of systematic and rigorous evaluations of the health partners (e.g., publishing findings vs. service provision);
delivery services provided by such clinics, even though there obtaining institutional review board approval for farm-
is little question that they lower access barriers for these worker studies; and interpretation or translation challenges.
workers. Thus, this review underscores prior observations Other challenges to conducting quality research with
that formal evaluations of existing farmworker health ser- farmworker populations include constructing generalizable
vices are missing from the literature, and that there is a samples, the seasonality of farm work, obtaining informed
paucity of studies examining MSFW health service needs, consent with non-Spanish speakers, and costs involved
utilization, or satisfaction [1]. These data are sorely needed with face-to-face interviews in disparate and rural research
for public health policy and program planning to improve the sites where farmworkers live and work [35].
health of MSFW. This finding also suggests a potential role
for public health and social science researchers to partner Health Professional Student Learning Encounters: High
with clinical practice colleagues to implement rigorous Levels of Collaboration
program planning and evaluation activities.
Not surprisingly, most articles focused on Hispanic/ Many articles reported on cultural learning encounters to
Latino populations, which are most heavily represented in benefit student training in the health sciences. Notable was
US agriculture. Nonetheless, we noted the same lack of the interdisciplinary approach in most cases, indicating a
consistency in defining MSFW that is common by agencies high level of cooperation between different disciplines
and programs [33], along with a priori assumptions about including medicine, nursing, dentistry, physical therapy,
this population and its features. Few articles explicitly health education, public health, and psychology. Invest-
defined the target population, preventing accuracy in ment in collaborative relationships with community part-
identifying specific information. Reports on mobile farm- ners such as farm owners, faith-based organizations, public
worker clinics should include reporting of demographic school systems, local hospitals, and chambers of commerce

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Table 3 Key features of mobile farmworker clinics

Mobile clinic feature Description

Services provided Common services: health screenings (cholesterol, diabetes, blood pressure, BMI), vaccinations, health education
(STDs, pesticides)
Less common services: dental, physical therapy, optometry, podiatry, womens cancer screenings, pediatric
services, prenatal care, nutritional counseling, psychological counseling
Outcomes targeted Common clinical outcomes targeted: access to health services, health professional student learning outcomes,
most common diagnoses, such as musculoskeletal symptoms, acute illnesses, chronic diseases
Less common outcomes targeted: food insecurity, cancer knowledge, access to cancer screening, prenatal care,
use of safety eyewear
Highlights of some clinic Men who reported musculoskeletal symptoms (MSS) were likely to be older, but those who reported back pain
outcomes were more likely to be younger. For women, all older women were more likely to have pain. The back was the
most frequent region with MSS symptoms [24]
289 or 62.8 % of farmworkers were food insecure, and non-H-2A workers 2.9 times more like to be food insecure
than H-2A workers [27]
Improvement in the use of prenatal services rose from 35 to 51 %; Hispanic representation at the health center
increased; there were fewer pregnancies among the younger population; improved use of prenatal services; but
nonsignificant declining trend in birthweights [48]
Major farmworker diagnoses included back pain, hypertension, musculoskeletal symptoms, GI disorders, eye
problems, and dermatitis [31]
68 % of clients used the mobile clinic as their primary source of care [32]
The top 5 problems for migrant children were dental caries, URIs (otitis media, otitis externa, sinusitis,
pharyngitis, allergic rhinitis), UTIs, anemia, and dermatitis [22]
Partnership models Most common partnership models included: Area Health Education Center or health professional school (e.g.,
nursing or medical school) as the lead agency with primary partners including Migrant Health Center or
Community Health Center, and health departments
Less commonly the partnership model included: farms (e.g., vegetable farms, vineyards); faith-based
organizations; public school systems; local hospitals; chambers of commerce; and Schools of Physical Therapy,
Dentistry, Public Health, or Psychology
Primary implementation Few bilingual staff, or translators for indigenous languages
challenges Frequent movement of the migrant farmworker population makes tracking patients difficult, and lack of follow-up
Coordination of partnership responsibilities and program logistics
No funds for expensive diagnostic tests such as mammograms
Inability of farmworkers to afford to pay for services
Clinic hours and transportation barriers

was also a common theme. One successful strategy for
promoting the time and location of the outreach clinics was
to notify the farm owners and farmworkers in advance for
logistical planning purposes [25, 31]. In most cases, the
articles that described training experiences relied upon
descriptive presentations and generalized statements about
their relationship to improving student learning outcomes
and developing more culturally competent practitioners.
These specific and significant experiences with mobile
farmworker clinics should be systematically investigated
and linked to the already robust literature on health science
student training and service learning [3640].
Program and Partnership Sustainability
Some of the mobile clinics had been operating for many
years, and the keys to sustainability of such programs can
be explained by referring to some major constructs from
Community Coalition Action Theory (CCAT) [10]. Some
of the characteristics of sustainable partnerships include: a
multiple and diverse organization membership structure; a
history of collaboration; a lead institution-convener group;
a functioning partnership decision-making process; lead-
ership and staffing; member engagement; assessment and
planning; implementation; health and community outcome
changes; and increased community capacity. One example
of a successful partnership identified in this review was the
Farm Worker Family Health Program (FWFHP), which
provides a two-week immersion experience for health
professional students in southern Georgia and has been
operating since 1993 [25, 26]. The FWFHP adopts a
partnership model between academic institutions and
community organizations to create a sustainable delivery
system for the farmworker health services it provides. The
partnership is described as a School of Nursing operating
together with a migrant health clinic, which provides

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additional local partnerships with AHEC, a summer edu- men, and especially men of color, remains a lack of data
cation program, child care centers, farms and other busi- [41], more systematic reporting on mens health is neces-
nesses. Since, during harvest season, the number of sary. These kinds of mobile clinicswhich reduce access
farmworkers exceeds the local migrant health clinic barriers known to be present in other settingscould play a
capacity, the mobile farm clinic is able to address the needs major role in advancing our knowledge of mens health.
of additional patients. The migrant health clinic takes the
lead on coordinating follow-up care and referrals. One of
Conclusions/Future Research
the keys to success of the FWFHP is the ability to provide
health care in multiple locations and at nontraditional hours
In conclusion, this set of articles suggests that there is a
to reduce access barriers. While the actual mobile clinic
coalition model that works well for these types of service
only operates for two weeks a year, the FWFHP operates as
partnerships to mature and evolve. Having an interdisci-
a year-round program to keep abreast of the needs of
plinary team of clinical partners from the university setting,
farmworkers and their families. The leadership of the
together with federally funded farmworker health clinics,
nursing school in the academic institution is one key to the
AHEC, and other community partners can produce sus-
longevity of this particular program.
tainable models for service delivery when there is a shared
Another feature of coalitions identified by CCAT is
mission and goal. It is evident that these community part-
stages of development. Such partnerships cycle through
nership models for delivering health care services fulfill a
stages including formation, implementation, maintenance,
health service need for MSFW that is not being met else-
and outcomes. To keep these partnerships active and
where. As other researchers have noted, collaboration is
engaged, new members must sometimes be recruited to re-
critical for the success of these partnerships, because suc-
energize the coalition. For example, a School of Physical
cessful collaborations consolidate expenses, develop cul-
Therapy joined an existing mobile clinic in Oregon, and
turally appropriate intervention approaches, reduce
reported positive research and student learning outcomes
duplication of effort, and share both the risks and rewards
from the addition of these services to the partnership mix
of the service partnership [45].
[23, 24]. In another example, a College of Public Health
Healthcare services partnerships to provide mobile farm-
joined an existing mobile clinic in Georgia to conduct a
worker clinics would benefit by adding academic or com-
needs assessment of farmworker health conditions and
munity partners who specialize in providing evaluation
injuries [31]. New partnerships are critical to the maturation
services to monitor processes and outcomes from these vital
of these coalitions through these stages of development.
services, as well as adding research components, such as
developing and testing interventions, where appropriate.
A Missed Opportunity for the Comprehensive Study
Future articles reporting the results of mobile clinic activities
of Mens Health
should include not only appropriate demographic data, but
longitudinal data on patient outcomes to measure if patients
Activities related to mens health were usually centered on
receive appropriate follow-up, diagnosis, and treatment over
occupational injuries. Only seven articles reported on
time. With emerging technologies and electronic medical
gender, and in these cases the majority of those served
records, it is becoming easier to track migrant patients who
were females because clinics focused on womens health
might be easily lost to follow-up in the past. Moreover, many
issues, including cancer screenings or prenatal care. As
MSFW return to the same clinics year after year, but are not
other programs to improve access to primary health care by
receiving proper case management. There are special case
the underserved have noted [41], few efforts have been
management considerations for MSFW [6]. The case manager
directed toward men, at the risk that they had become
also must encourage MSFW to take an active role in their own
invisible and their health needs neglected. While not
health care to assist in this process. While the literature on
invisible in articles reviewed hereoften because it is a
mobile farmworker clinics is limited, the studies identified in
given that men are the majority of MSFW and thus will
this review demonstrate the potential of this model to signif-
constitute the bulk of potential patientsgender is not
icantly impact the health of migrant farmworkers and form
brought into the discussion when reporting on men. Those
part of the agenda for farmworker social justice.
articles that did report on mens health focused almost
exclusively on occupational health concerns, such as
musculoskeletal conditions. Contemporary approaches to
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