In brief
This scoping review of 39 sources maps six barriers migrant farm workers face accessing Canadian health care: language and literacy challenges, fear of medical repatriation, lack of transportation, barriers to timely care and follow-up, restrictive work schedules, and health care coverage issues. The authors call for..
What this article is about
Quick Answer
This scoping review of 39 sources maps six barriers migrant farm workers face accessing Canadian health care: language and literacy challenges, fear of medical repatriation, lack of transportation, barriers to timely care and follow-up, restrictive work schedules, and health care coverage issues. The authors call for policy, practice, and educational interventions to close these gaps.
Student takeaways
Key Takeaways
- Six thematic barriers to health care access for migrant farm workers were identified: language and literacy challenges, fear of medical repatriation, lack of transportation, barriers to timely care and follow-up, restrictive work schedules, and health care coverage issues.
- Of 589 records identified through database and grey literature searching, 39 sources ultimately met inclusion criteria and were synthesized for the review.
- Reliance on non-certified interpreters, such as employers or coworkers, was repeatedly reported to cause miscommunication and breaches of patient privacy during health care encounters.
- Fear of medical repatriation was the most frequently discussed barrier across the reviewed sources, deterring workers from seeking care or reporting occupational injuries; historical records show 1,198 workers were repatriated without legal recourse between 1996 and 2011.
- Long work hours, some as high as 50 to 60 per week with no paid sick leave, combined with employer reluctance to grant time off, made it difficult for workers to access care during standard clinic hours.
Student summary
Why This Research Matters
Migrant farm workers come to Canada through programs such as the Seasonal Agricultural Worker Program to fill essential jobs in agriculture, yet many struggle to access the health care they are legally entitled to. This scoping review set out to map the existing research literature on barriers these workers face when trying to reach Canadian health care services. The researchers followed PRISMA-ScR guidelines, a recognized method for scoping reviews, and searched multiple academic databases plus grey literature such as reports and news articles. Of 589 records identified through database searching, 380 titles and abstracts were screened after duplicates were removed, and 325 were judged irrelevant. Fifty-five articles moved on to full-text review, and 16 were excluded because they did not meet inclusion criteria, for example focusing on the wrong population or not directly addressing health care access. This left 39 sources for the final synthesis, a mix of qualitative and quantitative studies, systematic reviews, commentaries, and analyses.
Through thematic analysis, the review team identified six recurring barriers. The first is language and literacy: many migrant farm workers do not speak English or French fluently, and clinics often rely on employers or coworkers as informal interpreters rather than certified professionals, which can lead to miscommunication and breaches of privacy. Limited health literacy also makes it hard for workers to understand medication instructions or navigate the health system, and language barriers were even reported to delay reporting of workplace injuries, leaving some workers ineligible for compensation. The second barrier is fear of medical repatriation. Workers worry that reporting an injury or illness could get them sent home and jeopardize future hiring, so some continue working while sick or injured rather than risk losing their job. Between 1996 and 2011, a reported 1,198 migrant farm workers were repatriated without legal recourse, and during COVID-19 some workers hid symptoms out of fear of being sent home. The third barrier is a lack of transportation. Many workers live in rural, remote, or employer-provided housing with little access to safe public transit, and depend on employers to drive them to appointments, so care can be delayed when employers are unwilling or unavailable.
The fourth theme covers barriers to timely care and medical follow-up, including confusion about what services are covered by provincial insurance or workplace compensation, and difficulty understanding medical terminology, both of which discourage workers from returning for follow-up visits. The fifth theme is restrictive work schedules: long shifts, with some workers logging 50 to 60 hours a week and no paid sick leave, make it nearly impossible to visit a clinic during regular hours, and many employers are reluctant to grant time off unless a situation is life-threatening; some workers wished clinics offered evening or weekend hours. The sixth theme is health care coverage issues, such as a waiting period of up to three months before provincial health insurance takes effect, leaving new arrivals to pay out of pocket, and private insurance plans that many clinics, labs, and pharmacies will not bill directly, forcing workers to pay upfront and submit claims afterward, with coverage often lapsing entirely upon job termination or repatriation.
Taken together, these six themes show that access to health care for migrant farm workers is shaped not just by individual choices but by structural conditions: immigration policy, employer control over transportation and time off, and gaps in insurance systems. The review's authors call on Canadian health policy experts, employers, and health care organizations to design policies, practice changes, and educational interventions that directly target these barriers, and they note the findings can inform public health nursing programs working with agricultural communities.
For nursing students, this review is a reminder that health equity work often starts with understanding the practical, everyday obstacles a population faces, not just their clinical needs. A nurse working in a rural clinic near farm operations might consider flexible appointment hours, use professional interpretation services rather than informal ones, and recognize that a patient's silence about symptoms could reflect fear of repatriation rather than a lack of concern. Because this is a scoping review rather than a single study, it does not measure how common each barrier is in numerical terms; instead, it maps the range of issues described across 39 sources so future research and policy work can address them directly.
Source abstract
Study Overview
Objective This scoping review aims to examine and map existing literature about barriers encountered by migrant farm workers accessing health care services in Canada. Methods The search was conducted in multiple databases and grey literature. The PRISMA-ScR was used to document the inclusion and exclusion process. Two or more team members screened and reviewed all articles to ensure accuracy in capturing data. Synthesis 380 records were screened by examining abstracts and titles, and 325 were deemed irrelevant. Of the remaining records, 55 had full-text assessments; 16 were excluded because they did not meet the inclusion criteria. Thirty-nine articles were extracted. They represented a mix of qualitative and quantitative studies, reviews, and other forms of commentaries and analyses. The thematic analysis revealed barriers that affect migrant farm workers’ access to Canadian health care services: (1) language and literacy challenges, (2) concern of medical repatriation, (3) lack of transportation, (4) barriers to timely care and medical follow-up, (5) restrictive work schedules, and (6) health care coverage issues. Conclusion This review provides a synthesis of the barriers experienced by migrant farm workers when accessing Canadian health care services. Canadian health care policy experts and organizations where Canadian migrant farm workers seek care are encouraged to design and implement policies, practice changes and/or educational interventions to address these barriers. This review may also inform public health nursing programming to promote positive health outcomes in the migrant farm worker population.
Evidence appraisal
Main Findings
- Six thematic barriers to health care access for migrant farm workers were identified: language and literacy challenges, fear of medical repatriation, lack of transportation, barriers to timely care and follow-up, restrictive work schedules, and health care coverage issues.
- Of 589 records identified through database and grey literature searching, 39 sources ultimately met inclusion criteria and were synthesized for the review.
- Reliance on non-certified interpreters, such as employers or coworkers, was repeatedly reported to cause miscommunication and breaches of patient privacy during health care encounters.
- Fear of medical repatriation was the most frequently discussed barrier across the reviewed sources, deterring workers from seeking care or reporting occupational injuries; historical records show 1,198 workers were repatriated without legal recourse between 1996 and 2011.
- Long work hours, some as high as 50 to 60 per week with no paid sick leave, combined with employer reluctance to grant time off, made it difficult for workers to access care during standard clinic hours.
Practice transfer
Clinical Relevance
- Nurses working with migrant farm worker populations should use professional, certified interpretation services rather than relying on employers or coworkers to reduce miscommunication and protect patient privacy.
- Primary care and occupational health nurses should proactively screen migrant farm workers for chronic disease, mental illness, sexually transmitted infections, and occupational injury, since these were the most commonly cited health concerns in the reviewed literature.
- Health care teams should be aware that a worker's reluctance to disclose symptoms or injuries may reflect fear of medical repatriation or job loss rather than a lack of concern about their health.
- Clinics and public health programs serving agricultural regions should consider offering evening or weekend appointments to accommodate restrictive work schedules described in the review.
- Nurses and health navigators can help migrant farm workers understand their insurance coverage, including provincial health insurance waiting periods and private insurance billing processes, to reduce delays in seeking timely care.
Faculty notes
Educational Relevance
This scoping review by Naidoo, Morrell, Crawley, Pittman, Mulcaster, Pfaff, Tay, Kumar, and Scott, published in the Canadian Journal of Nursing Research, maps the literature on barriers migrant farm workers (MFWs) face when accessing health care services in Canada. The team followed the JBI scoping review framework and reported findings using PRISMA-ScR. Databases searched included MEDLINE, CINAHL, ProQuest Nursing and Allied Health, PsycINFO, Emcare, the Cochrane Central Register and Database of Systematic Reviews, Dissertations & Theses Global, and Scopus, supplemented by targeted grey literature and expert consultation. No date limits were applied and non-English articles were translated. Two or more team members independently screened and extracted data, resolving disagreements by discussion or a third reviewer.
Of 589 records identified, 380 remained after duplicate removal and were screened by title and abstract; 325 were excluded as irrelevant. Fifty-five articles underwent full-text assessment, and 16 were excluded (wrong population, abstract-only, or did not address health care access), leaving 39 included sources. These comprised 20 primary research studies (mixed-methods, qualitative, quantitative, and one secondary data analysis) and 19 other sources such as reviews, analyses, opinion pieces, and news articles. The most frequently discussed health concerns were occupational injury and mental health, followed by COVID-19 and sexual/reproductive health; primary access points cited were clinics, public health services, occupational health, and hospitals.
Thematic analysis produced six interrelated barriers: (1) language and literacy challenges, compounded by reliance on non-certified interpreters such as employers or coworkers; (2) fear of medical repatriation, which discourages workers from reporting injuries or illness and has historical grounding in documented repatriation cases; (3) lack of transportation, tied to rural or segregated housing and dependence on employer-provided transit; (4) barriers to timely care and follow-up, driven by confusion over insurance and compensation entitlements and unfamiliarity with medical terminology; (5) restrictive work schedules, with long hours, no paid sick leave, and employer reluctance to grant time off except in emergencies; and (6) health care coverage issues, including provincial insurance waiting periods and private insurance plans that require upfront payment and later reimbursement, with coverage often lapsing at job termination.
For teaching purposes, this review is a strong exemplar of applying PRISMA-ScR to a vulnerable, occupationally and immigration-status-defined population, and it illustrates how structural and policy-level determinants (employer power, insurance design, immigration status) intersect with individual-level barriers (language, literacy) to shape access. It supports classroom discussion of social determinants of health, cultural safety, and the nurse's role in occupational and public health settings serving temporary foreign workers. Because the review synthesizes heterogeneous study designs and grey literature without formal quality appraisal or risk-of-bias assessment, faculty should guide students to treat the six themes as a well-supported map of the problem space rather than a ranked or quantified account of which barrier is most severe or how frequently each occurs. The database search was conducted in mid-2024, so more recent developments (e.g., policy changes) may not be captured. The authors recommend that policymakers and organizations serving MFWs design tailored policies, practice changes, and educational interventions, and they specifically flag public health nursing programming and primary care screening for chronic disease, mental illness, sexually transmitted infections, and occupational injury as practical next steps for nurses working with this population.
Critical appraisal
Limitations
- The review did not conduct a formal quality assessment or risk-of-bias evaluation of the 39 included sources, so the strength of evidence behind each theme was not graded.
- Included sources used highly diverse designs, including grey literature such as newspaper articles, opinion pieces, and commentaries, which increases variability and makes it harder to weigh the relative strength of each finding.
- The thematic synthesis relied on researcher interpretation of the source material, which can affect the reproducibility of the six identified themes.
Classroom use
Discussion Questions
- How might fear of medical repatriation change the way a nurse should approach a health history interview with a migrant farm worker?
- What specific steps could a rural clinic take to address the transportation barrier described in this review?
- Why might reliance on an employer or coworker as an informal interpreter create both communication and privacy risks for a patient?
- How does the structure of programs like the Seasonal Agricultural Worker Program contribute to the health care barriers identified in this review?
- What role can public health nursing programs play in addressing the six barriers identified by the authors?
- How might a three-month wait before provincial health insurance coverage begins affect a newly arrived worker's decision to seek care for an early symptom?
- In what ways do restrictive work schedules intersect with fear of job loss to discourage workers from accessing timely care?
- Why is it important for nurses to distinguish between an individual patient's choices and the structural barriers described in this review?
- What are the strengths and weaknesses of a scoping review methodology, like PRISMA-ScR, for studying a population such as migrant farm workers?
- What policy or practice change discussed in this review do you think would have the greatest impact on improving health care access, and why?
Knowledge check
Quiz
1. What type of review was conducted in this study?
- A randomized controlled trial
- A scoping review
- A meta-analysis
- A case-control study
Rationale: The title and abstract identify this as 'A Scoping Review' examining barriers migrant farm workers encounter accessing health care in Canada.
2. How many articles were ultimately included in the synthesis after full-text assessment?
- 16
- 25
- 39
- 55
Rationale: The abstract states: 'Thirty-nine articles were extracted' after 55 underwent full-text assessment and 16 were excluded.
3. Which reporting guideline did the researchers use to document their inclusion and exclusion process?
- CONSORT
- PRISMA-ScR
- STROBE
- COREQ
Rationale: The abstract states: 'The PRISMA-ScR was used to document the inclusion and exclusion process.'
4. Which of the following is NOT one of the six barrier themes identified in the review?
- Language and literacy challenges
- Concern of medical repatriation
- Lack of transportation
- Excessive availability of specialist referrals
Rationale: The abstract lists language and literacy challenges, concern of medical repatriation, lack of transportation, barriers to timely care and follow-up, restrictive work schedules, and health care coverage issues; excessive specialist referral availability is not one of the six themes.
5. According to the full-text findings, why do some migrant farm workers avoid reporting injuries or illnesses?
- They distrust vaccines
- They fear medical repatriation and jeopardizing future hiring
- They prefer alternative medicine
- They are unaware they can access care
Rationale: The full text explains that being listed as having reported a health concern 'penalizes workers who report health concerns, jeopardizing future hiring,' driving fear-based avoidance of care.
6. What issue with interpretation was commonly reported in the reviewed literature?
- Overuse of certified medical interpreters
- Reliance on non-certified interpreters such as employers or coworkers
- Mandatory translation apps in all clinics
- A shortage of bilingual physicians only
Rationale: The full text notes reliance on non-certified interpreters, including employers or coworkers, led to 'miscommunication, breaches of privacy' and dissatisfaction with care.
7. What insurance-related barrier was described regarding new arrivals in provinces like Ontario?
- Immediate free coverage from day one
- A waiting period of up to three months before provincial insurance takes effect
- Automatic lifetime coverage regardless of employment status
- No coverage requirements at all
Rationale: The full text describes a 'three-month waiting period for OHIP' that 'leaves workers uninsured upon arrival, forcing them to pay for medical expenses.'
8. How did restrictive work schedules affect migrant farm workers' ability to access care?
- Workers had unlimited flexible time off
- Long hours and lack of paid sick leave made accessing care during clinic hours difficult
- Employers always granted time off for any health concern
- Work schedules had no effect on health care access
Rationale: The full text states workers logged '50-60 per week' hours with 'no paid sick leave,' making accessing health care 'not feasible' during standard hours.
9. What limitation did the review authors acknowledge about their methodology?
- They conducted a full risk-of-bias assessment on every source
- They did not conduct a quality assessment or risk-of-bias evaluation of included sources
- They only included randomized controlled trials
- They excluded all grey literature
Rationale: The review acknowledges no quality assessment or risk-of-bias evaluation was conducted, a recognized limitation of many scoping reviews.
10. What do the review authors recommend as a result of their findings?
- Ending the Seasonal Agricultural Worker Program entirely
- Designing policies, practice changes, and educational interventions to address the identified barriers
- Relying solely on individual worker responsibility to seek care
- No changes are needed to current health care access for this population
Rationale: The abstract states health care policy experts and organizations 'are encouraged to design and implement policies, practice changes and/or educational interventions to address these barriers.'
Study cards
Flashcards
What is the main objective of this scoping review?
To examine and map existing literature about barriers encountered by migrant farm workers when accessing health care services in Canada.
What reporting framework did the researchers use?
PRISMA-ScR (Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews).
How many records were initially identified through database searching?
589 records were identified through database searching.
How many articles were included in the final synthesis?
Thirty-nine articles were included in the final synthesis.
How many articles were excluded at the full-text assessment stage, and why?
Sixteen articles were excluded, mainly for addressing the wrong patient population, not addressing health care access, or being abstract-only.
Name the first of the six thematic barriers identified.
Language and literacy challenges.
What is the second thematic barrier identified in the review?
Concern of medical repatriation.
What is the third thematic barrier identified in the review?
Lack of transportation.
What is the fourth thematic barrier identified in the review?
Barriers to timely care and medical follow-up.
What is the fifth thematic barrier identified in the review?
Restrictive work schedules.
What is the sixth thematic barrier identified in the review?
Health care coverage issues.
Why do migrant farm workers sometimes avoid reporting injuries or illness?
Because they fear medical repatriation and jeopardizing their eligibility for future hiring.
What problem did the review find with interpretation services used by migrant farm workers?
Workers often relied on non-certified interpreters, such as employers or coworkers, which led to miscommunication and privacy breaches.
What transportation-related dependency did the review identify?
Many migrant farm workers depend on their employers for transportation, giving employers significant control over their health care access.
What insurance coverage gap was identified for newly arrived workers in some provinces?
A waiting period of up to three months before provincial health insurance takes effect, leaving new arrivals to pay for care out of pocket.
How many hours per week did some migrant farm workers reportedly work?
Some workers reportedly worked 50 to 60 hours per week, with no paid sick leave.
What kind of sources made up the 39 included articles?
A mix of qualitative and quantitative studies, reviews, and other commentaries and analyses.
What is one limitation the authors acknowledged about their review methodology?
No quality assessment or risk-of-bias evaluation was conducted on the included sources.
Who does the review recommend take action based on its findings?
Canadian health care policy experts and organizations where migrant farm workers seek care.
What is one practical clinical action the review implies for nurses in primary care settings?
Screening migrant farm workers for chronic disease, mental illness, sexually transmitted infections, and occupational injury.
Search-ready answers
Frequently asked questions
What barriers do migrant farm workers face when accessing health care in Canada?
This scoping review identified six barriers: language and literacy challenges, fear of medical repatriation, lack of transportation, barriers to timely care and follow-up, restrictive work schedules, and health care coverage issues.
How many studies were included in this scoping review on migrant farm worker health care access?
Thirty-nine articles met the inclusion criteria out of 589 records initially identified, after screening and full-text review.
Why are migrant farm workers afraid to seek health care in Canada?
The review found that fear of medical repatriation is a major deterrent; workers worry that reporting an injury or illness could lead to being sent home and could jeopardize future hiring under programs like the Seasonal Agricultural Worker Program.
Do migrant farm workers have health insurance in Canada?
Coverage varies, but the review found gaps such as a waiting period of up to three months before provincial insurance takes effect for new arrivals, and private insurance plans that many clinics do not bill directly, requiring workers to pay upfront.
How does transportation affect migrant farm workers' access to health care?
Many migrant farm workers live in rural or remote areas with limited public transit and depend on employers for transportation, which can delay or restrict access to medical appointments.
What methodology was used in this scoping review?
The researchers used the PRISMA-ScR reporting guideline, searching multiple academic databases and grey literature, with two or more team members screening and reviewing all articles.
What role does language play in health care access for migrant farm workers?
Language and literacy challenges were identified as a major barrier, with reliance on non-certified interpreters, such as employers or coworkers, leading to miscommunication and privacy concerns.
How do work schedules affect migrant farm workers' ability to see a doctor?
The review found many workers face long hours, some up to 50 to 60 per week with no paid sick leave, and employers often reluctant to grant time off except for life-threatening situations, making it difficult to access care during regular clinic hours.
What do the review authors recommend to address these barriers?
They recommend that Canadian health care policy experts and organizations serving migrant farm workers design and implement policies, practice changes, and educational interventions to address the identified barriers.
What are the limitations of this scoping review on migrant farm worker health care access?
Limitations include the lack of a formal quality or risk-of-bias assessment of included sources, reliance on diverse and grey literature that increases variability, and a search conducted in mid-2024 that may not capture more recent developments.