Abstract
This sequential transformative mixed-methods dissertation uses a constructivist framework, Collin's matrix of dominance, Lamont's boundary work, and community-based participatory approach to understand (1) How do CHWs perceive their role in the farmworker community for accessing healthcare services? (2) How do CHWs navigate the institutional arrangements farmworkers confront in accessing healthcare? (3) What are the health and immigration policy implications of CHWs in the Latinx farmworker community in South Florida? (4) What are the challenges that CHWs and the farmworker community faced as COVID-19 emerged? The research consisted of two years of participant observations in the South Dade farmworker community, two focus group discussions with the farmworker community (N=18), two focus group discussions with CHWs (N=16), in-depth interviews with CHWs (N=20), health centers, and community-based organizations, and an online COVID-19 community health survey from open-ended responses of CHWs and health-oriented CBOs working with the farmworker community (N=21). Data analysis included constructivist grounded theory methodology and participatory member-check strategy. The findings highlight how immigration policies filter into health policies and practices to exacerbate disparities for Latinx immigrant farmworkers in charitable and federally qualified health centers. The study results underscore how CHW's role can facilitate or limit access to health services in their intermediary position, and participation in healthcare practices that produce inequalities. The study results address the complexities of this go-between role in health in the context of farmworker health and the local health system. The dissertation contributes to immigrant health disparities using a novel research approach and integrating the matrix of domination to the sociology of health and illness, labor, and organizations.