Cluster clinics for migrant Hispanic farmworkers with diabetes: perceptions, successes, and challenges.

INTRODUCTION: Diabetes is a chronic disease that requires individuals to schedule multiple office visits with a multidisciplinary team to learn how to successfully manage and delay the progression of complications. To respond to the health-care and educational needs of Hispanic migrant farmworkers who travel to Minnesota and North Dakota, the Migrant Health Service Inc diabetes program coordinator implemented evening cluster clinics. The purpose of this research project was to describe Hispanic migrant farmworkers' perceptions of the services provided to them at 37 multidisciplinary cluster clinics designed to serve this rural population diagnosed with diabetes.

METHODS: This descriptive research employed a questionnaire and individual interviews. Both quantitative and qualitative data were obtained from cluster clinic clients. Quantitative data consisted of the numbers and percentages of clients providing various responses to questionnaire items. The qualitative data consisted of the verbal responses of clients to two open-ended questionnaire items and to an interview protocol.

RESULTS: The main findings of the project indicated that 75-88% of the clients rated the services provided at the 37 cluster clinics as 'excellent'; an additional 21-25% rated them as 'good.' More than 85% of the clients indicated either that 'nothing should be changed' (59%) or that 'everything was fine' (26%). These ratings and content analysis of the interview data revealed that the clients perceived they had received quality services at these cluster clinics. The authors also discuss six characteristics that they believed contributed to the successful delivery of health care and education through cluster clinics. These characteristics include: (1) provision of both direct and referral services for this underserved population; (2) comprehensive delivery of services in a single setting; (3) collaborative delivery of services; (4) access-driven delivery of services; (5) delivery of culturally-sensitive and linguistically-appropriate services; and (6) evidence-based service delivery.

CONCLUSIONS: Cluster clinics are an effective way to improve health-care services, education, and counseling for the under-served or unserved Hispanic migrant population diagnosed with diabetes. The authors conclude with four primary challenges to the implementation of these cluster clinics which include: (1) locating and preparing facilities; (2) recruiting health-care providers for the clinics; (3) achieving effective, appropriate communication with clients; and (4) securing funding.