Health and access to healthcare among migrant agricultural workers in Spain: A mixed-methods study

Background Migrant agricultural workers (MAW) play a central role in sustaining Spain's agricultural labor markets, yet they remain disproportionately exposed to precarious working and living conditions with implications for health and healthcare access. This study explored self-reported health status, healthcare access, and healthcare utilization among MAW in Spain. Methods This study adopted a participatory mixed-methods design and recruited MAW using purposive sampling to participate in questionnaires and semi-structured interviews. Quantitative data were analyzed using descriptive statistics and between-group comparisons, while interviews were analyzed using reflexive thematic analysis. Results Participants reported good overall health and formal healthcare access, with 88.5% of the questionnaire participants (n = 400) holding a healthcare card and 76.3% having a general practitioner. However, qualitative findings (n = 30) highlighted negative health impacts of agricultural work and mental health concerns linked to migration-related stressors. Although only 10.5% of participants reported barriers to healthcare access, difficulties obtaining appointments, long travel distances, lack of transportation, and financial constraints were reported. Utilization of occupational health physicians was limited (6.3%), and most workers reported no entitlement to paid sick leave. Healthcare access was unevenly distributed, with women contracted in Morocco reporting more barriers (44%; n = 25). Finally, healthcare visits were sometimes used strategically to obtain administrative proof for residency procedures as well as to obtain care. Conclusion While MAW reported generally good health and widespread use of primary and emergency care, important disparities persist in access to occupational health services and in how different subgroups navigate the healthcare system. These findings highlight the need for targeted interventions addressing structural and employment-related barriers.