Perceptions About Discrimination in a Rural, Older, Racially and Ethnically Diverse Older Cohort


  • Katie Abel, BSN, RN University of Florida Health Shands Hospital
  • Lisa Ann Kirk Wiese, RN, PhD Florida Atlantic University
  • JuYoung Park, MSW, PhD Florida Atlantic University, School of Social Work
  • Ishan C. Williams, PhD, FGSA University of Virginia


Purpose:  The purpose of this pilot study was to examine perceptions of discrimination among a small cohort of rural older, retired minority Florida farmworkers. Potential sources of discrimination were explored, such as health literacy, age, sex, gender, racial/ethnic background, or rural residency.

Sample:  The study occurred in a rural area that is designated as a “hot zone” due to its HRSA designation as a medically underserved area (MUA), health provider shortage area (HPSA), and medically underserved population, despite lying only 50 miles due west of the affluent town of Palm Beach, Florida.  More than 40% of residents live below the poverty level, and only 65% have received a high school diploma.

Method:  A descriptive, correlational pilot study was conducted to investigate potential contributors to discrimination. Independent variables examined were age, sex, gender, rural residency, racial/ethnic background, and health literacy, using the Rapid Estimate of Health Literacy in Medicine, short form (REALM-SF) (Arozullah, 2007). The incidence of self-reported discrimination was investigated. Chi-square and pearson correlation analysis were employed to examine survey results. Findings were supplemented with  a brief narrative inquiry, and responses were analyzed using Saldaña’s (2015) model of cyclical coding.

Findings:  Twenty-five residents in a subsidized housing unit agreed to participate in this study. This convenience sample was 96% racially/ethnically diverse ((68% African American, 24% Haitian Creole, and 4% Hispanic American.) Most (78%) were retired field workers, and largely self-identified as female (72%). The residents’ average reading level was 4th-6th grade.  Health literacy (44%) and rural residency (24%) were the greatest sources of discrimination. Female gender discrimination was associated with ethnicity discrimination (r = 0.6, p = .002).

Conclusions:  Providers are strongly encouraged to assess their patients’ health literacy levels and experiences with discrimination to inform effective care delivery.

Keywords: Rural, older adult, farmworker, discrimination, health literacy, racially and ethnically diverse.

Author Biographies

Katie Abel, BSN, RN, University of Florida Health Shands Hospital


ICU RN, University of Florida Health Shands Hospital

Lisa Ann Kirk Wiese, RN, PhD, Florida Atlantic University


Adjunct Faculty, Community and Population Health, C.E. Lynn College of Nursing, Florida Atlantic University 

JuYoung Park, MSW, PhD, Florida Atlantic University, School of Social Work


Professor, School of Social Work, Florida Atlantic University

Ishan C. Williams, PhD, FGSA, University of Virginia


Associate professor, School of Nursing, University of Virginia