FarmResponse: Promoting Agricultural Competency to Improve Behavioral Health Outcomes in Rural Communities




Agriculture, behavioral health, rural mental health, classical test theory, grounded theory, medical education


Purpose. Agricultural communities experience elevated suicide rates and lack access to behavioral healthcare. FarmResponse is an online, interactive program designed to educate rural healthcare providers about the economic stressors and cultural aspects of working in agriculture. The curriculum is based on the Total Farmer Health model as it relates to factors for mental health in agriculture. The purpose of this report is to examine the quality of the measures used to assess training impact, quantify the effectiveness of the training, and assess participant perceptions in applying the training.

Sample. The sample was comprised of those who registered for the training between February, 2022 through February, 2023. A total of 621 completed the pretest and 520 completed the pretest and posttest. Although nearly all U.S. states were represented, 45.6% of participants resided in Texas and Pennsylvania.

Method. Classical test theory measures of difficulty and discrimination were used to examine the quality of the test questions at pretest. Distractor analysis was applied to the posttest questions to evaluate the quality of the incorrect responses compared to correct responses. Grounded theory was used to identify themes related to how participants viewed applying the training to their profession.

Findings. The test questions covered a broad range of difficulty and a tighter range for discrimination. Distractor analysis revealed two questions that could be improved. Participants significantly increased their knowledge of agricultural culture with a within person increase of 5.05 points (95% CI 4.81, 5.29). Seven themes were identified in response to benefits and challenges expected when employing the training.

Conclusions. FarmResponse increased participant knowledge of farming culture based on quality measures of effectiveness. Participants reported feeling positive about gaining needed resources and developing cultural competency, but also expressed concerns related to accessing farmers and ranchers to provide services and the stigma that reduces help-seeking.


Author Biographies

  • Cheryl L. Beseler, PhD, University of Nebraska Medical Center

    Associate Professor, Department of Environmental, Agricultural and Occupational Health, College of Public Health

  • Tara Haskins, DNP, RN, AHN-BC, AgriSafe Network

    Total Farmer Health Director

  • Mikaela Stoltzfus, MPH, AgriSafe Network

    Public Health Analyst