3.1. Pile-Sort Clusters

There were 44 participants who provided labeled piles. The two missing piles were from Lam Dong. There were 171 pile-sort piles created across the five focus groups. The median count of piles created per participant was four, with the number of piles ranging from two to seven. There was no observable difference in the number of piles created by province (p-value: 0.06). The median number of items per pile was 6, with the number of items per pile ranging from 2 to 20.

3.2. Climate Change Impact on TWH

Smallholder farmers in Vietnam acutely recognize the influence of climate change on their health. As women in Can Tho described, “our health has been negatively impacted since the weather is extremely hot and we suffer from severe dehydration”. Women in Lam Dong suggested chronic effects of working in the heat, noting that “if the weather is very hot, the elderly are more likely to experience an increase in high blood pressure. Many people have high blood pressure”. Infectious diseases were also of concern, with one participant noting that “heavy rainfall also brings about many diseases, such as dengue fever. With the increased rainfall, mosquitoes thrive, and this year, dengue fever has been spreading rapidly”.

Notably, the effect of climate on health and safety is not just at work, but within the community as well. Workers who live in low-lying areas and near riverbanks are especially concerned about the risk of landslides. As one participant in Lam Dong noted, “Heavy rain, slippery conditions, landslides. The terrain here is steep, making transportation difficult. Safety issues arise such as slipping, falling, traffic accidents, etc.”.

While we speculated heat would be the hazard of greatest concern, workers in Lam Dong stated they have not yet experienced the effects of heat as drastically as other regions. Changing rainfall patterns were their biggest concern. Across all five focus groups, changes in temperature were mentioned 53 times, 18 of which came from farmers in Lam Dong (34%, often regarding how they have not yet experienced it). Comparatively, of the 39 total mentions of changing rainfall patterns, 23 came from farmers in Lam Dong (59%). Of these, over half (n = 12) were in relationship to productivity, focusing on “the consequence is a reduction in crop yields”. This is an important indication of how climate influences work productivity and what that means for the wellbeing of the worker, a concept that is explored further in the next section.

Only females from Lam Dong mentioned the relationship between unpredictable rain and human health. The major disease of concern was dengue fever. Secondary health effects due to the increased use of pesticides were described: “Excessive rainfall leads to more plant diseases, which means that farmers have to use more pesticides. This requires more effort and increases exposure to farmers, especially women, who contact with harmful chemicals, affecting their health, particularly their reproductive health”. Further, the runoff of pesticides into streams and rivers has adverse consequences on those community members who rely on those water sources.

3.3. Climate Change Impact on Livelihood

The impact of climate change on the livelihood of farmers was a common theme throughout the focus groups. Male farmers in Can Tho spent a lot of time discussing how climate change has impacted their productivity (33 of 101 coded segments; 33%), highlighting that “farmers struggle to meet their needs when working”. This concept was expanded in Ninh Binh where a farmer explained that “[changing weather] affects all stages: planting, caring for the crops, harvesting, and even transporting guavas for sale”.

Reduction in crop yields as it relates to income was a specific concern of men in Can Tho. Income concerns were mentioned 14% of the time in their focus group compared to 8% of the time in the mixed-sex Ninh Binh focus group and 3% of the time in the remaining focus groups. In speaking about the market value of rice, one male in Can Tho described that “the prices are also unstable and fluctuating. Sometimes, more loss than gain”, which ultimately leads to a loss of livelihood and “farmers [having] to abandon farming”. In Can Tho, both men and women noted the government’s role in assisting farmers with their economic standing. While discussions with the males focused on market stabilization, females suggested that “the government could provide support and arrange additional jobs for women to earn extra income and reduce free time”.

3.4. Adaptive Strategies, Farmers’ Needs, and Trusted Sources of Information

During the focus groups, workers noted adaptive strategies that they have used to address the impacts they are currently experiencing due to climate change. The most described adaptive strategy was based on the principle “mặtmate trời lên thì mình lặn, mặt trời lặn thì mình lên”, which is the concept of setting when the sun rises and rising when the sun sets. As workers described, it simply becomes too hot to work. In multiple instances (10 of 28 segments; 36%), farmers reflected on the fact that they now must leave the fields earlier in the day because it is too hot. As a female participant in Can Tho reflected, “in the past, I left my house at 7 am and went back home at 10 to 11 am, now we have to start at 6 am and stop at 10 am because of the sun, it is too hot, I can’t stand it”, which results in a reduction in the total workable hours in a day. In this case, removing the hazard is the adaptive solution; as one farmer noted, “there aren’t many other options available”.

Workers in every focus group mentioned hydration as a type of adaptive strategy. A female in Ninh Binh described the importance of hydration by explaining that “the hot weather still has an impact, and the heat is still very tiring…when we’re done, we go back to rest, drink water to recover our health”. However, farmers also emphasized the importance of electrolyte rebalancing. Of the nine passages mentioning rehydration, 56% (n = 5) noted the use of sugared lemonade, tea, or milk instead of water. Responses to the vignettes demonstrated that farmers are aware of the signs of heat stress. In Lam Dong, a female participant explained that “when during harvesting, if farmers feel tired or have headaches, normally they would try to keep working, it, hence, affects their health, we should change this habit, should think about long-term goals”. Males in Lam Dong and Ninh Binh both demonstrated knowledge of how to address heat stroke, explaining that “in the above situation, there is a phenomenon of workers suffering from sunstroke, heat exhaustion, and fatigue. The handling method is to immediately stop working, move the affected person to a cool area, provide light fan ventilation, and offer them green tea with sugar. Loosen clothing if needed. If the person recovers within 5–15 min, that’s normal. However, if they remain unresponsive, it is advisable to call a doctor for hospitalization”. When asked if they had ever received formal training on handling these situations, they responded “we listen to the radio and have witnessed it a few times, on TV and the radio, they also provide instructions on how to handle it. I’ve also observed a few times when someone fainted, and they provided first aid like that, and the person recovered afterward”.

A common theme that emerged among all focus groups is that occupational safety and health knowledge was commonly gained through personal experience. As a female in Lam Dong summarized, “[formal] knowledge about occupational safety is often lacking among farmers, leading to their negligence”. As a female in Can Tho noted, while “there are also occupational safety classes, when applying them in practice, it’s quite different from the theory”. This was highlighted when discussing the proper use of personal protective equipment (PPE) when applying pesticides. While workers understand the need to use PPE, two issues were mentioned. The first is that the cost of PPE is prohibitive for farmers. The second is that the use of PPE negatively affects the ability to work. As a female in Can Tho described, “in outdoor conditions, it can get very hot, and it becomes exhausting and difficult to breathe with a mask on. We wear long-sleeved shirts and gloves, but we can only wear them for a while, then it becomes too hot, and we can’t breathe, so we have to take them off.” Farmers identified a “need [for] more suitable personal protective clothing”.

When discussing where farmers obtain their information, radio, TV, and social media were mentioned 33% of the time (10 of 30 coded segments). Other important sources of information include the government, specifically the Department of Agriculture, cooperatives, and communal farmers’ associations. While farmers feel that “we cannot address this on an individual scale”, it was well established that information sharing between those with experience is one of the best sources of information, as “experience and knowledge can [only] be gained from working process”.