Promotoras De Salud Research Articles

A Path Analysis of a Randomized Promotora de Salud Cardiovascular Disease–Prevention Trial Among At-Risk Hispanic Adults

This study assessed effectiveness of an educational community intervention taught by promotoras de salud in reducing cardiovascular disease (CVD) risk among Hispanics using a structural equation modeling (SEM) approach. Model development was guided by a social ecological framework proposing CVD risk reduction through improvement of protective health behaviors, health beliefs, contextual and social factors. Participants were 328 Hispanic adults with at least one CVD risk factor. SEM analyses assessed direct and indirect effects of intervention participation on CVD risk (Framingham score) and latent variables nutrition intake and health beliefs. The model fit was adequate (root mean square error of approximation = .056 [90% confidence interval = .040, .072], comparative fit index = .967, normed fit index = .938, nonnormed fit index = .947). Intervention participation was associated with improved nutritional consumption, but not lower CVD risk. Stronger health beliefs predicted healthier nutritional habits. This project provided evidence for the adequacy of a conceptual framework that can be used to elicit new pathways toward CVD risk reduction among at-risk Hispanic populations.

The Role of Community Health Workers in Combating Type 2 Diabetes in the Rio Grande Valley

The purpose of this study was to determine the effectiveness of the use of community health workers (CHWs, aka promotoras de salud in Spanish) in the control of type 2 diabetes (diabetes mellitus) in the Rio Grande Valley (RGV). Known from the literature as "a disease of the 21st century" and being the third leading cause of death in the United States, type 2 diabetes is a very common disease in the RGV because of its predominantly Mexican American population, a group genetically vulnerable to the disease. Unlike prior studies that examined the overall effectiveness of the CHW model, the authors used registered CHWs as primary diabetes educators. Another innovation of this study was the authors monitored a wide range of biologic (HbA1c and body mass index [BMI]) and behavioral (diabetes knowledge, self-efficacy, self-management activities scores) outcomes. The research hypothesis was that the educational service provided by CHWs to the diabetic patients would assist them in controlling their disease. The design of the study was experimental. The target population consisted of Mexican American adults from RGV diagnosed with type 2 diabetes and willing to participate. The intervention group received monthly visits from CHWs. The results showed a significant improvement after one year of intervention in all outcomes, except BMI, in the experimental group.

Abstract B6: Social marketing intervention to increase HPV vaccine utilization among Hispanic girls: Preliminary data

Abstract Incidence and mortality rates from cervical cancer are higher in Hispanic women compared to non-Hispanic white women. The recently approved HPV (human papillomavirus) vaccine has been proven effective in preventing 70% cervical cancer cases (those caused by two types of high-risk HPV). This translational research study draws on Rogers’ Diffusion of Innovation theory to address the need to hasten the pace of diffusion of this new vaccine, especially among populations with high rates of cervical cancer. An academic-community partnership employed the methodology of community-based prevention marketing (CBPM) to develop a culturally appropriate, multilevel intervention aimed at increasing the utilization of the HPV (human papillomavirus) vaccine against cervical cancer among Hispanic girls. CBPM combines social marketing theories and techniques with community-based participatory research (CBPR) approaches for the development and implementation of public health interventions aimed at producing behavior change. In this presentation we will present the social marketing plan used in the intervention and preliminary data. The intervention uses a combination of Spanish-language media-radio, newspaper and printed brochures-to disseminate the messages throughout the community. A trained lay health promoter (promotora de salud) at Progreso Community Center receives phone calls to answer general questions about the vaccine and eligibility requirements for the VFC program, refers patients to appropriate locations to obtain the vaccine, and provides follow-up reminders. We present baseline intervention data on rates of HPV vaccine utilization by race/ethnicity and preliminary data on responses to the media campaign. The study contributes valuable knowledge about culturally and linguistically appropriate social marketing strategies for HPV vaccine use among Hispanics. Citation Information: Cancer Epidemiol Biomarkers Prev 2010;19(10 Suppl):B6.

Reducing the Health and Digital Divides: A Model for Using Community-Based Participatory Research Approach to E-Health Interventions in Low-Income Hispanic Communities

Low-income Hispanics are the most digitally underserved population in the U.S. This article examines the potential of community-based participatory research approach to e-health to decrease the disparities in access to technology and health information in low-income Hispanic communities. To demonstrate this framework, we describe the process of designing a community-based e-health intervention to increase knowledge and parental self-efficacy in coping with young children's mental health problems including mental health service utilization. Our model incorporates utilizing promotoras de salud (lay community health educators) and community media principles to create the content of e-health interventions and train community members in using the technology. This case study illustrates the processes involved in using this approach, barriers for participatory e-health interventions in bridging the Digital Divide, and lessons learned.

Abstract 982: Increasing HPV vaccine utilization among Hispanic girls to reduce cervical cancer disparities

Abstract Incidence and mortality rates from cervical cancer are higher in Hispanic women compared to non-Hispanic white women. The purpose of this pilot study is to implement and assess a multilevel, culturally- and linguistically-appropriate social marketing intervention targeting the Hispanic population to increase utilization of the HPV vaccine among Hispanic girls ages 9-18 in Nashville/Davidson County, Tennessee. The specific aims are to (1) pre-test and disseminate culturally- and linguistically-appropriate media messages to promote use of the HPV vaccine in the target population; (2) provide information, referral and follow-up reminders to families to encourage initiation and completion of HPV vaccine series; and (3) assess the impact of the intervention by comparing changes in HPV vaccine utilization rates for Hispanic girls in partner clinics and in the state Immunization Registry. This pilot translational research study draws on Rogers’ Diffusion of Innovation theory. We employ the methodology of Community-Based Prevention Marketing, which combines social marketing theories and techniques with community-based participatory research (CBPR) approaches. The intervention uses a combination of Spanish-language media_radio, newspaper and printed brochures_to disseminate the messages throughout the community. A trained lay health promoter (promotora de salud) at Progreso Community Center receives phone calls to answer general questions about the vaccine and eligibility requirements for the VFC program, refers patients to appropriate locations to obtain the vaccine, and provides follow-up reminders. In this presentation we will present how formative research findings were used to develop the intervention and preliminary baseline intervention data. Targeted interventions to Hispanic communities such as this one to encourage use of a new cervical cancer vaccine could help eradicate ethnic disparities in cervical cancer. The study contributes valuable knowledge to the dearth of research on possible barriers for Hispanics to use this vaccine or about culturally- and linguistically-appropriate social marketing strategies for HPV vaccine use among Hispanics. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 101st Annual Meeting of the American Association for Cancer Research; 2010 Apr 17-21; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2010;70(8 Suppl):Abstract nr 982.

Understanding the Role of the Promotora in a Latino Diabetes Education Program

We explore the role of the promotora de salud (health promoter) who provided diabetes self-management education to Puerto Rican diabetics in her community. The education program was developed as a hospital and community-based organization partnership. Information from both Spanish-language focus groups with 35 class participants and an in-depth interview with the promotora indicated patients appreciated having the classes taught in Spanish by a Latina promotora from their community. Respondents reported satisfaction with the program, increased ability to self-manage diabetes, and strengthened connections with other Latino diabetics. Terms patients used for the promotora included comadre, hijita, and buena profesora. Some of these words denote almost kinship-level connections, suggesting that patients were forming strong connections with the promotora. Specific promotora roles were identified but varied among patients, promotora, and the literature. This hospital and community-based organization partnership promotora model appears to be effective for providing chronic disease self-management education in an urban community setting.

Abstract B15: Measuring medical mistrust at Dia de la Mujer Latina health fiestas

Abstract Mistrust of research and the medical system is a frequent barrier to participation in clinical trials. However, there is a paucity of data on how medical mistrust serves as a barrier to participation in clinical research among Latinas from various Latin American ethnic groups. Culturally, Latina women are the key decision makers when it comes to healthcare. Therefore, this study focused on Latinas who attended three Dia de la Mujer Latina (DML) health fiestas. Methods: Promotoras de Salud (community health workers) were trained to present a bilingual Medical Abuse and Medical Mistrust Awareness Survey (MAMMAS©), culturally translated, to Latinas from 18 years of age and older at 3 DML Health Fiestas events (Puerto Rico, Houston,Texas and Miami, Florida). MAMMAS© is innovative because it breaks down their perception of the medical institutions as well as their knowledge of clinical research, the HPV vaccine and the well-documented medical abuse historical cases. Questions captured demographics, insurance coverage, assimilation, acculturation, knowledge of preventive screenings for breast and cervical cancer, understanding and perception of clinical trials, awareness of historical medical abuse, mistrust of medical providers, their insights about barriers to obtaining these cancer screenings; and if the barrier of mistrust would hinder them from participating in a clinical research or clinical trial. Conclusions: The results of the MAMMAS survey will emphasize the need for more research on this topic. There were a total of 357 participants who completed the survey, however, there were 527 who began the process but did not complete due to their confusion with the response scale. 201 Survey respondents were conscious of the importance of cancer screening, but expressed fear as a major barrier. 294 Survey respondents believed that mistrust plays a key role in their participation into clinical trials. 253 Survey respondents felt that patients may have been deceived or misled by healthcare organizations 204 Survey respondents stated that mistakes are usually covered up by healthcare organizations. 227 Survey respondents believed that healthcare organization have experimented on patients w/o their knowledge. 269 Survey respondents were aware of some form of medical abuse that occurred. Citation Information: Cancer Prev Res 2010;3(1 Suppl):B15.

A Community Intervention on Portion Control Aimed at Weight Loss in Low-Income Mexican American Women

A pilot study was conducted to determine if a nutritional intervention aimed at portion control leads to significant weight loss in a community of low-income Mexican American women. Nineteen low-income Mexican American women were randomized to a standard care group or an intervention group in portion control. The trial was 20 weeks in length, and the intervention included four 2-hour classes. Both interventions were administered by a certified nurse-midwife (CNM) and a promotora de salud (i.e., lay health advisor). Women in the intervention group lost more weight than women in the standard care group, though this difference was not statistically significant. The mean weight loss in the intervention group was 6.57 pounds (2.9 kg) compared to a mean weight loss of 2.8 pounds (1.3 kg) in the standard care group (P = .47). Mean weight loss, regardless of group, was significantly greater when participants reported self-weighing (P = .02). This pilot study in portion control for low-income Mexican American women merits further study.

Project MATCH

Adequate training and support are critical for community health workers (promotoras de salud in Spanish) to work effectively. Current literature on promotora training is limited by a focus on promotoras' knowledge and satisfaction immediately after training. The relevance of training to subsequent work performance and the need for ongoing training are rarely addressed. This article describes the training and evaluation components of a promotora intervention focused on diabetes self-management. Training Methods Project MATCH (the Mexican American Trial of Community Health Workers) is a clinical trial designed to test the effectiveness of an intensive, promotora-based intervention to improve disease self-management for Mexican Americans with diabetes. The MATCH investigators designed a multicomponent promotora training program that provided both initial and ongoing training. The investigators used multiple methods to determine promotoras' knowledge levels, initial competency in intervention delivery, and changes in this competency over time. Evaluation Methods and Results The evaluation results show that although the initial training provided a solid knowledge and skills base for the promotoras, the ongoing training was critical in helping them deal with both intervention-related and personal challenges. The experiences of the MATCH study suggest that in addition to strong initial training, promotora interventions benefit from ongoing training and evaluation to ensure success.

A Randomized Community Intervention to Improve Hypertension Control among Mexican Americans: Using the Promotoras de Salud Community Outreach Model

The objectives of this study were: 1) to evaluate the acceptance, effectiveness, and sustainability of a promotora (community health worker) pilot program to improve hypertension control among medically underserved Mexican Americans of the El Paso, Texas area, and 2) to demonstrate improvements in clinical measures of blood pressure, BMI and waist circumference, self-reported behaviors and changes in attitudes and beliefs about blood pressure among Mexican American hypertensives. Participants were eligible if they had been diagnosed with hypertension and if they were willing to be randomized as either participants in the intervention or as controls. A total of 58 participants enrolled in the intervention group and 40 participants served as controls. This was a 9-week promotora intervention. Health behavior constructs and clinical data were measured pre-post intervention. Perceived benefits, and two heart-healthy behaviors (salt and sodium, and cholesterol and fat) were shown to be statistically significantly different between the intervention and control groups.

Developing a Disaster Preparedness Campaign Targeting Low-Income Latino Immigrants: Focus Group Results for Project PREP

Low-income immigrant Latinos are particularly vulnerable to disasters because they are both ill-prepared and disproportionately affected. Disaster preparedness programs that are culturally appropriate must be developed and tested. To develop such a program, we conducted 12 focus groups with low-income immigrant Latinos to understand their perceptions and understanding of disaster preparedness, and facilitators and obstacles to it. Participants were concerned about remaining calm during an earthquake. Obstacles to storage of disaster supplies in a kit and developing a family communication plan were mentioned frequently. Misunderstandings were voiced about the proper quantity of water to store and about communication plans. Several focus groups spontaneously suggested small group discussions (platicas) as a way to learn about disaster preparedness. They wanted specific help with building their family communication plans. They rated promotoras de salud highly as potential teachers. Results will guide the development of a disaster preparedness program tailored to the needs of low-income Latino immigrants.

Abstract B17: Measures to assess narrative influences on cancer prevention behaviors

Abstract B17 Background Narrative approaches to health promotion in cancer prevention have recently gained much attention. Cultural grounding to produce narrative-based messages is a well-suited method of health promotion to address health disparities, but cognitive and emotional mechanisms that purportedly work through narratives to change behavior are rarely specified nor directly measured. A model for assessing narrative characteristics and effects on intention to change behaviors (derived from narrative theory and entertainment-education) was proposed and tested in pilot studies of a community-based, storytelling intervention for Latinos. Method Seven sessions with health information embedded in narratives taught by experienced Promotoras de Salud (who assisted in developing story content) were pilot-tested prior to full study implementation. Novella-style stories featured a group of neighbors with various interpersonal challenges, and incorporating colorectal cancer prevention (dietary, physical activity, and screening) messages. Participants evaluated each story presented and answered questions pre- and post-intervention regarding intention to modify health behaviors. Scale items to assess factors theoretically predicted to change behavior were created; data reduction and regression modeling were used to examine model elements. Results Fifty-five Latinos completed the pilot study and assessed stories in each session; mean age 39.6, mean education level, 9th grade; 92% prefer Spanish; median annual income $15-25K. Factor analysis on story characteristics produced two scales, Cultural (α = .755) and Emotional Content (α =.817). Factor analysis on mediators expected to predict behavior yielded Identification (α = .925), Engagement (α = .976) and Attention (α = .966). Model testing indicated significant relationships between some of the story characteristic measures and mediators: Cultural and Emotional Content of stories was related to Identification with stories and characters, and Cultural Content was related to Attention (p < .01 for all). Mediators showed moderate relationships to health behavior change intentions, with significant findings for Identification predicting intentions to increase physical activity (p < .05) and Engagement predicting intentions for dietary change (p < .01). Conclusions Development and preliminary tests of measures to assess narrative characteristics and factors expected to mediate behavior change show promise for theory building. Story characteristics measured as cultural and emotional content provided predictive value for mediators shown in previous research to be important for persuasion and behavior change, Identification and Engagement (otherwise known as “transportation” into the story). Further, Identification and Engagement preliminarily appear to provide predictive power for cancer prevention behavioral intention. Implications The model and corresponding measures tested in this pilot study provide a starting point for evaluating narrative interventions prior to intervention. As our larger community study progresses and additional data are collected on attitudinal and behavioral responses to narratives, a more detailed model will be specified and tested (including social proliferation effects) for theory-building to understand more about narrative effects on behavior change. Funding: NCI Citation Information: Cancer Prev Res 2008;1(7 Suppl):B17.

Promotoras De Salud and Portion Control: A Community Intervention Aimed at Weight Loss in Low-Income Mexican-American Women

Purpose: To pilot test a brief intervention in portion control. Research Question: Does portion control intervention, in a community of low-income Mexican-American women, lead to significant weight loss? Hypothesis: Low-income Mexican-American women will have significant weight loss after an intervention in portion control. Significance/Background: Traditional approaches to care have done little to narrow the gap of health disparities. A significant health disparity is the rising rates of overweight and obesity in Mexican-American women. Methods: A 20-week randomized control trial in 19 low-income Mexican-American women. The intervention consisted of four 2-hour classes. The control group received routine care. Both groups were led by a certified nurse-midwife (CNM) and a promotora de salud (lay health advisor) team. Findings: Women in the intervention group lost more weight than women in the standard care group. The mean weight loss in the intervention group was 6.57 pounds (2.9 kg) compared to a mean weight loss of 2.8 pounds (1.3 kg) in the standard care group (P = .47). Mean weight loss, regardless of group, was greater when participants stated that they exercised 2 or more days a week (P = .35) and when participants reported self-weighing (P = .02). Discussion: A community-based partnership in portion control led by promotoras de salud in partnership with CNMs is an effective intervention for weight loss in low-income Mexican-American women that merits further study.

A Pilot Program Using Promotoras de Salud to Educate Farmworker Families About the Risks from Pesticide Exposure

This paper reviews a successful community-based education effort to minimize pesticide exposure to migrant and seasonal farmworkers and their families through innovative training curricula, informal participatory educational techniques and culturally sensitive outreach methods. In 2004, Migrant Clinicians Network, Inc., trained lay health educators, or promotoras de salud, from local agencies in southern New Mexico in pesticide safety and in ways to successfully promote safety information in the farmworker community. Through home visits and small group workshops, the promotoras trained 273 farmworkers and farmworker family members on ways to reduce exposures to pesticides in their homes and at work, with an emphasis on protecting children. The families received a Spanish language comic book that reinforced the pesticide safety information, emphasizing the health effects of acute and chronic pesticide exposure and steps to protect farmworker children from pesticide exposure. The project resulted in a significant increase in knowledge regarding the routes of exposure, the vulnerability of children, the signs and symptoms of pesticide poisonings and the ways to minimize pesticide exposures. Additionally, the project showed improved behaviors aimed at minimizing pesticide exposure through accidental poisonings in the home. This pilot project proved the efficacy of an in-home, one-on-one approach with a culturally appropriate educational comic book as an instrument to help transfer education to the community. Moreover, the educational method involving promotoras offers a training-of-trainer approach that is easy to implement and potentially replicate.

Las Mujeres Saludables: Reaching Latinas for Breast, Cervical and Colorectal Cancer Prevention and Screening

Community health advisors have effectively promoted breast and cervical cancer prevention and screening among low-income Latina women. Specific elements of such programs, such as enhanced social support, may explain successes. Promotion of colorectal cancer screening has been less studied. Promotoras de Salud (i.e., Latina health advisors) implemented a 12-week program among women recruited from community-based organizations. The program educated 366 Latinas in breast, cervical and colorectal cancer prevention and screening and emphasized social support among class members. Pre- and post-intervention assessments demonstrated significant increases for fruit and vegetable consumption (3.05 to 3.60 servings/day), and physical activity (65.15 to 122.40 minutes/week). Of women previously non-compliant, 39 percent, 31 percent and 4 percent received Pap tests, mammography, and fecal occult blood test (FOBT), respectively. A culturally aligned education program using community health advisors and emphasizing social support among participants may improve prevention and selected screening behaviors, but more intensive interventions may be required for colorectal cancer screening compliance.