Promotoras

Primary author: Drew Evans

A promotora is a “lay health worker or CHW [community health worker] who educates, motivates, and supports the members of her community in their pursuit of health” (Deitrick et al., 2010). Promotoras are generally utilized in the “underserved Latino community, serving as an important bridge between Latinos and the health care system, acting as an interpreter of both language and culture” (Deitrick et al., 2010). Because promotoras are inherently part of the community in which they become involved, they understand the healthcare needs as well as barriers that community members face. Promotoras do not generally have a strong medical background, but they go through “extensive training in the health issue they are asked to address” in the community (Deitrick et al., 2010). Frequently, promotoras “have the same chronic illnesses as [their] clients,” making it easier for them to relate to the community, build trustworthy relationships, and even act as a role model for others (Deitrick et al., 2010). In addition to providing education, communication, and emotional support, promotoras can also use their connections to help those with little access to care due to “language, economic, or geographic issues” (Deitrick et al., 2010). In short, promotoras provide an important link between the community and healthcare workers to help “address the health disparity issues faced by the growing Latino population in this country” (Deitrick et al., 2010).

Promotoras and community health workers (CHWs) have been called upon in several instances in order to “motivate their fellow community members within existing and expanding social networks towards positive health-related behaviors and to support them as they make decisions about and seek health care” (Reinschmidt et al., 2006). Serving as intermediaries between community members and members of the healthcare team, promotoras have been shown to have a “positive impact in education, screening interventions, or both” (Reinschmidt et al., 2006). As chronic disease prevalence is increasing at dramatic rates nationally, and especially in the underserved populations, promotoras and CHWs can help fulfill an important role in helping individuals understand and make informed decisions regarding their healthcare as well as be compliant with recommended treatment plans.

The Latino community has responded to the use of promotoras because of the “different types of social support” and “relat[ing] well to her socio-cultural and personal characteristics” which “built the foundation for trust” (Reinschmidt et al., 2006). It has been shown that interventions involving promotoras within the Latino community have “increased adherence by facilitating Hispanic women’s self efficacy” (Reinschmidt et al., 2006). As an example, “using the transtheoretical model of change, [the use of promotoras] has demonstrated significant improvements in outcomes for patients living with diabetes” (Deitrick et al., 2010). This could be due to emotional support but also to helping patients overcome language and cultural barriers when it comes to seeking healthcare and following a treatment plan to manage their diabetes or other chronic disease(s). In another example, promotoras intervened in the Latino community to “increase CVD (cardiovascular disease) knowledge and heart-healthy practices, increase participation in physical activity… [and] increase awareness and knowledge through community-based health promotion activities” (Balcazar et al., 2009). As such, it seems that promotoras can be most effective in helping raise awareness of health issues or in helping chronic disease patients cope with and manage their illness.

There are many benefits and few challenges to the use of promotoras to promote health in underserved Latino communities. Their strength and success lies in that they are people of the same community, often sharing backgrounds, language, and cultural similarities. They have been positively utilized to decrease barriers, such as language or level of education, by breaking down health information into understandable dialogue. Having someone to whom patients can relate increases patient trust and confidence in the plan of care, thereby increasing self-efficacy. The main limitation, however, is funding. Because promotoras are found in communities that are underserved and/or of low socioeconomic status, public funding for intervention programs is often limited (Deitrick et al., 2010). Perhaps with increased evaluation and awareness of intervention programs, funding resources will increase so that promotoras can be used to help prevent chronic disease as well as help community members manage their ailments.

As for implications in public health that can be gleaned from promotoras, it is important to know that lay persons can be relied upon to help effect change, even with no formal medical training. Secondly, it is important to understand how instilling support systems, such as the promotoras, can help patients gain more confidence and trust in their healthcare. Informal support groups for patients of similar backgrounds may be a way by which public health researchers can work with community leaders to increase emotional support for chronic disease patients. Lastly, with the ever-growing diversity of the United States, public health workers must increasingly rely on already-integrated members of communities in order to target populations more specifically and increase the health status of a certain population.

Balcazar, H., Alvarado, M., Cantu, F., Pedregon, V., and Fulwood, R. A Promotora de Salud Model for Addressing Cardiovascular Disease Risk Factors in the US-Mexico Border Region. Preventing Chronic Disease: Public Health Research, Practice, and Policy. 2009 6(1): 1-8.

Deitrick, L., Paxton, H., Rivera, A., Gertner, E., Biery, N., Letcher, A., Lahoz, L., Maldonado, E., and Salas-Lopez, D. Understanding the Role of the Promotora in a Latino Diabetes Education Program. // Qualitative Health Research //. 2010. 20(3) 286-399.

Reinschmidt, K., Hunter, J., Fernandez, M., and Lacy, C. Understanding the Success of Promotoras in Increasing Chronic Disease Screening. // Journal of Health Care for the Poor and Underserved //. 2006. 17: 256-264.