Linking Hispanics and Latinos to Health Care: Promotora Programs

September 15, 2015
Maureen Fitzgerald
Communications Coordinator, ATTC Network
Editor, NIATx

September 15-October 15 2015 marks National Hispanic Heritage Month, first established in 1968 to honor and recognize Hispanics and Latinos and their many contributions to U.S. culture and society.

Among the Latinos making a difference today are groups of Promotores: bilingual, bicultural healthcare workers who receive special training to help their neighbors navigate local social and health services and gain access to education, employment, and healthcare.

Promotoras (women) and promotores (men) are trusted advisors who are welcomed into homes and community centers to talk about reproductive health, nutrition, parenting and how to manage chronic health conditions such as diabetes and hypertension.

Promotora programs are widely used in the states and communities with large Hispanic and Latino populations, and are gaining recognition elsewhere in the U.S.

Promotoras: A brief history

While the promotora model was in use in Latin American countries since 1960, it did not gain attention in the United States until the mid-1960s to the 1970s. It was during those two decades that the United States federal government initiated a support campaign for the outreach to rural, marginalized, and hard-to-reach communities with the intention of improving access to care. Such model regained attention in the 1990s thanks to efforts from Centers for Disease Control and Health Resources and Services Administration.
  • Beginning in the 1950’s: Promotores de Salud flourished through Latin America to bring health care to the poor
  • Late 1980’s: Promotores de Salud became well known in the migrant and seasonal farm working communities.
  • In California, Promotoras programs were first used in 1988 by organizations working in AIDS/HIV prevention.
  • Today Promotora programs are used by many organizations to educate people about topics including cancer, diabetes, geriatrics, health (general), HIV/AIDS, housing, lead poisoning prevention, mental health, reproductive health and more.
"It is the ability and willingness of promotoras to link vulnerable Hispanic community members with the formal healthcare providers that make their role indispensable to society.”  Dr. Josefina Lujan, "Got Hispanic Clients? Get a Promotora "
While many promotora programs focus on chronic physical health conditions, few have addressed behavioral health issues. And as the National Hispanic and Latino ATTC Fact Sheet "Meet Your New Clients" points out: “Hispanics are disproportionately impacted by substance abuse,” among other health conditions. Access to culturally and linguistically appropriate behavioral health care is a high priority need —that promotoras can help address.

And now, a new initiative by the National Hispanic and Latino ATTC is training promotoras to help their neighbors learn more about substance use disorders.

Interactive learning
The first training, “A Skill Building Training on Substance Use for Promotoras,” took place August 26-27 at the University of Texas at Austin, School of Social Work, and was offered in collaboration with the university’s Office of Minority Health and the South Southwest ATTC. Dr. Darice Orobitg collaborated with NHLATTC consultant Victor Flores and Cielo Mohapatra of the Arizona Department of Health Services to develop a culturally relevant training tailored to the language, literacy, and learning styles of promotoras in the Texas border community of Travis County. Carmen Andujar, Logistics Specialist for the NHLATTC, coordinated the event.

Did you know that the Red Solo Cup has
built-in measures for standard drink sizes?
“We knew that we would need to include a lot of visuals and keep the sessions very interactive,” says Carmen. “Many of the participants have completed very little formal education and may have limited reading skills in Spanish or English.” The training also included props--like the Red Solo Cup that came in handy for demonstrating standard drink size.

This group of promotoras was eager to learn and the session allowed plenty of time to address questions that participants asked after each slide. “In particular, they wanted to know the street names of specific drugs and how to recognize symptoms of drug use,” says Carmen.

La ropa sucia se lava en casa, or “We wash our dirty clothes at home”: Overcoming stigma

The stigma associated with substance use is especially strong in Latino communities. Latino families tend to keep this problem within and may discuss it first with a priest and then with the family, but rarely seek outside help.

“Substance use is still considered a moral failing that brings shame to the entire family. There’s a lot of resistance to seeking treatment due to fear of rejection from the community,” adds Carmen. Overcoming stigma will require a lot of work, says Darice, but training more promotoras about substance use offers great potential for changing attitudes with the Latino community about addiction, treatment, and recovery.

Recognizing the many advantages of promotora programs has increased efforts in states like Texas to create promotora education and certification programs.

The Colonias Program of the Center for Housing and Urban Development (CHUD) at Texas A&M University is one of them. Its Promotora/Community Health Working Training Academy offers a certification program that will allow health care organizations to hire promotoras for paid positions in health care settings. And what’s even more exciting is that the program may soon include substance use training. The National Hispanic and Latino ATTC is talking with the Colonias program about providing the training.

“The Promotoras training is another opportunity for the National Hispanic and Latino ATTC to support and expand the workforce that provides addiction treatment and recovery services to Hispanic and Latino populations,” says Darice.

For more information or to schedule a promotora training in your area, contact Carmen Andujar at the National Hispanic and Latino ATTC.


A presentation on “A Skill Building Training on Substance Use for Promotoras” will be included at this week’s symposium, Behavioral Health and Primary Care Integration for Latinos: Assessment, Treatment, and Recovery.


Coming up:
Mark your calendar for the National Hispanic and Latino ATTC webinar
September 30, 11-12CST
Familia Adelante: An Effective Substance Use Prevention and Stress Reduction Program for Latino Adolescents 

Click to register

Resources:

Got Hispanic Clients? Get a Promotora

Cultural Elements in Treating Hispanic and Latino Populations Desk Reference

National Hispanic and Latino ATTC Products and Resources  

Centers for Disease Control and Prevention: Promotores de Salud/Community Health Workers

SAMHSA Behavioral Health Equity: Hispanic or Latino


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