Using Promotores/ Community Health Workers as Navigators to

Improve Clinical Outcomes.

Venus Ginés M.A.Instructor, Baylor College of

Medicine and Founder, Día de la Mujer

Latina

ObjectivesDiscuss the role of Promotores/Community Health Workers according to the parameters set by the state of Texas.

Identify the MINE Project – how Promotores and Community Health Workers Motivate, Inform, Navigate and Empower our Latino Community.

Describe the Promotores/Community Health Worker model and how it can be replicated across the country in a variety of healthcare services.

Who is a Promotor (a)- Community Health Worker?A person who, with or without compensation:

Represents the ethnic, socio/economic and educational traits of the population he/she serves;

Trained to bridge the gap that exists between communities and health and human service systems;

Respected and trusted by their neighbors and peers who provide informal counseling and social support;

Program Status –Jan 2011 Certified Promotores or Community Health

Workers Total number – approximately 1000Location - 52 counties Promotor(a) or Community Health Worker

Training and Certification Advisory Committee (9)

4 certified P/CHWs2 public members1 member with experience in adult education

and training of P/CHW2 professionals who work with P/CHW

Promotor (a) /CHW CurriculumCommunications Skills

Talking with someone who:

has a sexually transmitted disease,

may need mental health services

Interpersonal Skills • Health Literacy

• Cultural Competence

Service Coordination Skills

• CHIP/ CHIP Perinatal

• Understanding the role of community health centers

Capacity-Building Skills

• Teaching skills for behavior change

• How to motivate your patient & their family about follow up

Advocacy Skills • How to advocate about

health issues for Latinos or other minority groups

• How to advocate for children

Teaching Skills

• Plan + Effect Presentation

• Teach on “How to talk” to your doctor

Knowledge Base on Specific Health Issues • Breast Cancer & Survivorship• Cervical Cancer - Human Papilloma Virus

(HPV)• Cardiovascular – Diet & Nutrition• HIV/STD• Disaster Preparedness• Diabetes

Organizational Skills • How to prepare for a

Health Fiesta or cultural event

• How to prepare and analyze Pre and Post Surveys

Promotores/Community Health Workers delivering a culturally-specific health message.

1. Building relationships with the community2. Understanding the Culture3. Addressing the barriers - especially

MISTRUST4. Navigating patients through health care

system.

Understand Cultural Transformation: BUILD a Relationship with the CommunityKnow the demographics

Understand major issues affecting the community, (i.e. cancer, obesity, mistrust, etc.)

Search for trusted collaborators/partners within the Community

The Latino Population in the US

Latinos are the fastest growing group in the US

45 million (documented) –equal to 15% of the US Population + 12 million (undocumented)

By 2030 Latinos will represent 25% of the population with over 98 million

Sources: US Census Bureau American Community Survey 2007 & Population Projection Program

Acculturation Levels

Acculturation levels – Hispanic vs. Latinos

Latinos don’t all speak the same language

Latinos have different literacy levels

Cultural translations vs. literal translations

“Are you talking to me?”

Demographics: Latino Population

We are Young! 34% are age 18 or younger and living in poverty. The median age is 27 years.

Generational Status: the 3rd generation, who are more acculturated will adopt more mainstream medical care as US-born Americans.

Sources: US Census Bureau Community Survey 2007, Income and Poverty Rates; The Commonwealth Fund Health Insurance Survey 2005

Dia De La Mujer Latina

Diverse Historical Backgrounds

• Mexicans – 2/3 of the Latino population; at least 2

million seasonal/migrant workers; not welcomed but

desperately sought after for cheap labor.

• Puerto Ricans – US Citizens-travel back & forth

• Cubans – Exiled from Cuba – welcomed to US

• Central Americans – many refugees, have TPS,

• South Americans – Portuguese is the most spoken

language in South America-Brazil – 51% of population;

Italian is 2nd mostly spoken language in Argentina.

Cultural Values

American Latino

Career-OrientedTraditional MedicineLinear ThinkingMore directMeetings with

AGENDASTime is a Deadline

Family-OrientedFolk MedicineCircularMore indirectMeetings with FOODTime is a Guideline

Main Barriers to Healthcare

Accessibility

Affordability

Accountability Dia De La Mujer Latina

Accessibility Nationally, 37 % of Latino/Hispanics are

uninsured, compared to 16% for all Americans.

Many hospitals don’t have interpreters always available

High level of denial/understanding of specific risk factors.

Criteria and paperwork cause fearAbout 40% of Latino/Hispanics either do not

speak English at all or do not speak it well.

Dia De La Mujer Latina

AffordabilityEconomic status parallels educational status.

The poverty rates are 14% respectively for Cuban Americans, 31% for Puerto Ricans, and 27% for Mexican Americans, compared to 13.5% of all Americans.

31% of Latino/Hispanic children with working parents lack medical insurance coverage.

Undocumented immigrants don’t have the opportunity to buy health insurance, most rely on faith healers.

Dia De La Mujer Latina

Accountability Medical Mistrust and

fear are the most frequently cited barriers to care among Latino populations

Relationship building-are you here today and gone tomorrow

Who can I trust with my own and my families care and information?

Results: MAMMAS© Survey83% were aware of some form of medical abuse that

occurred.

89% believed mistrust contributes to the lack of participation into clinical trials.

71% felt that patients may have been deceived or misled by healthcare organizations.

74% believed that healthcare organization have experimented on patients without their knowledge.

78% felt that patient information is not always kept private.

80% were cautious about healthcare organizations.

87% stated that mistakes are usually covered up by healthcare organizations.

86% were conscious of the importance of cancer screening, but felt that fear may be hindering many from access to care.

Understanding the Mistrust

• Perception vs Reality

• History of Medical Abuse

Social Worker

Hospital Admin

Health Fiestas

Nurse, PAs &

Nurse Practitioner

DoctorResearchers

Promotores + Community Health

Workers

Patients

Evidence-Based Intervention

The Promotoras model is adaptable as evidenced by its use in addressing a number of community issues, including HIV/AIDS, Diabetes and other chronic illnesses, and community organizing. While their roles, job titles, responsibilities and activities may vary depending on client or community needs, they save lives.

Eliminating Disparities: Día de la Mujer Latina-Health Fiesta Outreach 2010

Dallas

Austin Houston

El Paso

San Antonio

Corpus Christi

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Edinburg (Valley

Orlando,FLHomestead, FL

Miami, FL

San Juan, PR

Washington, DC

Philadelphia, PA

New York City, NY

San Diego, CA

Seattle, WA

Día de la Mujer Latina-Cancer Outreach

Hialeah, FL

Chicago, IL

Lexington, KY

SavannahAugusta

Phoenix, AZ

Salt Lake City, UT

Denver, CO

Pueblo, CO

Des Moines, IA Erie, PA

Casper, WY

Augusta, GASavannah, GA

Atlanta, GA

Houston, TX

Indianapolis, IN

Columbus, OH

Jacksonville, FL

New Jersey, NJ

Raleigh, NC

Milwaukee, WI

Ann Arbor, MI

Sioux City, IA

Dallas, TXEl Paso, TX

San Antonio, TX

Corpus Christi, TX

Austin, TX

Maui, HI

Las Vegas, NVBurbank, CA

San Jose, CA

When Asked by the PLOS Medicine Journal …Which Single Intervention Would Do the Most to

Improve the Health of Those Living on Less Than $1 Per Day?

Paul Farmer of Partners in Health responded,

"Hire community health workers to serve them"