India J. Ornelas
Assistant Professor, Health Services
KL2 Scholar
Building Relationship with CASA Latina
• Started meeting them with when I came as a postdoc
• Conducted interviews there on stress, discrimination and
• Presented the findings at CASA Latina staff meeting
• High levels of stress
• Depressive symptoms
• Social isolation
• Staff were interested in program to help address some
of the findings from the study
• I approached them with the idea of writing a grant to
pilot a stress and coping curriculum
ALMA : Amigas Latinas Motivando el Alma
Pilot Intervention in NC
• Trained 40-45 local promotoras in Durham, Wake and Chatham counties
• 6 sessions to train groups of 12-15 Latinas
• Recruited through churches, community organizations and agencies
• Skill building on coping strategies for isolation, anxiety, sadness
• Appled relevant topics: immigration, isolation, family re-organization
• Tangible items such as a comfort basket as potential strategies
• Promotoras shared information with 2-3 other Latinas in their social
network (Compañeras)
• Promotoras teach self-help strategies to compañeras to improve compañeras’
coping skills and reduce their stress
• Saw reductions in depressive symptoms, perceived stress and increase
in coping skills
ITHS Community Pilot Grants
• Funds can be used for small pilot research, quality improvement projects, or non-research activities that
develop research capacity. All proposed research must be participatory, which means involving
community, tribe and practice members in the health research processes.
• Examples include but are not limited to:
• Conference, seminar or course attendance(example only):
Attend a course, seminar, training workshop or conference related to community, tribe, or practice-based participatory
health research that will help increase research capacity.
• Organize a gathering of your community, practice or tribe(example only):
Organize a meeting for community or practice members to talk about research questions that are important to study
(for example, Town Hall).
• Conducting research or quality improvement work (examples only):
Hire a consultant to help write a research grant proposal.
Build research review or regulatory capabilities at your organization, community, or practice. Examples include
creating cultural or tribal review boards, institutional review boards (IRBs), or other regulatory systems.
Collect preliminary data from a community or practice to support a future grant proposal.
Conduct chart reviews to find gaps in services, such as racial and ethnic health disparities.
Conduct an interview or focus group (qualitative study) with providers and patients to learn why a health intervention
does not work as well for some groups of people.
Survey a specific racial or ethnic group of people to learn about their views on cancer and cancer prevention
We got the money… what?
• Negotiating responsibilities and budget
• Changes to the curriculum
• Project Coordinator/Trainer came out from North Carolina
to spend 2 days training CASA Latina staff on the
curriculum and how to facilitate meetings
• Half-day training with CASA Latina on data collection
CASA Latina Curriculum
Session 1: Introduction to the program and to stress
• Activity – Book and video about immigration story
• Activity – Sponge, how much stress can you take?
• Activity – How do you deal with stress?
• Homework: Make a card for a loved one
• Gift: Toolbox
• Session 2: Separation
• Activity –“Josefina’s Story”
• Brainstorm – Healthy and Unhealthy ways of coping with
Activity – Writing with your bellybutton
Activity – Web of social support (with yarn)
“Mi Abuelita Dice…”
Homework: Practice a healthy way of coping – like walking
Session 3: Adjusting to Life in Seattle
Information about social support
Activity: Share the cards they made
Activity: Social networks (here and there)
Activity: Introduction to meditation (raisin)
Gift: Frame for a photo of loved one
Session 4: Coping with Stress
Activity: Loteria with Coping Strategies
Yoga and Meditation
Homework: Practice meditation
Gift: Relaxation CD and candle
Session 5: Seeking Mental Health Services
• Invited therapists from SeaMar and Consejo to explain the
how to seek mental health services and the role of a
psychologist/social worker
• Activity on holistic health
• Reflection in pairs over the workshop
• Gift: soap
• Recruited 22 participants
• Of those 12 came to at least one session
• 9 attended all five sessions
• An additional 6 came to at least one session after we did
the pre-tests
• Low-income, primarily from Mexico, Spanish dominant
Years in the US
Married/living as married 36%
Employed year round
Evaluation Results
Pre-Test (N=22)
Post-Test (N=10)
CESD Scores (range 0 - 60)
PSS (range 0 - 56)
Acculturative stress (0 - 84)
Coping (range 1 – 4)
Focus Group
Purpose: To obtain feedback on the session content and how it was offered
“I have a lot more abilities than what I
“To value ourselves, to make time for
ourselves…it is very valuable for me
because I give all of my time….I have 4
“Free time is also for me…to get rid of
stress and be better.”
“The other day it was raining so hard, and
I kept going without an umbrella…walking
in the rain…I felt so good…not cold…and I
said to myself, “yes, the ALMA sessions
have done a lot for me.”
“You have the ability to transform
stress…to decrease stress…by a variety of
ways, like meditating.”
What do you do differently now?
“I learned to practice more exercise and that helps me control my
“I learned to walk my dog for [lowering] stress”
“To put into practice the different tips [from actions to manage stress
sheet] …I see it and I read it because I hung it up in my kitchen.”
Managing Stress
“Related to the relaxation [activity] was what I liked most…I am less
“I think that what called most to my attention was the relaxation
[activity]…to learn how to relax because we lived so stressed”
Lessons Learned and Next Steps
• Working in the community always takes longer than you
think it will
Be mindful of the burden to the community
Be mindful to the burden on you
Be responsive to community needs
Follow through – our next step is to find funding to test
and implement as promotora or stress reduction program