Venus Ginés M.A.
Instructor, Baylor College of
Medicine and
Founder, Día de la Mujer Latina
Objectives
 Discuss 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 1000
 Location - 52 counties
Promotor(a) or Community Health Worker Training
and Certification Advisory Committee (9)
 4 certified P/CHWs
 2 public members
 1 member with experience in adult education and
training of P/CHW
 2 professionals who work with P/CHW
Promotor (a) /CHW Curriculum
Teaching Skills
Communications Skills
Service Coordination Skills
•
Plan + Effect Presentation
Talking with someone who:
•
CHIP/ CHIP Perinatal
•
Teach on “How to talk” to
your doctor

•
Understanding the role of
community health centers

has a sexually transmitted
disease,
may need mental health
services
Interpersonal Skills
Advocacy Skills
Capacity-Building Skills
•
Health Literacy
•
•
Teaching skills for behavior
change
•
Cultural Competence
•
How to motivate your patient &
their family about follow up
•
How to advocate about health
issues for Latinos or other
minority groups
How to advocate for children
Organizational Skills
•
How to prepare for a Health
Fiesta or cultural event
•
How to prepare and analyze Pre
and Post Surveys
Knowledge Base on Specific Health Issues
•
Breast Cancer & Survivorship
•
Cervical Cancer - Human Papilloma Virus (HPV)
•
Cardiovascular – Diet & Nutrition
•
HIV/STD
•
Disaster Preparedness
•
Diabetes
Promotores/Community Health Workers
delivering a culturally-specific health message.
1.
2.
3.
4.
Building relationships with the community
Understanding the Culture
Addressing the barriers - especially
MISTRUST
Navigating patients through health care
system.
Understand Cultural Transformation:
BUILD a Relationship with the Community
 Know 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
“Are you talking to me?”
 Acculturation levels – Hispanic vs. Latinos
 Latinos don’t all speak the same language
 Latinos have different literacy levels
 Cultural translations vs. literal translations
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
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.
Dia De La Mujer Latina
Cultural Values
American
Latino
 Career-Oriented
 Family-Oriented
 Traditional Medicine
 Folk Medicine
 Linear Thinking
 Circular
 More direct
 More indirect
 Meetings with AGENDAS
 Meetings with FOOD
 Time is a Deadline
 Time 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 fear
 About 40% of Latino/Hispanics either do not speak
English at all or do not speak it well.
Dia De La Mujer Latina
Affordability
Economic 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© Survey
 83% 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 • Perception vs Reality
the Mistrust
• History of Medical Abuse
Researchers
Doctor
Social Worker
Promotores +
Community Health
Workers
Health Fiestas
Hospital Admin
Nurse, PAs &
Nurse Practitioner
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
● El Paso
Austin
●
Houston
San Antonio ●
●
Corpus Christi ●
Edinburg (Valley
Día de la Mujer Latina-Cancer Outreach
Seattle, WA
Milwaukee, WI
San Jose, CA
Las Vegas, NV
Burbank, CA
Chicago, IL
Casper, WY
Denver, CO
Salt Lake City,
UT
Pueblo, CO
New Jersey, NJ
New York City, NY
Ann Arbor, MI
Sioux City, IA
Columbus, OH
Des Moines, IA
Indianapolis, IN
Philadelphia, PA
Erie, PA
Washington, DC
Lexington, KY
Phoenix, AZ
San Diego, CA
Augusta
Augusta, GA
Savannah
Savannah, GA
Dallas, TX
El Paso, TX
Raleigh, NC
Atlanta, GA
Austin, TX
San Antonio, TX
Houston, TX
Orlando,FL
Jacksonville, FL
Hialeah, FL
Homestead, FL
Corpus Christi, TX
Miami,
FL
Maui, HI
San Juan, PR
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"