Original post by Community Medical Centers.

At the end of Latin dance fitness classes, instructor Susana “Suzzy” Pinal says her students would gather to talk – often about their health or their family’s medical issues. She was always getting questions about new medications a doctor prescribed or a natural remedy viewed on the internet.

“I would tell them it is important to know what is the source that it’s coming from. Is it a trusted resource? Is it a doctor? What kind of license does the doctor have?” Pinal says. “I’m not a doctor, I just have my medical assistant certificate.”

But after 65 hours of training this winter to become a Promotora de Salud, or community health worker, Pinal feels more qualified to offer advice and teach her neighbors and fitness students what she knows.

Community Medical Centers helped secure a $75,000 grant, through its leadership role in the Fresno Community Health Improvement Partnership’s Diabetes Collaborative, to hire eight promotoras and a program coordinator. The Diabetes Collaborative along with Every Neighborhood Partnership, a non-profit serving low-income Fresno neighborhoods, is using the grant funding to educate recognized neighborhood community leaders on the promotora health promotion model.

Under the grant for Every Neighborhood Partnership, promotoras engage Latino, Hmong and Black families and individuals at risk of developing diabetes and chronic disease conditions in southeast and southwest metropolitan Fresno.

Great need for culturally appropriate healthcare

In the U.S., Latinos have higher rates of medical conditions leading to heart disease and stroke, including diabetes, obesity, high cholesterol and high blood pressure. Heart disease and cancer are the leading causes of death. But more alarming is the fact this ethnic group is 50% more likely to die from diabetes or liver disease than whites.

Much of this discrepancy is tied to lack of access to culturally appropriate care, medical providers who speak the same language and regular health screenings. Because of this, Spanish-speaking and immigrant communities are more likely to turn to a community leader for health advice than to a doctor, says Alma Martinez, Community’s community outreach project manager who helped write the promotora grant.

“There aren’t many trusted sources in the community. And that combined with fear and language barriers makes the promotora role much more vital for agencies to get factual and timely health information to families,” Martinez explains. In addition to hospitals and clinics, health plans and public health agencies are looking to promotora outreach to disseminate vital information for families who may be hard to reach.

Bridge-builders help create trust in institutions

“It’s important, especially this past year with all the distrust in government and the uprisings, to build institutional trust and community trust,” says Andrew Feil, executive director of Fresno’s Every Neighborhood Partnership. “It’s really about connections and about building those relationships.”

Pinal agrees, “It’s really important for us to share in the community in our cultural ways. Our culture is very afraid and lots of people don’t understand about COVID and the vaccination. There’s the fake news about vaccinations all around. I’ve been having conversations with groups of old ladies asking about it and asking what I am thinking about vaccination.”

Every Neighborhood Partnership has been relying much more on promotoras to distribute resources and education. “We just got 6,000 diapers to give out and we could’ve gone through food distribution sites,” explains Feil. “But we are letting our residents build their networks and find the folks who need them. In a matter of two weeks through eight promotoras, they’re already taken. That’s the shift we’re trying to make – to empower and support our neighborhood residents as the bridge-builders.”

Fresno County’s first promotora program

This is the first promotora program in Fresno County, but other places are employing similar outreach workers with great success. Using promotoras to talk about various health issues has helped improve cervical cancer screening rates among Hispanic women, according to the Centers for Disease Control and Prevention, which produces educational fotonovelas, or comic books, and other health promotion materials specifically for promotoras.
 
Besides dispensing health education, promotoras often act as mentors, patient advocates and translators for their neighbors. But their primary focus is on increasing access to care and better management of chronic diseases, especially diabetes.

Promotoras train in disease management, Medi-Cal connection

Jennifer Parra, Every Neighborhood Partnership’s promotora program coordinator says that promotoras received training on:

• Signing up families for managed Medi-Cal and Cal Fresh food assistance
• Improving self-management of diabetes and other chronic diseases
• Preventing trauma and injury through Community Regional Medical Center’s program
• How to recognize and mitigate Adverse Childhood Experiences (ACEs) and create more nurturing environments for children
• Mentoring and communication techniques
• How to tap into city resources such as zoning code enforcement in their neighborhoods

Crucial this year for promotoras was digital and technical literacy as they switched to virtual training and online outreach due to public health restrictions during the coronavirus pandemic. “Everything is virtual now,” says Parra. “So Suzzy has been trained on Zoom and GoToMeeting as well, and so she has been helping people to use their computers and we’re going to be doing more training on that.”