and Promotora? - The Center for Applied Behavioral Health Policy

Implementing a Promotoras
Comunitarias Model
By Silvia Esqueda, M.S, MFT
(626) 394‐9142
sesqueda@socal.rr.com or promotorasinmh@yahoo.com

Objectives
• A historical perspective of the Promotoras
Comunitarias model
• Promotora’s characteristics
• Promotoras Teaching Approach
• Spectrum of methodologies in health education
• An effective strategy for community
well‐being
• The Promotoras’ role in the mental health field
• How to start a Promotoras Program
• Infrastructure and funding needed to implement a
Promotoras Program‐Commitment from the
organizations

Promotoras Comunitarias
Community Health Education
• Community health education is not a new
concept (natural helpers)
• Different countries have used this model through
out history. People have looked to their family
members, friends, and neighbors for health care
information.
• Before the development of the medical profession,
community members (many of whom had
received their training from older relatives) were
the only health practitioners.

Promotoras Comunitarias
a Historical Perspective
• 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.

Promotoras Comunitarias
a Historical Perspective
• What is a Community Health Worker (CHW) and
Promotora? Promotoras are community members who serve as liaisons
between their community and health, human and social service
organizations. They work with organizations and institutions ‐ formally
and informally, as employees or volunteers ‐ to bring information to their
communities.
• CHW/Promotoras provide a continuum of service in a variety of
capacities; they are referred to as health care workers,
Brigadistas, outreach workers, advocates, case managers,
educators, community liaisons, community organizers, and
Promotoras de Salud.
• Promotores de Salud are neither outreach workers nor
untrained volunteers
• Promotores de Salud are well trained and are usually, but not
always paid for their work.

Promotoras Comunitarias
• Promotoras use a variety of methods to make
contact with the community. From intimate
group gatherings in individuals' homes to large
community meetings.
• Promotoras make direct contact with target
audiences, conveying crucial information to
provide community support.
• There are no statistics on how many Promotores
work in the different states, however it is known
that the vast majority of Promotores are women.

Promotor/a’s Characteristics
• Speaks the same language of the
community they are working with
• Understands “Personalismo”‐Personal
connection/heartfelt service
• Lives in the community
• They do door to door strategy
• Can be a professional in their country of
origin
• A leader who cares about his/her
community

Promotoras Teaching
Approach
• “Popular Education” is based largely on the ideas of
Brazilian Paulo Freire (1921 ‐ 1997)
• All people have a large store of knowledge as a
result of their life experience
• Education is interactive, participatory, and fun.
• Action oriented
• More appropriate to use the word “Capacitar” (to
build capacity) instead of “Training”

Spectrum of Methodologies in Health Education
Popular Education
Medical Model
•Learning through people’s * Passive learning methods
experience and stories; people “teaching” and knowledge
are active learners attainment focus
•Curriculum recognize * Standardized curriculums-centered
and integrate people’s culture on white middle class values
•Transfer of information * Transfer of information is centered
integrates diverse on white, middle class learning
learning orientations orientations
•Community driven curriculum * Agency driven curriculum
•Community engagement * Experts define and drive solutions/
to identify solutions programs

Strategy for community Well‐Being and
Social Change
Community
Promotora
Families

An Effective Strategy for Community
Well‐Being
Promotora
• Personal and professional growth
• Self ‐Esteem Improves
• Promotora shares and applies
information with immediate family
• Children view their mothers as teachers
• Family dynamics change

Benefits to Families
• Promotoras provide relevant health information
• Provide linkages to wide range of services
• Are the bridge between the families and the
healthcare systems
• Help families navigate the system
• Advocates

Benefits to the Community
• Promotoras are from the community. They
represent the needs and assets of the
community‐(community forums SPA 4)
• Participate in events or committees for the
improvement of their communities
• Promote change in their communities
• Educate community on policy issues
• Volunteers

Benefits to the Health
Care System
• Remove cultural and linguistic barriers
(patient liaisons)
• Increase trustworthiness of institutions
• Know the trends in the community and provide
information to help design effective programs
• Expand institution’s service delivery to include
prevention strategies
• Effective outreach strategies to promote services
(health fairs etc..)

Promotoras as a Preventive
Strategy in Mental Health
• Promotoras provide feedback to CBO’s on the lack of
MH services for adults and undocumented families
• Promotoras facilitate classes on child abuse
prevention, substance abuse, domestic violence etc.
• Promotoras provide referrals to MH providers
• Promotoras as Case Managers (Hathaway‐Sycamores
model)
• Promotoras’ role in the County USC Hospital
(emergency waiting area)
• Promotoras as Counselors

How to start a Promotoras
Program
1. Community outreach (information on the Promotoras
model)
2. Identification of community leaders
3. Informative/orientation meeting
4. Interviewing process of potential candidates
5. Training of the candidates on the curriculum; including
mental health and group facilitation skills

How to start a Promotoras
Program
6.Pre and Post test on the trained material
7.Evaluation of the Promotoras readiness to begin
their work out in the community
8.Supporting/supervision structure for the Promotoras
9.Collecting Data
10.Assessing trends in funding to sustain the
Promotoras program
11.Commitment from Board, CEO, Development Dept.,
Staff. * Seek support from community groups and
political entities