Community Health Workers Addressing Reproductive Health Disparities in Immigrant Latino Communities

Background and Purpose: This study addresses the theme of Achieving Equal Opportunity, Equity, and Justice as it relates to the use of community health workers (CWH) to implement an evidence-based intervention (EBI) to reduce racial/ethnic disparities in reproductive health in a marginalized, underserved immigrant Latino community.

Despite an overall reduction in adolescent birth rates over the past decade, Latina youth continue to have the highest rates of teen births in the U.S. at 41.7 births per 1000 girls compared to the national rate of 26.5 births per 1000 girls ages 15-19. Latino youth are also at increased risk of acquiring sexually transmitted infections and HIV/AIDS. Through a community-based research partnership, a team of researchers, parents, and community partners piloted Families Talking Together (FTT) a brief, parent-based sexual risk-reduction program designed specifically for Latino families. Existing research suggests that FTT enhances parent- adolescent communication about delaying sex, reduces frequency of sexual intercourse among sexually active teens, and fosters greater parental monitoring and supervision of their adolescent children. FTT has been implemented in a variety of settings across the country; however, little is known about the feasibility and acceptability of Promotoras de Salud, community health workers, as implementers of EBIs in reaching underserved immigrant communities.

Methods: This mixed-methods study incorporated a community readiness framework and pre-implementation strategies that focused on a variety of implementation issues. The feasibility study examined the implementation of the CHW service-delivery mode through a formative evaluation consisting of pre-, post-, and follow-up surveys with participants (N=36); fidelity questionnaires with the Promotoras (N=36), and interviews with project staff (N=5).

Results: Participants included immigrant Latina mothers predominantly from Mexico (92.7%) and Central American countries. Of the 45 parents approached, the vast majority participated (n=41). Of the 41 parents enrolled, 36 completed the intervention, demonstrating a high retention rate (87%). Promotoras implemented the full intervention with a high degree of fidelity. Results from our quantitative analysis suggest that FTT achieved program outcomes by significantly increasing parent-child communication, and enhancing parents’ comfort level, ease, preparation, and intentions to communicate with their adolescent about delaying sexual debut. Qualitative findings highlighted the acceptability of the intervention and Promotoras’ recruitment enhancements, even if it involved a particularly challenging topic for Latina mothers. Findings also underscored the substantial health and mental health needs among participants as well as the negative impact of the changing political environment on service delivery.

Conclusions and Implications: The study demonstrates how community-based research and implementation science can inform efforts to address racial/ethnic reproductive health disparities in immigrant communities through the delivery of an EBI through a CHW model.

Considering the impact of immigration policy on recruitment and retention, future studies might examine the implementation of FTT through CHWs in a home-based structure. Further, studies might evaluate the delivery of mental health consultation through CHW to supplement reproductive health content in order to address the significant mental health and substance abuse needs of immigrant families.