Promoting Health and Social Equity Among Latinxs: Outcomes and Lessons Learned from a Community-Based, Multi-Stakeholder Promotoras Program in the Southeast U.S

Background: Community health workers (promotores de salud in Spanish) have helped improve the health of U.S. Latinx communities by connecting members of their community with health and social services. Often, these promotores focus on specific social or health conditions. However, the impact of promotores who do not focus on a specific health problem—yet continue to bridge the gap between their communities and healthcare and social services—is less understood. One such program is Lazos Hispanos (Hispanic Links).

Purpose: Calling upon CBPR, Lazos Hispanos was launched in 2017 to improve the health and wellbeing of Latinxs living in a small, low-income, mixed-immigration-status community in Georgia. This study discusses the first-year outcomes of the bi-directional integration of knowledge and co-learning between three key groups: (a) promotoras, (b) members of the Latinx community, and (c) local healthcare and social service providers.

Methods: We conducted a mixed-method evaluation of the three groups. Eight promotoras completed pre- and post-test surveys to assess changes in five dimensions of self-efficacy and knowledge of social determinants of health (alpha coefficients ranging from .64 to .96). Informed by heuristic inquiry, five promotoras completed in-depth, semi-structured group interviews to assess their experiences as promotoras de salud and gather program recommendations. We conducted a brief phone interview of 10% of the total 138 community participants to assess their interactions with the promotoras. Lastly, of the 12 service providers/organizations holding MOUs with the project, seven completed a survey and participated in semi-structured, in-person interviews at the end of Year 1.

Results: Several themes emerged from these data: (a) the promotoras’ confidence and knowledge of community services increased through specialized training; (b) community participants appreciated the promotoras’ diligence, care and professionalism, as they ensured that three-quarters of the 220 referrals resulted in access to the desired services; and, (c) service providers reported increased accountability to culturally responsive practices, described the promotoras as their ambassadors, and valued Lazos Hispanos as connectors among service providers, community members, and promotoras.  

Conclusions and Implications: Year one outcomes demonstrate that Lazos Hispanos effectively enacted change at multiple levels: organized women in the community to gain confidence and skills as promotoras; increased the ability of community agencies and clinics to serve and be culturally responsive to the Latinx community; and empowered members of the Latinx community with knowledge and skills to seek and obtain quality social and medical services. These findings underscore the importance of: (i) collaborating with multi-level stakeholders, (ii) gathering multi-level, multi-method evaluation data, and (iii) (re)centering community health workers programs on general access to health and social services to address health disparities and social inequities among racially/culturally and economically marginalized communities.