Newswise — HOUSTON – (July 2, 2015) – Sylvia Hernando became a Community Health Worker (CHW) because she wanted to help others. Hernando had been a stay-at-home mother and was looking to go back to school when she heard about the CHW certification program at The University of Texas Health Science Center at Houston (UTHealth) School of Public Health.
“The class was very helpful – they train you, prepare you and give you the skills you’ll need to help people find health services,” said Hernando.
After graduating from the certification program last year, Hernando began working with a program at the UTHealth School of Public Health El Paso Regional Campus called Healthy Fit. She assists individuals who need mammograms, human papillomavirus screenings, colonoscopies and, for people age 65 and older, pneumonia checks.
“People may not know how to start or where to go for help. I connect them with resources that will help them live a healthier life. Sometimes that means directing them to free or inexpensive exercise classes. Other times it means educating people on how to manage their blood pressure,” said Hernando.
A CHW, called a promotora de salud in Spanish-speaking communities, is a public health worker with the unique ability to serve as a liaison between health and social services and the community members most in need. Researchers at the School of Public Health have been using this model of care delivery to serve Hispanics living along the Texas-Mexico border for more than 30 years.
“Hispanics, especially those with low incomes, are disproportionately affected by diseases. The traditional health care system in America cannot fully cope with the rising prevalence of cardiovascular disease in this minority group,” said Hector Balcazar, Ph.D., regional dean at School of Public Health’s El Paso campus.
According to the Centers for Disease Control and Prevention, the leading causes of death for Hispanics are cancer and heart disease. In the early 1990s, Balcazar and his team of researchers in El Paso partnered with the National Institutes of Health (NIH) for its Health for Your Heart (Salud Para Su Corazon) Latino-Hispanic Community Cardiovascular Disease Prevention and Outreach Initiative.
The team has been actively implementing and evaluating the manual called Su Corazon, Su Vida, which includes culturally appropriate health education materials for Hispanics in the United States. The manual has been used in communities across the country to train CHWs and deliver programs that work to address heart disease in Hispanics.
“It’s very common to think of obesity as a biological problem and not take a community perspective. We’re working toward transforming the community as a whole, which could lead to better health outcomes,” said Balcazar.
In addition to the manual, School of Public Health researchers worked with the Centers for Disease Control and Prevention (CDC) to release fotonovelas about hypertension and high cholesterol. These materials explain how to reduce sodium, cholesterol and fat levels and why it is important to do so when one is at risk for diseases such as hypertension and obesity.
“We’ve gotten a great response from people across the country who are interested in using these fotonovelas. They’re being placed in clinics and community centers,” said Balcazar.
Research shows efficacyIn 2008, the School of Public Health researchers completed a clinical trial called Health Education Awareness Research Team (HEART), which examined the effectiveness of a CHW-led program on cardiovascular disease risk reduction among Hispanics in El Paso.
The results of the trial, published in 2010 in Preventing Chronic Disease, showed a significant increase in awareness of cardiovascular disease risk factors, more confidence in participants’ control of those factors, improved dietary habits and lower cholesterol levels.
In a study published last year in the International Journal of Environmental Research and Public Health, Balcazar and his colleagues surveyed residents across El Paso about their perceptions of the CHW program. Twenty percent of those surveyed responded that they had heard of the program and the 8 percent who had used their services had very positive perceptions. Of those who had not heard of the program, most felt positively about the program when it was explained to them.
Last month, Balcazar and colleagues published the results of a new program of HEART called MiCMiC (Mi Corazon Mi Comunidad) in Frontiers in Public Health. The MiCMiC study evaluated the impact of an intervention in which promotoras encouraged the use of community physical activity and nutrition resources. The researchers found that participants saw significant improvements in health behaviors and moderate improvement in cardiovascular risk factors.
International reachGiven the success of the promotora model in El Paso, Balcazar began working with colleagues at his alma mater, Universidad Iberoamericana Ciudad de Mexico, to implement a version of Su Corazon, Su Vida that would translate well to Mexican residents. Balcazar took a sabbatical from the School of Public Health in the summer of 2014 to aid in the program’s adaptation.
“The university in Mexico City is surrounded by high-risk, impoverished neighborhoods. The Jesuits there have a mandate to try and improve the well-being of communities nearby,” said Balcazar.
Balcazar and several promotoras from El Paso began a training program to develop a network of promotoras in Mexico City. The results were positive and they determined that the promotora model could be adapted to the health realities that Mexican residents face.
In a study published in March in Preventing Chronic Disease, Balcazar and his colleagues in Mexico City found that the Mexican promotora model led to significant improvements in some heart-healthy habits among adult participants. The number of adults younger than 60 who took action to modify lifestyle behaviors rose from 31 to 63 percent. Most participants reduced their cholesterol and fat consumption and participants older than 60 increased their weight control and reduced salt consumption.
Pushing for policy changesCHWs have been a part of the public health system for decades, but have become more common in recent years due to a growing body of research, such as the School of Public Health’s, that attests to their effectiveness. According to Balcazar, state and federal policies have not kept pace with the growing interest in the workforce. At least a dozen states are seeing significant movement toward more supportive policies regarding CHWs.
In 2011, the Institute for Health Policy at UTHealth School of Public Health partnered with Balcazar and his team to create a Project on Community Health Worker (CHW) Policy and Practice. The purpose of the project was to serve as a statewide and national resource for advancement of the CHW workforce through research, policy analysis and stakeholder education.
“The medical model is strong, but it is a sick model of care. Now the country is facing questions about the value of prevention. The sick model of care is costing us so much money and the community health worker model is preventing people from getting sick,” said Balcazar.
The health policy team aims to find out what it would take to develop this kind of workforce at state and regional levels.
CHWs are employed at many of the School of Public Health’s regional campuses. In Brownsville, they are connecting community members with local fitness classes, teaching proper nutrition and providing resources to uninsured individuals.
In Houston, some are working with patients at the Center for Healthy Aging to understand insurance plans and remind them of doctor’s appointments. Others are helping to spread information about human papillomavirus prevention and assisting in cancer screenings.
Hernando believes this kind of work is necessary, especially when it comes to reaching low-income individuals.
“When you visit the doctor, they may only have a few minutes to talk to you about whatever is wrong, but when you have a promotora who tells you where to go to for help, calls you to check in and follows up to see how you’re doing - it’s like a bridge to a healthier life,” said Hernando.
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