Health Center (MCHC), is a Federally Qualified Health
Center (FQHC) providing healthcare in the border town of
Nogales, Arizona. With a population of around 20,000,
is 95% Hispanic/Latino, according to U.S. Census Bureau
data and is located in
Santa Cruz county with its total population about 84%
According to several government agency reports, about
percent of the nation's population is
Hispanic/Latino. Prior to COVID-19, their death rate was
about 24% lower than in Whites and the leading causes of
death in this racial/ethnic group was heart disease and
According to the CDC,this population has a 50% chance
of developing type 2 diabetes, developing it at a younger
age, and experiencing higher rates of both kidney failure
and diabetes-related blindness.
Because the average Hispanic/Latino age is nearly 15
years younger than Whites, prevention steps are
anticipated to have a high impact on future disease
rates, especially since this group represents the largest
U.S. racial/ethnic minority population and is growing at
the fastest rate.
In 2012, grant work focused on further establishing an
integrated system of diabetes care for their
Hispanic/Latino diabetic patients using an approached
that included state-of-the-art continuing medical
education (CME) for primary care clinicians. For
patients, enhanced self-management tools and increased
family involvement/supports were added.
For selected participants, promoteras were able to enter
clinical data via a specialized tool within the clinic's
electronic health record allowing for improved tracking
of grant outcome measures. Because this population is
difficult to reach, key to bridging program barriers were
promotoras-led education and community engagement efforts
along with clinician engagement.
MCHC's 2015 grant focused on healthy eating by offering
increased access to healthier foods and education about
exercise in addition to hands-on interactive education on
food preparation, along with an emphasis on changing
food-choice habits paired with information on weight
Among the incentives provided for program completion were
food boxes containing diabetes-appropriate food and
provided by the contracted consortium partner, the
Nogales Community Food Bank (NCFB).
MCHC was a
Health Improvement Special Project (HISP) grantee and
involved in a project that focuses on cardiovascular
disease prevention in a target group age 50-74 years and
incorporates the use of the previously available CDC
heart age calculator.
Each of MCHC's grants has built on the successes of the
previous grant outcomes. The use of culturally-sensitive,
evidenced-based curricula and models of care that
concentrate on diabetes, obesity, and more recently,
heart health have all contributed to the success of Vivir
Mejor. Other factors are:
leaders: Sometimes referred to as lay health
educators or lay health advisors, lay leaders are not
fully trained CHW's, but do share sameness of
experiences and sameness of community as the patients
they assist. Specific to MCHC's outreach programs, lay
leaders are previous participants-turned volunteers who
are trained by the Mariposa promotoras and receive
stipends to provide multi-topic education classes and
conduct interactive learning sessions. In the MCHC
model, they expand beyond the clinic's patients and
provide community outreach and education.
Salud: Based in social cognitive theory,
self-efficacy, skill development and reduction in
barriers needed for healthy behavior changes.
Adelante (Steps Forward): 12-week- program which
includes interactive sessions on chronic disease
prevention, nutrition, and physical activity and
facilitated by Promotoras de Salud.
Promotoras de Salud: Promotoras are community health
workers (CHWs) who can also function
patient navigators for chronic disease management.
These specialty workers have been at the core of MCHC's
work for 3 decades.
Some sample services offered from 2012-present:
Vivir Mejor! education topics using evidence-based
Pasos Adelante in a once weekly session:
What is Diabetes? Nutrition &
Diabetes, Heart & Diabetes, What am I Eating?
Complications of Diabetes, Foot Care, The Effects of
Stress, Counting Carbs
Physical activity classes included yoga, aerobic
exercise, body strengthening, and Rhumba
Nutrition counseling with a Certified Diabetes
Please contact the models and innovations contact directly for the most complete and current information
about this program. Summaries of models and innovations are provided by RHIhub for your convenience. The
programs described are not endorsed by RHIhub or by the Federal Office of Rural Health Policy. Each rural
community should consider whether a particular project or approach is a good match for their community’s
needs and capacity. While it is sometimes possible to adapt program components to match your resources, keep
in mind that changes to the program design may impact results.