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Promotora de Salud/Lay Health Worker Model

In this model, community health workers (CHWs) are members of the target population and share many of the same social, cultural, and economic characteristics. As trusted members of their community, promotoras provide culturally appropriate services and fulfill the following roles:

  • Patient advocate
  • Educator
  • Mentor
  • Outreach worker
  • Translator

Promotoras are the bridge between the diverse populations they serve and the healthcare system. The promotora model is often used in the United States and Latin America to reach Hispanic communities. According to the Centers for Disease Control and Prevention:

Promotores de salud, also known as promotoras, is the Spanish term for CHWs. The Hispanic community recognizes promotores de salud as lay health workers who work in Spanish-speaking communities.

Rural communities often use this model to improve the health of migrant and seasonal farmworkers and their families. Promotoras who work specifically with migrant and seasonal farmworkers may be referred to migrant health promoters. For resources related to establishing a promotaras program for migrant health workers, see Migrant Health Promoters resources. Promotoras working with migrant or seasonal farmworkers often conduct environmental health and home assessments and deliver education about environmental health hazards. They address topics such as lead poisoning prevention, water quality, hazardous waste, and pesticide safety. These types of programs are common in rural border communities.

Examples of Rural Promotora/Lay Health Worker Models

  • The Vivir Mejor! (Live Better!) System of Diabetes Prevention and Care is a program created by the Mariposa Community Health Center that uses promotoras to deliver a culturally competent diabetes education program to rural populations.
  • In rural southern Georgia, the Salud es Vida Cervical Cancer Education program developed a lay health worker (promotora) program to provide information on cervical cancer, human papillomavirus (HPV), and the HPV vaccine to Hispanic farmworker women.
  • The AMIGAS program engaged promotoras to deliver a program that doubled the rate of cervical cancer screening among Mexican-American women in one border community and one urban community in Texas and one rural community in Washington. The AMIGAS program materials are available online for free.

Implementation Considerations

This model is most effective when promotoras are members of the target population, not just people who speak the same language or share some characteristics with the communities they serve. Even in cases where promotoras are members of the target population, they may encounter barriers to providing services. A common barrier in border communities includes distrust of the program. Additionally, many promotora programs serve rural and frontier communities, where transportation is limited and travel to the target population is difficult or time-consuming. Programs should consider the implications of requiring travel of the promotora, including travel costs and time.

Program Clearinghouse Examples

Resources to Learn More

Promotores de Salud/Community Health Workers
Website
Offers resources and training for CHWs on topics such as cervical cancer screening, high cholesterol control, and diabetes education and prevention.
Organization(s): Centers for Disease Control and Prevention
Date: 9/2019

Improving Quality of Care for Latinos Project: Community Health Worker/Promotoras Network
Document
Describes the building of a statewide network of CHW/promotoras to improve the quality of care received by Latinos in California.
Organization(s): California HealthCare Foundation

Community Health Worker Resource Directory
Website
A portfolio of English and Spanish health promotion materials specifically developed for Latino(a) communities in isolated and/or underserved communities.

MHP Salud Resource Portfolio: Resources for Community Health Workers and Program Managers
Website
MHP Salud has a series of free, downloadable resources for planning, implementing, and evaluating CHW programs. There are both guides and templates of documents available, many of which are also in Spanish. To access MHP Salud materials, you must create a free user account. Some particularly helpful resources are highlighted here:

  • Integrating CHWs into Health Disparities Initiatives
    Document
    Provides examples and tools on how CHWs can be employed specifically in work targeting health disparities.
    Organization(s): MHP Salud
    Date: 4/2013
  • CHWs and Why They Work
    Document
    Presents examples demonstrating the impact of CHWs in providing leadership, peer education, support and resources to support community health.
    Organization(s): MHP Salud
    Date: 5/2015
  • Promotor(a) Program Manual
    Document
    Provides information on the design, planning, and evaluation of promotora programs based on MHP Salud's extensive experience developing and managing promotora de salud programs within Latino populations. Includes information on the recruitment, training, and supervision of staff.
    Organization(s): MHP Salud

Promotoras: Lessons Learned on Improving Healthcare Access to Latinos
Document
Explores the promotora model used to increase healthcare access to immigrant elders, adults, and their children in Central Valley, California.
Organization(s): Central Valley Health Policy Institute
Date: 2009

Texas A&M University - Border Health Environmental Coordination Program
Document
Describes a program monitoring childhood exposure to pesticides in colonias along the border of the United States and Mexico and investigates the utility of health education as an intervention to reduce pesticide exposure.
Organization(s): Texas A&M University - Border Health Coordination Program
Date: 8/2007

The Way of the Heart: The Promotora Institute
Website
Provides free services based on the CHW model on the Arizona/Mexico border. Services include outreach, education, training, referral and advocacy for women and their families.
Organization(s): The Way of the Heart: The Promotora Institute

Migrant Health Promoters

Farmworker Feedback on In-Clinic Health Services in Vermont
Document
Offers a bilingual English and Spanish survey for farmworkers to provide feedback on their experience with in-clinic health services.
Organization(s): Bi-State Primary Care Association
Date: 2017

Protocols for Health Promoters
Document
Outlines the best practices to be used by migrant health promoters when distributing healthcare access and health education materials or when coordinating healthcare.
Organization(s): Bi-State Primary Care Association

Care Coordinator Privacy and Confidentiality Documents
Document
Provides a confidentiality and personal health information protections written policy and agreements to be signed by the migrant healthcare promotor.
Organization(s): Bi-State Primary Care Association
Date: 8/2012

Client Encounter Form
Document
A resource for the healthcare coordinator when documenting information during a client encounter.
Organization(s): Bi-State Primary Care Association
Date: 12/2013

Consent to Release Information
Document
Provides a bilingual English and Spanish consent form for the release or exchange of health records.
Organization(s): Bi-State Primary Care Association
Date: 12/2013

Farmworker Important Contacts Cards
Document
A template of a bilingual (English and Spanish) contact card for farmworkers useful when providing them with important information in the case of a medical emergency. Includes notes about what information should be included when filling out the cards.
Organization(s): Bi-State Primary Care Association
Date: 12/2013

Position Description: Migrant Health Promoter
Document
A sample of a job description for a migrant health promoter position including the required skills, responsibilities, and qualities of a successful candidate.
Organization(s): Bi-State Primary Care Association
Date: 12/2013

A Quick Guide to Working with Interpreters
Document
Explains how to effectively work with language interpreters.
Organization(s): Bi-State Primary Care Association
Date: 12/2013