Promotoras link providers with the community

Bi-lingual workers connect with patient population

Promotoras, or specially trained community health workers, help bridge the gap between members of the community and the medical providers at St. Elizabeth Health Center in Tucson, AZ.

"The promotoras come from the grass roots of the community. They provide preventive and self-management health care education and help clients identify affordable ways to receive regular medical care" says Sr. Janet Sue Smith, ACS, RN, MAPS, director of community outreach, St. Elizabeth Health Center.

Most of the promotoras who work with St. Elizabeth Health Center have a health care background and have attended a one-year course at the local community college to become a certified promotora.

"They must be bilingual, since close to 62% of our clientele is Spanish-speaking. They must demonstrate that they have the ability to teach and that they can relate well to the community," Smith says.

The program works because the patients know that the promotoras are like them and feel comfortable talking to them, she adds.

"The patients will talk to the promotoras about questions and concerns they wouldn't mention to the doctors or nurses," she says.

The promotoras provide a variety of group health education classes three or four months a week at 12 different sites within the community as well as supporting programs and group activities in the clinic setting.

"This gives them visibility and a grassroots link to the community," Smith says.

In addition to providing education, the promotoras provide support to members of the community and help them find needed community resources. Because the promotoras are known within the community, people know where to go for information and assistance, Smith says.

"People call and ask where they can get the strips for their glucometer or where they can get a new glucometer because the old one broke. Our clients do not have third-party payers who can help with these expenses," she says.

The health center promotora program links its clients with discount programs and drug companies as well as community agencies and organizations that can help them get the medical care and supplies they need.

"We never know what situation we will encounter. The promotoras often need to work both sides of the border to help clients receive medical care that will help stabilize their condition," she says.

Working with the Carondelet Health System under a grant, promotoras call qualified patients who come to the emergency department at local hospitals and don't identify a primary care provider. The program fielded more than 7,000 calls last year.

The promotoras offer information on community resources and help clients understand where they can receive affordable and needed ongoing medical care.

One recent call was with the wife of a man who had been treated in the hospital for severe burns and released to home.

"She was supposed to change the dressing but didn't understand what she was to do. At the same time, her blood pressure was out of control because of all the stress she was under," Smith says.

The promotora checked the health care system and found out that the patient had been signed up for emergency Medicaid coverage under the Arizona Healthcare Cost Containment System (AHCCS), but didn't understand it. The promotora was able to help identify the couple's assigned provider. She called the doctor's office, explained the situation, and set up the necessary appointment.

"A lot of clients don't have insurance and frequent the emergency department for chronic disease management and non-emergent conditions," Smith adds.

Some of the people the promotoras work with are eligible for AHCCS but don't understand how to identify a new provider or how to complete the necessary paper work.

The promotoras may assist them with the calls or paperwork or refer them to the health center eligibility staff for further assistance, she says.

"The promotora network interfaces at times with a variety of community networks to address multiple needs," Smith says.

They work in the health center's lead abatement program in the clinic and in the community and on initiatives to improve oral health for pregnant women.

Other educational programs include fall prevention for seniors with diabetes, foot care for seniors, and breast cancer awareness.

The promotoras make use of the time that patients spend in the clinic waiting room by running videos on health topics and conducting cooking demonstrations in the waiting rooms twice a week.

They use food that is readily available from the food bank and show the patient how to create healthy dishes, and then share samples.

Every Friday, the promotoras hold "Fruity Friday" educational sessions, passing out pieces of fruit and giving a three-sentence talk on the benefits of eating that particular fruit.

They conduct cooking classes on a regularly scheduled basis in the clinic and present them at health fairs.