Promotoras Create Healthy Change One Resident at a Time

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Obesity, cancer, and health disparities were increasing in the northern Colorado city of Fort Collins (11.43% Latino).

In response, a community advocacy group called Vida Sana formed to find ways to alleviate these disparities and support Latino residents.

Dierdre Sullivan, a founding member of Vida Sana, soon recognized the best way to boost health was to use promotoras (community health workers) to teach residents how to help themselves.

Latinos struggle with health disparities in Colorado

Dierdre Sullivan, an activist in Fort Collins, Colo., has witnessed the local Latino population grow rapidly by 52% from 2000 to 2010.

Sullivan said health disparities increased rapidly, too. About 14% of Latinos live in poverty.

Many healthcare providers lack cultural competence.

Cancer, diabetes, heart disease, mental health, and other health issues related to obesity, which is over 60%, are major concerns. Among all health-risk behaviors—physical activity, fruit and vegetable consumption, etc.—Latinos in Colorado fare worse than the state’s population as a whole.

“Our community continually ranks as one of the healthiest in the nation,” Sullivan said. “However, it doesn’t look that way for the low-income members of our community.”

By the late 2000s, local health organizations became inundated with requests for services. It became clear that the population needed assistance and someone needed to step up to help, Sullivan said.

In 2008, Vida Sana formed to meet that need.

The community advocacy group was founded through a partnership among Larimer County Department of Health and Environment, the Healthier Communities Coalition of Larimer County (HCC), and the former Community Organizing to Reach Empowerment. The group works within the University of Colorado Hospital System.

“We knew that ‘health’ meant dealing with every single level of the socio-ecological framework,” Sullivan said. “The individual person is at the center, the family, the neighborhood and community, radiate out on up to the very upstream system type changes, such as municipal governments, school districts; things like that.”

Vida Sana set out to learn where exactly Latinos needed help, and what kind of help they needed.

The conducted neighborhood surveys and focus groups, and eventually identified five neighborhoods in Fort Collins and one in Loveland, all in Northern Colorado, that gravely needed assistance.

People were concerned with childhood obesity, diabetes, cancer, and cardiovascular disease, Sullivan said.

“It was interesting, because our office at the time faced out onto this empty field and I would look out every day and see these mothers pushing strollers across it and struggling,” Sullivan explained. “I thought, ‘Hey, let’s put together a built environment coalition and get something going on this end to help these people get sidewalks and bike lanes and pedestrian crossings.’ They said, ‘No. Get us some Zumba classes at the recreation center. Get us some cooking classes. This is what we want.’”

The responses indicated to local health officials that something needed to be done, said Edgar Dominguez, Vida Sana health equity coordinator

Could promotoras help in Fort Collins?

One potential avenue to start grassroots change was the promotora model.

A promotora is a layperson in a Latino community who gets specialized training to provide basic health education in the community without being a professional health care worker. They often serve as liaisons between the community they live in and health professionals and social service organizations.

A promotora model in Fort Collins could “help these communities, give them the tools to affect healthy changes, and be voices for those changes”—such as access to nutritious foods, walkable neighborhoods, clean water, and more.

Before Vida Sana, no organization, governmental or grassroots, in the community was taking the lead in education and intervention and helping this population. The need was there; it was a matter of putting the right people in place to help address it.

Finding the right people who could go into the community and connect the people with the classes, resources, and materials that they not only needed but wanted was how Vida Sana would succeed.

So Vida Sana they began seeking out the most ideal candidates for a potential promotora program.

“We live in a very mindful community, a very well-intentioned community,” explained Sullivan. “With that said, they have not always understood the best way to address the shifting demographics and the issues. I tend to use the term ‘over-surveyed and underserved.’ We didn’t want that to be the case with Vida Sana. We wanted the community to see results of what we were doing.”

Funding a promotora program takes funding.

Funding for Vida Sana was originally obtained from a grant from Colorado Department of Public Health and Environment (CDPHE). It received grant money — as much as $75,000 — from the Colorado Department of Health’s Office of Health Disparities, now the Colorado Office of Health Equity, with a focus to increase health education and assessment of the Latino community.

However, once the grant ran out, they were not able to obtain funds from them again. They then became fully a part of the University of Colorado Hospital System.

“We’re fully under their umbrella now as we look to obtain funding to help fully sustain it and that is where we have been now for the past four years,” Sullivan said. “Funding has been a continual issue with us. It is the only thing that keeps us from helping everyone who needs it.”

The promotoras begin to make an impact

Vida Sana started to plan how promotoras could engage residents on key issues.

Promotoras would be from the community and able to connect with residents on a personal level and on a level of speaking the same language—a huge part of overcoming the barriers plaguing the population.

“The perfect community health worker model is someone who actually lives in the neighborhood,” Sullivan said. “You walk in and you find out who everybody goes to when they have questions about something.”

They envisioned the job of the promotoras would be to assess which needs the residents had and connect them to the available resources. Vida Sana would train the promotora with needed tools and resources to connect people.

“Access to care is a huge issue for us,” said Dominguez, who helps to recruit promotoras. “One of the main jobs of the promotoras is connecting community members to healthcare coverage, mainly through the Affordable Care Act.”

They decided to start the program by hiring one full-time promotora in 2012.

In their initial phase, the promotora went door-to-door talking to friends, neighbors, and other community residents assessing their needs and connecting them with the resources that were at their disposal.

“The concept was a grassroots campaign to address the needs of the community. We let them (the residents) direct it,” said Kim Sharpe, coordinator of the University of Colorado Health’s HCC. “We asked them what the most pressing health needs were and what they wanted (the program) to be called.”

Since launching, the program has expanded from one to four promotoras (with plans for a fifth), and residents actively seek out these promotoras.

“For me, I know a lot of the people here,” said Edna Chavez, a promotora with Vida Sana for 2 years. “Having a connection with the people, because I am from here, helps me talk to them. I can understand better what’s going on when in some cases they may not want to talk to anyone else.”

For Sullivan, the promotoras, and Vida Sana, proof of the success is the ability to gauge referrals that have come through thanks to their promotoras.

“We have about a 50% success rate in our services and referrals,” said Sullivan. “This is really good for this community. We also are now moving into more outcome-oriented measures. We are really starting to see the positive outcomes we are having. It’s really great to see.”

The City of Fort Collins also joined the effort, providing Zumba and cooking classes at the Aztlan Center to those living in the neighborhoods that registered with Vida Sana and expressed interest. Vida Sana members also can attend nutrition seminars through the Kendall Anderson Nutrition Center at Colorado State University, get assistance through the Food Bank of Larimer County and receive referrals to local health clinics such as the Salud Family Health Center.

Vida Sana has grown to a coalition of over 200 community members works together to identify the risk factors that contribute to health disparities and create community based solutions for Latinos.

“We are really seeing that we are starting to move the needle and make a difference in things like physical activity,” Sullivan said. “We’re starting to see changes in the amount of moderate to strenuous physical activity that is taking place. We’re also tracking weight loss.”

Sustaining healthy changes for Latinos

In their day-to-day duties, the promotoras collect data on community members, especially in terms of the time and types of health screenings that the residents undertake.

“At the end of the day, we want to show how sustainable our program is and what benefits it is bringing to the City,” Sullivan said.

Vida Sana continues to grow and despite a limit to their resources, they are showing that they are making a difference in the community.

“The response from our residents has been very, very, very good,” said Sullivan. “We are finding that people are very open to us. We’re very trusted in the community. It is only going to get bigger and better.”

Learn more about the benefit of promotoras!

Promotoras de Salud!