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“Moving toward Barrios Saludables:

Latino Health Initiative (LHI) Department of Health and Human Services Montgomery County, Maryland “ Vías de la Salud” Health Promoters Program. “Moving toward Barrios Saludables: Lessons Learned from Promotores Interventions in Latino Neighborhoods” STATE WORKSHOP ON LATINO HEALTH

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“Moving toward Barrios Saludables:

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  1. Latino Health Initiative (LHI)Department of Health and Human ServicesMontgomery County, Maryland “Vías de la Salud” Health Promoters Program “Moving toward Barrios Saludables: Lessons Learned from Promotores Interventions in Latino Neighborhoods” STATE WORKSHOP ON LATINO HEALTH March 11, 2009 Gianina Hasbun, MA Mercedes Moore, RN Nancy Newton, MPH

  2. “VIAS DE LA SALUD” HEALTH PROMOTERS PROGRAM • Established in 1997. Became part of the LHI in 2000. • A comprehensive community program to promote healthy behaviors and increase access to health care among low-income Latinos. • Five year strategic plan guides its action. • Mission: “Improve the health and well being of the low-income Latino community in Montgomery County through training and empowerment of Latino health promoters to promote healthy behaviors, facilitate access to health services, and advocate of health policies that benefit the community”.

  3. VIAS AND THE BLUEPRINT • Activities are guided by priority areas outlined in the Blueprint for Latino Health in Montgomery County.

  4. MORTALITY Heart Disease Cancer Unintentional Injuries (accidents) Stroke Diabetes HIGH PREVALENCE DISEASE Asthma Chronic obstructive pulmonary disease HIV/AIDS Obesity Suicide LATINO HEALTH SNAPSHOT At a national level: Source: Hispanic or Latino Populations, Office of Minority Health and Health Disparities, Centers for Disease Control and Prevention, 2004

  5. LATINO HEALTH SNAPSHOT • In Maryland, diabetic end-stage renal disease among Latinos was 10% to 20% higher than for non Latino whites ages 55 and older and hypertensive end-stage renal disease were 1.5 to 5 times higher than for whites. (Maryland Department of Health and Mental Hygiene) • In the U.S., the rate of obesity for Latinos increased from 14.5% in 1987 to 24.9% in 2001 (Rhoades, Altman, Cornelius, 2002) • In a Study conducted by LHI in 2005, three of four Latinos ages 40 and over reported being overweight (46%) of obese (30%).

  6. LATINO ACCESS TO HEALTH CARE • Lack of health insurance • Lack of culturally and linguistically competent services • Eligibility issues (lack of understanding of eligibility requirements) • Unavailability of adequate transportation, limited hours of operation, continuity of care. Source: Blueprint for Latino Health in Montgomery County, 2008-20012.

  7. COMPONENTS OF THE PROGRAM 1. Training and empowerment of health promoters. 2. Promotion of healthy behaviors: - Physical Activity - Healthy eating - Tobacco - Oral health 3. Facilitate access to care 4. Advocacy

  8. OTHER PROJECTS • Emergency Preparedness • Smoking Cessation • Pedestrian safety • National Kidney Foundation

  9. THE PROMOTORES • 38 trained volunteer lay health promoters with same cultural, linguistic and demographic characteristics of the community they serve. • 34 females • 4 males • 17 new health promoters in FY09 • 21 of them have an average of 6 years in the program • All immigrants: vast majority are from Central America. • Work: babysitting, housecleaning, elder care.

  10. THE PROMOTORES • Formal education: elementary school to college. • 25% do not have health insurance either for them or their families; 38% have just for their children. • Average age: 50 years

  11. THE PROMOTORES • Help families with Maryland Child Health Insurance Program applications. • Inform about programs and resources available in the County • Attend health fairs to educate Latinos on tobacco use prevention, healthy eating and the importance of physical activity. • Conduct educational sessions in community centers and clinics. • Perform physical activity sessions (caminatas). • Advocate for health issues relevant to the Latino Community. • Main roles of health promoters:

  12. VIAS AS A CULTURALLY AND LINGUISTICALLY COMPETENT PROGRAM • Comprehensive experiential training curriculum designed and tailored to respond to the needs of the health promoters. • Popular Education and Participatory Methodology. • No lecture-type activities • Hands-on activities – Practice before community interventions • Action – Reflection – Action

  13. VIAS AS A CULTURALLY AND LINGUISTICALLY COMPETENT PROGRAM • Promoters participates in the planning, design and evaluation of the program. • Program is based on needs of the community. • Understanding the concept of grass-roots health promoter. • All sessions are conducted in Spanish.

  14. VIAS AS A CULTURALLY AND LINGUISTICALLY COMPETENT PROGRAM • Program conducted by bi-cultural staff. • Speaking Spanish is insufficient • Ability to connect, understand and respect cultural values, beliefs, practices and needs of the population • Shared immigration experiences. • Trust: trusted community agencies, community trust in promoters.

  15. VIAS AS A CULTURALLY AND LINGUISTICALLY COMPETENT PROGRAM • Promotional items for community with key messages. • Interventions are conducted in pairs, in their neighborhoods. • Limited number of key messages. • Simple language and appropriate literacy level.

  16. VIAS AS A CULTURALLY AND LINGUISTICALLY COMPETENT PROGRAM • Health promoters’ and participants’ needs considered: child care, healthy snacks and meals during trainings and educational interventions. • Incentives: grocery store certificates, small gifts, professional learning opportunities, program recognitions, annual retreat. • A time for socializing and networking.

  17. PARTNERSHIPS • Linkages to Learning • Community Ministries of Rockville • Proyecto Salud • TESS Center • Suburban Hospital • American Cancer Society • Advance Practice Center of MC • National Kidney Foundation • Primary Care Coalition

  18. STEPS FOR AN INTERVENTION • Coordinate with partner (school, clinic, church, CBO, etc.) • Identify promoters to conduct interventions. • Promoters plan intervention • Prepare educational and promotional material according to topic presented • Promoters pick-up material at office • Promoters implement intervention • Promoters/coordinators evaluate intervention • Promoters report numbers to coordinators and on monthly report • Coordinators enter data in database

  19. PROGRAM EVALUATION • Pre and post tests for promoters’ trainings • Pre and post tests for caminatas • Caminata report • Monthly report • Continuous improvement instrument (for supervision and self evaluation) • CFK reports

  20. RESULTS • 26 caminatas during 2006 – 2008: elementary schools, ESOL classes, low-income housing services, and community organizations. • Over 400 participants (adults and children).

  21. RESULTS In FY08: Post-intervention surveys of parents indicated: • 54% increased physical activity • 64% increased consumption of fruits and vegetables • 72% reported an increase in drinking water (vs soda). Pre and Post test evaluation in adult participants showed: • 43.3% increase in healthy behaviors such as practicing physical activity more than 3 time a week.

  22. RESULTS • IN FY08: • 517 families were referred to MCHP, CFK, and other County Programs • 2,261 individuals reached in 64 education interventions • 2,878 individuals reached in 27 health fairs • 423 individuals reached at 6 sites • 6,075 volunteers by 23 health promoters • 56 training hours for health promoters • 83% of HP were very satisfied and 17% satisfied with Program • 13% increase healthy eating and physical activity knowledge in health promoters. • 92% retention rate

  23. CHALLENGES • Evaluation is a key element of the program however too much paperwork can be overwhelming for HP and distract their attention from the core activities. • Promoters have difficulty using the monthly report – key instrument for data collection. • Limited resources to manage expansion of program, mentoring system, professional development.

  24. CHALLENGES • Environment: weather (too hot or too cold), security (afraid to walk after dark). • Fear of participating due to anti-immigration climate. • Lack of concurrent educational efforts targeting the Latino community. Parallel outreach efforts are crucial in helping people transition through the stages of change.

  25. LESSONS LEARNED • Establishment of partnerships contributed to: • Increase opportunities for educational interventions and caminatas. • Enhancement of networking skills of HP • A limited number of key messages increased efficiency of promoters, their confidence and credibility in the community. • Careful attention to building and nurturing relationships with HP contributed to a high retention rate. • HP represent community: increased trust.

  26. LESSONS LEARNED • Using wisely the HP’s skills, talents and experience of HP increased efficiency and self-efficacy. • The caminatas more than a physical activity program, venue to socialize, share and feel sense of community (highly needed in the Latino Community). • Flexibility in promoters’ schedules to accommodate demands of participants increased community participation. • Incentives for promoters and participants are essential for maintaining high motivation.

  27. CONTACT INFORMATION MERCEDES MOORE, RN (240) 777-3470 mercedes.moore@montgomerycountymd.gov GIANINA HASBUN, MA(240) 777-4519gianina.hasbun@montgomerycountymd.gov NANCY NEWTON, MPH 301-585-3452 n.newton@verizon.net WEBSITEwww.lhiinfo.org

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