"The cornerstone of [Promotor(a)] programs is the recruitment of community members who possess an intimate understanding of the community's social networks as well as its strengths and its special health needs."-National Community Health Advisor Study¹

Promotores and Promotoras are community members who promote health in their own communities. They provide leadership, peer education, support, and resources to support community empowerment, or capacitación. As members of minority and underserved populations they are in a unique position to build on strengths and to address unmet health needs in their communities. Promotores(as) integrate information about health and the health care system into the community's culture, language and value system, thus reducing many of the barriers to health services. They also help make health care systems more responsive. With the appropriate resources, training and support, Promotores(as) improve the health of their communities by linking their neighbors to health care and social services, by educating their peers about disease and injury prevention, by working to make available services more accessible and by mobilizing their communities to create positive change.

Farmworkers and Latino health organizations, including Migrant Health Promotion, generally refer to these individuals as Promotores(as) or Promotores(as) de Salud, literally "health promoters." In English, most call themselves Community Health Workers. There are many additional terms, including:

• Camp Health Aides

• Colonia Health Workers

• Lay Health Advisors

• Outreach Workers

• Community Health Representatives

• Indigenous or Village Health Workers

The HRSA Community Health Worker National Workforce Study, published in 2007, estimated that as of 2005 there were approximately 121,000 Community Health Workers in the U.S. At that time, the number was growing at over seven percent annually (C.H Rush, personal communication, May 15, 2009).

What Do Promotores(as) Do?

The nature of the training, roles, responsibilities and duties of Promotores(as) varies considerably from program to program.

Qualities of Promotores(as)

Promotores(as) have personal characteristics such as empathy, resourcefulness and a desire to help their communities.

Skills of Promotores(as)

To do their complex work, Promotores(as) must possess or build multiple skills.

Contributions of Promotores(as)

Promotores(as) effectively address many barriers to better health for underserved populations.

What Do Promotores(as) Do?

"I feel proud of being a Promotora. You feel special because you aren't only going to learn for yourself, but also to help and inform more people."-Zulema Cruz, Promotora

The nature of the training, roles, responsibilities and duties of Promotores(as) varies considerably from program to program. Paid and volunteer* Promotores(as) may work part- or full-time with clinics, nonprofit organizations, public health departments or other organizations. Promotores(as) conduct outreach and health education in clients' homes, community centers, clinics, hospitals, schools, worksites, shelters and farmworker labor camps. Many Promotor(a) programs focus on serving the needs of specific ethnic or racial groups, while others focus on vulnerable segments of the population or prominent health problems. Although Promotores(as) engage in a broad range of activities, they share a number of common roles. Promotores(as) provide:

• A link between communities and health and human service agencies

• Informal counseling and support

• Culturally-competent health education

• Advocacy

• Capacity building on individual and community levels

• First aid and emergency assistance¹

* All Promotores(as) who participate in Migrant Health Promotion programs receive a wage, stipend, or incentive.

Qualities of Promotores(as)

"People who are Promotores(as) have a gift for service and a noble and kind heart. We think about things and take care of people. We identify with the people and the needs of the community."-Mirian Perez, Promotora

Promotores(as) are typically empathetic, resourceful and willing to help others. Such qualities are personal characteristics that can be enhanced but not necessarily taught.² The Promotor(a) qualities most commonly cited in the National Community Health Advisor Study are:

• Relationship with community being served

• Desire to help the community

• Empathy

• Persistence

• Creativity and resourcefulness

• Personal strength and courage

• Respectfulness¹

Migrant Health Promotion seeks these qualities when recruiting community members to be Promotores(as).

Skills of Promotores(as)

"A Promotor is a leader and does everything possible so that his or her community will succeed. As leaders, they need to be counselors, defenders, spokespeople and visionaries. They need to have the ability to organize the community - to discover the talents that exist in the members of the community in order to take them and work with them. But without the spirit of service, these skills are nothing."-Lucy Ceballos Felix, Promotora and Program Specialist

Skills are abilities that can be gained through study and practice.² In order to do their complex work, Promotores(as) must possess or build multiple skills. According to the National Community Health Advisor Study, Promotores(as) are more effective in their work when they have the following skills:

• Communication skills

• Interpersonal skills

• Teaching skills

• Service coordination skills

• Advocacy skills

• Capacity-building skills

• Knowledge base¹

In Migrant Health Promotion's programs, Promotores(as) develop these skills through training and practice designed to support personal and community empowerment.

Contributions of Promotores(as)

"Sometimes you don't get results instantly, but you plant a seed."-Marisol Luevano, Promotora

Promotores(as) effectively address many barriers to better health for underserved populations. Some of their accomplishments include:

• Improving access to services

• Helping people understand the health and social service system

• Enhancing client and health provider communication

• Increasing appropriate rates of service utilization

• Decreasing costs for organizations and government programs

• Improving adherence to health recommendations

• Reducing the need for emergency and specialty services

• Improving overall community health status

Promotores(as) accomplish these and other outcomes by providing education and advocacy and building capacity in their communities.^{3 4 5} View specific outcomes of Promotores' and Promotoras' work with Migrant Health Promotion in the Program Results section.

References