Program ResultsImproving Health Outcomes
Migrant Health Promotion's work improves the health of farmworkers and rural communities in multiple ways. In this section, Migrant Health Promotion offers examples of the measurable, demonstrated impact of Promotores' and Promotoras' work on community health by topic. Please note that these examples are illustrative, not exhaustive. Some of these programs accomplished additional objectives and many other successful programs are not described in this section.
- Maternal and Child Health
- Physical Activity and Nutrition
- Prevention and Control of Diabetes
- Eye Safety in the Field
- Breast and Cervical Cancer Screening and Prevention
- Pesticide Safety
- Effective Treatment of Tuberculosis
- Children's Health Insurance
- Food for Mothers and their Children
- Public Policy Changes
- Mental Health
- HIV Testing and Prevention
- Substance Abuse and HIV Prevention with Teens
Maternal and Child Health
During the summer of 2003, 45 Promotores(as) at five Migrant and Community Health Centers in Michigan led individual and group education, provided referrals and hosted special events to improve the health of the women and children in their camps. These Promotores(as) ensured that:
- 97 percent of pregnant farmworker women received prenatal care. In comparison, only 61.5 percent of Michigan Hispanic women received adequate care in 2002.1
- 83 percent of new farmworker mothers chose to breastfeed. Nationally, only 71 percent of Hispanic women in all occupations breastfed2 and only 63 percent of Michigan women in all racial groups breastfed their babies.3
- 81 percent of farmworker children five years of age and under were up to date on their immunizations. The immunization rate for Hispanic children ages 19-35 months in the United States was 73 percent for the year 2000.2
"I never would have considered breastfeeding if it wasn't for my Promotora. She answered so many questions, and she was there to help me if I needed it. She even helped my mom learn about some of the myths."
-New mom and labor camp resident
Physical Activity and Nutrition
In 1999 and 2000, Promotoras leading the Camina Conmigo (Walk with Me) Program recorded 4,419 contacts through physical activity sessions with more than 1,500 community members and they provided nutrition education to 1,573 individuals. "The exercise sessions helped me change my lifestyle," said one community member of her experience with Camina Conmigo in the Rio Grande Valley of South Texas.
Four Promotoras in the Para Nuestra Salud (For Our Health) Program led walking groups in South Texas counties with over 1,165 participants in 2001. More than 200 women participated in physical activity at least two times each week for a minimum of 12 weeks: "This is the first time I have ever really exercised," said one community participant. The Promotoras also conducted peer education and outreach focused on women's health; 768 individuals, or 81 percent of those referred, received health care as a result.
"If it wasn't for this program [Para Nuestra Salud], I would have never made the time to exercise. Since I have joined the group, I feel more motivated, more energetic and agile."
-Exercise group participant
Prevention and Control of Diabetes
Through the REACH Promotora Community Coalition, 18 full-time and four seasonal Promotoras working in the Rio Grande Valley recorded 6,175 health encounters with over 1,000 community members in 2002. Their activities included educational classes, healthy cooking demonstrations, physical activity sessions and other accessible activities designed to prevent and control diabetes. Activities are based in schools, at health centers and in the community. Preliminary results from pre- and post-intervention surveys indicate that individuals participating in the community-based activities are eating healthier and exercising more. They have increased their intake of fruits and vegetables by seven times per week and increased the number minutes per week they spend walking or exercising. The program has also achieved policy and environmental changes in the Valley. For example, the Promotoras worked with Progreso and Rio Hondo Independent School Districts to replace sugary drinks from school vending machines and successfully advocated for local stores in the colonias to offer low-fat milk and healthier cooking oils.
"I am a diabetic… and I am grateful to this program because it has helped me better control my diabetes. I went from a 206 blood glucose level to a 106!"
-Colonia resident
Eye Safety in the Field
During the summers of 2001-2003, Promotores(as) in Illinois and Michigan provided safety glasses to their co-workers and conducted educational activities about the importance of preventing eye injuries and illnesses. As a result, the percentage of farmworkers wearing safety glasses at work increased from less than one percent to more than 26 percent at the worksites served by Promotores(as) in Michigan. Results from pre- and post-intervention surveys indicate that farmworkers who received training from the Promotores(as) were more likely to wear safety glasses and more likely to answer questions about eye health and safety correctly when compared to control groups. These results are statistically significant.
"All the people learned something, especially about eye illnesses... They think, 'we're just old.' They don't think it's the consequence of working in the fields, in the sun. They don't think that's why we get cataracts, pterygium, illnesses like that."
-Sandra Arellano, Promotora
Breast and Cervical Cancer Screening and Prevention
In Michigan, 72 percent of Farmworker Women Receive Annual Exams
In 2002, 42 Promotores(as) at five Migrant and Community Health Centers in Michigan worked with their farmworker peers to break down access barriers to annual gynecological exams. Through one-on-one education, Women's Health Night events at the clinics and other group activities, they ensured that 72 percent of women had received a pap test in the last year by the end of the 2002 migrant season. In comparison, only 68.7 percent of all women in Michigan had received a pap test in the past year.4
"She was 53 years old and hadn't had a pap smear in 12 years. If it hadn't been for this program and the Promotoras pushing them to get their paps, she wouldn't have known she had cancer. We think because we don't have babies that we don't have to go."
-Alicia Sanchez, Program Coordinator, InterCare Community Health Network, Bangor, MI and Promotora
In Texas Women Gain Health Care and Knowledge
In 2003, eight seasonal Promotoras increased breast and cervical cancer awareness and facilitated access to screening among Latinas in the border region of South Texas. Over 2,000 women received individual education or participated in Promotora-led group education sessions using Migrant Health Promotion's Nuestra Salud videos and activity guide. The Promotoras completed health assessments with 1,500 individuals, and over 500 individuals received cancer screening as a result.
"I enjoy what I do, I love to hear the women we refer tell us that they kept their appointments and everything went well. Others are not so lucky and have shared with us their diagnosis of breast cancer or cervical cancer. In these cases, I find comfort in that they are now aware of what is going on with their bodies and are getting the appropriate treatment and care they need."
-Lucy Ceballos Felix, Promotora and Training Specialist
Pesticide Safety
In the summer of 2000, Promotores(as) in Northwestern Michigan taught their co-workers and neighbors about pesticide safety, pesticide poisoning and the federal worker protection standard. They conducted 600 one-on-one educational encounters about pesticides and 26 pesticide safety group sessions with 558 people. Evaluation results reveal that the Promotores(as) reached 100 percent of the people in their camps with pesticide safety information. The Promotores(as) successfully organized their co-workers and advocated for changes in the workplace. They staged two work stoppages when they were sprayed with pesticides and informed the growers that it is illegal to spray while workers are in the field. Both growers stopped the practice of spraying while the farmworkers were at work.
"Twice, one of our Camp Health Aides and his family were working in the asparagus fields, and the grower began to spray in the same field. Our Camp Health Aide advised his family to leave the area, but some of the people did not want to leave for fear that the grower would somehow retaliate. But the Camp Health Aide reassured them that it was their right to leave the field and the grower could not retaliate, so they walked off the field. When the grower saw them leaving, he stopped and left the field so they could continue to work."
-Carmen Garcia, Program Coordinator, Pesticide Education Program, Shelby, MI and former Promotora
Effective Treatment of Tuberculosis
In the Rio Grande Valley, five Promotoras provided directly observed therapy (an effective treatment regime for tuberculosis) to 142 patients, conducted 370 screenings and provided education to 4,296 colonia residents in 1998. The Texas Department of Health credits the Promotoras with maintaining a 96-100 percent compliance rate for tuberculosis treatment among their colonia patients. In Texas, the overall completion rate for tuberculosis therapy for more than one year was 89 percent in 1998.5
Children's Health Insurance
The Children's Health Coalition of the Rio Grande Valley has reached thousands of families with essential information about the Children's Health Insurance Program (CHIP) and Children's Medicaid programs. In August of 2002, Coalition members helped families at over a dozen regional schools apply for CHIP and Children's Medicaid during the registration week and distributed information and applications at several retail stores during the Covering Kids' Back-to-School Campaign. Coalition members worked closely together to stay abreast of rapidly changing policy and reached thousands of families with updated news. In 2003, four Promotoras helped over 500 Texas families apply for or renew CHIP and Children's Medicaid coverage for their children, and they reached over 1,000 families with important information about insurance coverage and preventive health care.
"My 11 year old son has asthma. CHIP has helped my family afford taking him to regular doctor visits, occasional specialist visits and buying two prescription drugs every month. I don't know what I would do without the affordable CHIP coverage. I would have to choose between paying my light bill or purchasing my son's medication every month."
-Program participant and mother of three
Food for Mothers and their Children
In collaboration with the Texas Department of Health and local WIC (Women, Infants and Children's Supplemental Nutrition Program) agencies, Migrant Health Promotion trained and supported six Promotoras in the WIC Outreach Program. They helped colonia women understand the process and enroll during the 2000 winter season. The Promotoras provided education to 1,200 low-income families and made more than 500 referrals; 70 percent of their WIC referrals resulted in new families receiving benefits.
Public Policy Changes
In 2001, La Voz Latina (the Voice of Latinas) in Government Program in Texas trained and supported four Promotoras who advocated for positive policy changes related to reproductive health. They presented their state representatives with over 1,000 signatures urging them to support affordable women's health care in the border region of Texas. In 2002, four Promotoras visited Washington, DC to meet with legislators about initiatives to increase the access of farmworkers and border community members to Migrant and Community Health Centers and to begin studies on Toxic Shock Syndrome. Their efforts resulted in increased funding for farmworker Promotor(a) programs. La Voz Latina Promotoras also took this opportunity to provide grassroots insight to the advocacy efforts of national farmworker health organizations.
"Wow! We met our goal of scheduling an appointment and meeting personally with our State Representatives and Senator and actually had a real conversation about our concerns regarding the colonias and the need for more health and social services."
-Promotora
Mental Health
In 2002, Promotores(as) in Colorado, Michigan and North Carolina provided education, referrals and emotional support to farmworkers with mental health, substance abuse and related concerns. They conducted a pre- and post-season survey to evaluate the impact of the Salud Para Todos Program on farmworkers' stress and depression levels. Results of the survey demonstrate that 73 percent of the farmworkers increased their knowledge about stress and depression and that 60 percent decreased their levels of stress.
"We made people aware about mental health issues, and this has helped them take responsibility for their choices."
-Promotora
HIV Testing and Prevention
Eight Promotores(as) trained as HIV test counselors reached 2,286 community members in South Texas with information about HIV/AIDS, risk factors and prevention during a three-month period in 2002. They provided pre-test counseling, OraSure Tests and post-test counseling to 260 community members. These community members received services within the privacy of their own homes, in a culturally and linguistically competent manner. A growing body of research suggests that voluntary HIV testing and post-test counseling about risk factors for HIV infection can help promote reductions in sexual risk behaviors and increased condom use.6, 7
"A lot of people say that they didn't know this or that about HIV when we are talking to them ... and they need to know it to protect themselves."
-Magdalena Hernandez, Promotora
Substance Abuse and HIV Prevention with Teens
Twenty-two Teen Health Aides in the Infórmate (inform yourself) Teen Health Program completed 1,205 individual health education contacts with farmworkers and community residents at three Michigan sites in 2002. Teen Health Aides also reached 596 participants through group health education sessions. The Infórmate Theater Troupe reached over 1,300 people with 26 performances about HIV and substance abuse.
Farmworker teens participating in Infórmate activities completed surveys designed to demonstrate the impact of the program on their lives. Among participants who saw a theater performance and participated in two follow up discussions, 95 percent reported that they felt more open to and accepting of people living with HIV as a result of the program. Seventy-four percent of these same participants reported an increase in positive health behaviors, such as behaviors that reduce the risk of HIV infection or substance abuse, and 92 percent reported no drug use throughout the season.
"It was all very fun, and we also learned that we can have fun without drinking and doing drugs!"
-Maria Rubio, Teen Health Aide
(1) Michigan Department of Community Health (2002). Percent of live births by level of prenatal are, race and ancestry of mother, Michigan residents, 2002. Retrieved June 25, 2004, from http://www.mdch.state.mi.us/pha/osr/natality/tab1.8perc.asp
(2) Centers for Disease Control and Prevention, National Center for Health Statistics and National Immunization Program, National Immunization Survey. (n.d.). Childhood immunization: Percentage of children age 19 to 35 months vaccinated for selected diseases by poverty status, race and Hispanic origin, selected years 1994-2000. Retrieved June 25, 2004, from http://www.childstats.gov/ac2002/tbl.asp?id=4&iid=24
(3) Ross Products Division, Abbott Laboratories. (n.d.). Mother's survey: Breastfeeding trends through 2000. Retrieved June 25, 2004, from http://www.ross.com/aboutRoss/Survey.pdf
(4) National Center for Chronic Disease Prevention & Health Promotion. (2003, November 17). Behavioral Risk Factor Surveillance System, prevalence data, Michigan – 2002, women's health. Retrieved June 25, 2004, from http://apps.nccd.cdc.gov/brfss/race.asp?state=MI&cat=WH&yr=2002&qkey=3597&grp=
(5) Centers for Disease Control and Prevention, National Center for HIV, STD, and TB Prevention, Division of Tuberculosis Elimination. Table 35. Completion of Tuberculosis Therapy (COT): 59 Reporting Areas, 199. Retrieved June 25, 2004, from http://www.cdc.gov/nchstp/tb/surv/surv2000/pdfs/t35.pdf
(6) Kamb, M. L., Fishbein, M., Douglas, J. M., Jr., Rhodes, F., Rogers, J., Bolan, G. et al. (1998). Efficacy of risk-reduction counseling to prevent human immunodeficiency virus and sexually transmitted diseases. JAMA, 280(13), 1161-1167.
(7) Anonymous. (2000). Efficacy of voluntary HIV-1 counseling and testing in individuals and couples in Kenya, Tanzania, and Trinidad: A randomized trial. The Lancet,356(9224), 103-112.
