No abstract

Community health workers (CHWs)-or promotoras de salud in Spanish-have successfully addressed the health needs of Latinx and immigrant populations. However, for promotoras, setting boundaries is particularly difficult given challenges like residing in the same communities as their participants. The purpose of this study was to describe the development and impact of a boundary setting training to support the emotional well-being of immigrant promotoras. The training (four 1-hr sessions) was informed by social cognitive theory and a Chicana feminist framework. The promotoras who participated in the training helped create Lazos Hispanos, a community-based participatory research (CBPR) study and CHW program located in the Southeastern United States. The goal of Lazos Hispanos is to increase access to health and social services among local Latinx community members. Five promotoras completed the training after 1 year of participating in the program. Thematic analysis was used to interpret findings from two semistructured group interviews. Two themes emerged: (1) the promotoras negotiated gendered and cultural expectations when setting boundaries, and (2) they felt a stronger sense of personal and professional agency. Findings suggest that this boundary setting training had a positive effect on their sense of professionalism, emotional well-being, and ability to establish boundaries. They reported having less guilt and anxiety as they navigated gendered and culturally informed expectations. Similar training could be adapted to other immigrant and minoritized groups. Public Significance StatementPromotoras de salud often experience challenges when setting boundaries with participants. Gendered and cultural values and expectations often complicate this process. We developed gender and culturally responsive training for establishing professional boundaries. The training resulted in enhanced emotional well-being among the promotoras as they learned to set limits, expectations, and goals early in the relationship with community participants.

The value of community assessments depends on the researchers’ ability to reach a diverse and representative sample of participants. This process is particularly challenging when assessing the health and well-being of vulnerable populations that are reticent to participate in research because of demographic and sociopolitical factors. One such group is Latinxs (the gender-neutral version of Latinos or Latinas) of mixed immigration status who live in low-income, socially and geographically isolated enclaves in the Southeast. Framed by community-based participatory research and social marketing theories, this study describes practical strategies for health researchers, practitioners, and advocates seeking to engage and build trusting relationship within U.S. Latinx communities. First, identify and leverage points of entry to different segments of the communities of interest by engaging meaningful gatekeepers from different sections of the population and searching for places where potential participants gather. Second, reduce the burden of assessments by using incentives and creating intentional reciprocity. Third, establish critical, long-lasting trust with community members, leaders, and allies by adapting data collection procedures, ensuring confidentiality, engaging bilingual facilitators, and most important, being present with and for the community. Finally, presenting the findings back to the community can increase the ownership of the process.

Promotoras de salud (Spanish for female community health workers) are integral to efforts to enhance the health and well-being of Latinx individuals, families, and communities. The purpose of this study was to describe the challenges that promotoras face and the proposed solutions from the perspective of the promotoras themselves. Five promotoras who worked for a year as volunteers in a community-based participatory research study, Lazos Hispanos, participated in two group interviews. Eight challenges emerged—balancing their new work with their family commitments, handling their perceived imbalance of power with men, managing the emotional impact of hearing participants’ problems, facing and handling the barriers imposed by having limited English language skills, feeling discouraged by the perception of ethnocentric beliefs and discrimination from some providers, feeling disheartened by the cultural beliefs of some Latinx participants, handling the lack of transportation for themselves and for the participants, and managing the burden of data collection for the research aspect of the program. The explanation of these challenges and the practical solutions they proposed are embedded in their intersecting identities. The solutions are a valuable addition to the practice of health promotion and community-based participatory research, particularly within Latinx communities.

The goal of Lazos Hispanos is to enhance the health and well‐being of the Latinx community through promotoras, who connect community members with service providers for multiple health and social needs. A community‐based participatory research conceptual model framed the multimethod evaluation of promotoras, service providers, and community participants at baseline and at the 1‐year follow up. The promotoras increased their self‐efficacy and knowledge, felt a strong sense of commitment to the community, viewed themselves as a bridge between participants and providers, and felt empowered by their new role. Service providers valued the promotoras as their ambassadors in the community and Lazos Hispanos as central to connecting service providers, promotoras, and community members; they noted that this collaboration increased their accountability with the Latinx community. This multistakeholder evaluation highlights the depth of positive changes achieved during the first year and the challenges of a community‐embedded project and the benefits and possibilities of calling upon theoretically informed evaluation models.