No abstract

Community health workers (CHWs) have gained increased visibility in the United States. We discuss how to strengthen the role of CHWs to enable them to become collaborative leaders in dramatically changing health care from “sickness care” systems to ones that provide comprehensive care for individuals and families and support community and tribal wellness. We recommend drawing on the full spectrum of CHWs’ roles so that they can make optimal contributions to health systems and the building of community capacity for health and wellness. We also urge that CHWs be integrated into ”community health teams” as part of “medical homes” and that evaluation frameworks be improved to better measure community wellness and systems change.

BackgroundTo address cardiovascular disease risk factors among Hispanics, a community model of prevention requires a comprehensive approach to community engagement. The objectives of our intervention were to reduce cardiovascular disease risk factors in Hispanics living in 2 low-income areas of El Paso, Texas, and to engage the community in a physical activity and nutrition intervention.MethodsDrawing on lessons learned in phase 1 (years 2005-2008) of the HEART Project, we used an iterative, community-based process to develop an intervention based on an ecological framework. New community partners were introduced and community health workers delivered several elements of the intervention, including the curriculum entitled "Mi Corazón, Mi Comunidad" ("MiCMiC" [My Heart, My Community]). We received feedback from the project's Community Health Academy and Leadership Council throughout the development process and established a policy agenda that promotes integration of community health workers into the local and state workforce.OutcomeCollaboration with 2 new community partners, the YWCA and the Department of Parks and Recreation, were instrumental in the process of community-based participatory research. We enrolled 113 participants in the first cohort; 78% were female, and the mean age was 41 years. More than 50% reported having no health insurance coverage. Seventy-two (60%) participants attended 1 or more promotora-led Su Corazón, Su Vida sessions, and 74 (62%) participants attended 1 or more of the 15 exercise classes.InterpretationHEART phase 2 includes a multilevel ecological model to address cardiovascular disease risk among Hispanics. Future similarly targeted initiatives can benefit from an ecological approach that also embraces the promotora model.

Previous studies have demonstrated that acculturation is associated with negative birth outcomes among mothers in numerous immigrant populations, including Latinas. This study used structural equation models to reanalyze data employed in the 1989 Scribner and Dwyer study on the effect of acculturation (measured through the Cuellar scale) on mothers' low-birthweight status. Data revealed that language components dominate the effects of acculturation on low-birthweight status. Acculturuation appears to affect low-birthweight status indirectly through smoking and dietary intake but not through parity. Acculturation has a persistent direct effect on low-birthweight status, suggesting that other intervening variables are operant.

This article describes a two-factor schema for the development of culturally appropriate cancer risk reduction interventions for Mexican American women. Regarding this approach, risk factors for two major cancer areas are reviewed: cigarette smoking and obesity/diet. We first describe a schema that facilitates the planning of strategies associated with preferred health interventions and preventive approaches for cancer risk reduction with Mexican American and other Latino/Hispanic persons. This schema examines Acculturation and Education as key factors that should be considered in developing health education messages and interventions that are culturally and educationally appropriate to the identified subpopulations of Hispanics in terms of language and informational content of the message and in terms of psychological factors related to health behavior change. Empirical data from a community sample is presented for the purpose of illustrating the validity of this schema. Then we review studies that examine the effect of acculturation on the distribution of the risk factors, based on studies in the current literature. Here we note the target group of women with the highest risk, based on the available information on Acculturation and other sociodemographic factors. Additionally, an illustration is presented where information and the concepts offered by the two-factor schema facilitate the analysis of (a) health education message needs and (b) needed behavior change, thus pointing to (c) more appropriate health promotion strategies for targeted Hispanic/Latino individuals or groups. The information described in this article aims to help program planners, researchers, and health educators in the design of more effective programs of health intervention for Mexican American and other Hispanic/Latino women.