An Ecological Model Using Promotores de Salud to Prevent Cardiovascular Disease on the US-Mexico Border: The HEART Project

Abstract

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.

Awareness of Cardiovascular Disease and Preventive Behaviors Among Overweight Immigrant Latinas

“…Earlier community-based studies evaluating Su Corazón report similar findings about knowledge development. 6,7,8 Of particular importance is the increased percentage of Latinas aware that heart disease is the leading cause of death in women following the group education (91%) in comparison to the prior low percentage (59%). This finding also is markedly higher than data reported about responses to this item among Latinas in national surveys.…”

“…Salud Para Su Corazón (SPSC), designed to increase knowledge about risk factors and heart-healthy behaviors, was launched 2 decades ago by NHLBI 4,5 and continues today with promotora-led interventions. 6-8 Despite great strides in promoting public health outreach educational programs, survey findings still show that ethnic/racial minority populations face disparities in awareness and knowledge about heart disease and prevention strategies. Although Latinos/Hispanics (terms used interchangeably here) are included in these surveys, those at higher risk for CVD--overweight, immigrant Latinas, particularly those of Mexican descent--are not purposefully recruited.…”

Formative Evaluation of a Pilot Study of a University Exercise Class for Female Muslims

“…Female college students, compared to males, demonstrated lower ability to set goals (ES = 0.57) and plan (ES = 0.38) for PA [36]. Moreover, among a sample of college students composed of 70% females, higher scores on these factors directly resulted in higher levels of PA [37].…”

Avaliação da efetividade da promoção da atividade física por agentes comunitários de saúde em visitas domiciliares

“…Apesar disso, entende-se que a formação dos ACS para a promoção da atividade física e os cursos de educação permanente ou de capacitação são promissores 10,11,12,13,45 . Nessa perspectiva, o processo de formação em educação profissional realizado com as ACS do distrito de Ermelino Matarazzo, apesar de não ter sido efetivo para aumentar o nível de atividade física e melhorar os estágios de mudança de comportamento da população atendida, proporcionou melhora no conhecimento das ACS acerca das recomendações de atividade física para a saúde, além da (re) significação acerca da prática de atividade física na vida pessoal e profissional, valorizando-se a possibilidade do autocuidado, transformando um conhecimento anterior mais funcionalista para uma visão mais integrada, ampla e prazerosa da prática de atividade física, bem como a importância do conhecimento adquirido influenciando a maneira como elas promoviam a atividade física para os usuários do SUS 21 .…”

“…No que diz respeito aos processos educativos, em vários países, cursos têm sido desenvolvidos com ACS para que eles promovam atividade físi-ca e alimentação saudável para a população com uso de estratégias como organização de grupos de prática de atividade física, encontros de educação em saúde e visita domiciliar 10,11,12,13 . Nos Estados Unidos, o aumento na prática de atividade física foi encontrado como resultado de estudos de intervenções promovidas por ACS por meio das visitas às populações carentes 14,15 .…”