Preparing Mexican-Origin Community Health Advocates (Promotores) to Conduct SBIRT for Problem Drinking in the Emergency Room

Abstract

Community Health Advocates (CHAs), known as Promotores in Spanish-speaking communities, are an important resource for the mobilization, empowerment, and the delivery of health education messages in Hispanic/Latino communities. This article focuses on understanding cultural, didactic, and logistical aspects of preparing CHAs to become competent to perform a brief intervention and referral to treatment (SBIRT) in the emergency room (ER). The CHAs training emphasizes making connections with Mexican-origin young adults aged 18–30, and capitalizing on a teachable moment to effect change in alcohol consumption and negative outcomes associated with alcohol use. We outline a CHA recruitment, content/methods training, and the analysis of advantages and challenges presented by the delivery of an intervention by CHAs.

Vida PURA: results from a pilot randomized trial of a culturally adapted screening and brief intervention to reduce unhealthy alcohol use among Latino day laborers

“…Although not significant, results at 6 weeks post-intervention showed reductions in both AUDIT scores and drinks per week that were consistent with the effect sizes in our study. Another study conducted a randomized controlled trial of promotor-delivered brief intervention for young adult Latino patients in the emergency department in El Paso, Texas [34]. They observed reductions in number of drinking days per week for the intervention group, at levels that were comparable to our study [19].…”

“…Promotores are trained community health workers with an appreciation of the social and cultural context of the communities they serve, in part, due to their shared demographic characteristics. Previous studies have shown that community health workers can be trained to provide SBI in various settings [33,34].…”

Participant Satisfaction and Acceptability of a Culturally Adapted Brief Intervention to Reduce Unhealthy Alcohol Use Among Latino Immigrant Men

“…Findings related to satisfaction with tablets are consistent with findings from the formative research for the Vida PURA study-that some Latino immigrant men have low levels of formal education and therefore utilizing simple graphics can help make the information more accessible for this population (Ornelas et al, 2016). The findings were also consistent with evidence suggesting that promotores are a trusted source of health information for underserved populations, including men (Arvey & Fernandez, 2012;Ramos et al, 2018;Rosenthal et al, 2010). Participants also highlighted specific promotor characteristics that contributed to their positive perceptions of the brief intervention, which included being friendly, personable (i.e., warm and understanding), trustworthy, knowledgeable, and organized.…”

“…These qualities reflect cultural values often shared by Latinos, such as personalismopersonal attention in establishing affective connections and working relationships (Flores, 2000). Together, these findings confirm that culturally adapting the intervention by having promotores deliver the intervention was critical in establishing rapport and developing trusting relationships with the study participants (Ramos et al, 2018) and delivering the information in an accessible way, each contributed to high levels of satisfaction with and acceptability of the intervention (Barrera et al, 2017). Establishing these trusting relationships may be particularly important for Latino men who have been previously mistreated or discriminated against by those in the health and social service agencies (Fleming et al, 2017;Mann-Jackson et al, 2018).…”

Mexican Traditional Medicine: Application of a Traditional and Complementary Medicine System to Improve Opioid Use Treatment in Latinos

“…Doña Elisa, a local abuela and Sra. Alma, a mental health promotora, who has had SBIRT and Mental Health First Aid training with our facility (Ramos et al, 2018), attends his first substance assessment appointment, then sits with the psychiatric nurse practitioner, client, and the family as opioid use disorder and treatment options are explained to the client. A decision to start MAT is made using a familybased decision-making approach (Carman et al, 2013;Villatoro et al, 2014).…”