By Allison Crawford
Dr. Gia Mudd-Martin was working as a public health nurse in South America in the 1980s when she first heard about promotoras. “Promotora” is the Spanish term for a community health worker, or someone who is trained to provide health education and outreach services within their community. Dr. Mudd-Martin saw how effective these programs were and, upon returning to the United States, decided to pursue a doctoral degree to research and demonstrate their effectiveness.
After earning her doctorate in Texas, she moved back to her hometown of Louisville. Having previously worked with the Latinx population in Kentucky, contacts she made during that time reached out to her upon her return.
“I had several people from the community approach me and say, ‘You know, you’re back in Louisville and we understand that you have your Ph.D. Can you help us conduct some research that will help us understand how to decrease the terrible, increasing rates of cardiovascular disease and type 2 diabetes?’” Dr. Mudd-Martin said. Her answer was Corazones Saludables, the community-based research study she continues today as faculty at the University of Kentucky College of Nursing and an investigator with the Research and Interventions for Cardiovascular Health, or RICH, Heart Program. Using a community-based research approach Dr. Mudd-Martin worked with the Latinx community to develop an intervention to reduce risk for these diseases. With help from community members, Dr. Mudd-Martin found an existing promotores curriculum from the US-Mexico border and tailored it to fit the more midwestern and southern-influenced culture of central Kentucky’s Latinx community.
“What’s different about community-based research is that [it recognizes] the academician and the researcher do not have all the answers. That actually, a lot of the answers rest with the community itself and by engaging with the community you can develop better programs that will have longer-term impact,” Dr. Mudd-Martin said.
The study’s Community Principal Investigator, Rosa Martin, has been critical to the success of the study. Among other aspects for which she has been responsible, Ms. Martin oversees recruitment of promotoras to take the curriculum into the community. Around 2009, Virginia Cruz was working with the local health department when Rosa recruited her to be promotora. “I saw that the program was great and it was really going to help,” Virginia recalls. “So I said, ‘Okay, I am in.’”
Virginia says the promotoras work with study participants for a year: 8 weeks of classes, and 10 more months of checking in about participants’ goals. Once the year is up, she says participants don’t want to leave because they can see how much the program benefits them.
“Maybe in the middle of the class we start seeing change,” Virginia said. “People get so excited, you know, ‘I did this,’ ‘I made this change,’ ‘I feel better,’ ‘I lost weight.’ It’s not only in the future, it’s right now. We are seeing the impact of the classes, giving us the assurance that this is going to work, that this is going to help the Hispanic, Latin community a lot.”
Typically, these types of trial studies compare the outcomes of a group that receives an intervention to the outcomes of a group that receives no intervention. However, Dr. Mudd-Martin said the community wanted both groups to receive interventions that could help improve health. Since the study is guided by the community, each Corazones Saludables group wound up receiving a different format of health education intervention. By comparing the outcomes of each group, researchers will be able to identify which health education format works best to decrease risk factors for diabetes and heart disease in the Spanish-speaking community.
The study stays accountable to the community through its Community Advisory Board, populated by people that work in health fields or with organizations, like KEJC, serving the Latinx population. KEJC’s Outreach Coordinator Miranda Brown helps people access healthcare and navigate the world of health insurance, frequently in Spanish. Her direct experience provides the study with further insight into factors it should consider as they work with participants.
“One of the things that has come up in the study is how being an immigrant impacts your mental health and how that in turn impacts your lifestyle, how active you are, what you eat, and that in turn affects your likelihood of developing diabetes and heart disease. And so, your health is directly tied to your experience as an immigrant,” Miranda said.
The board also serves as a sort of referral service. When participants need further medical care or help signing up for insurance, researchers may refer them to organizations that serve on the advisory board. This symbiotic relationship furthers the study's community-based approach as well as serves participants.
Dr. Mudd-Martin says once the study accumulates enough data to determine which health education format works best, she hopes to find grants that will allow her to implement that format on a larger scale. Wrapping up the study with an additional implementation grant will take about 8 more years, after which she hopes the health education program will be self-sustainable. “So this will not stay with the university. This stays with the community. Everything we’re doing stays with the community. That’s part of training the promotoras, is that their knowledge, their expertise stays with the community as well.”