Outreach boosts disease prevention at U.S./Mexico border

Personal contact by community health outreach workers increased Mexican-American women’s adherence to annual preventive medical exams by 35 percent, a new study finds.

“Community health workers appear more and more convincingly to be a highly effective bridge between those who give and those who receive health care,” say Jennifer B. Hunter, M.P.H., M.A., and colleagues of the Southwest Center for Community Health Promotion at the Mel and Enid Zuckerman Arizona College of Public Health.

Their research appears in the journal Health Education & Behavior.

Nearly all the women, who lived in Douglas, Ariz., were Hispanic, the ethnic group that has the lowest rates of health insurance coverage in the United States, Hunter says. “They are less likely than the general population to visit physicians, to have preventive health examinations or to have regular sources of care.”

All of the women were uninsured. Most were married, lived below the federal poverty level and had less than a high school education. They were offered free preventive clinical examinations, including a Pap smear, a clinical breast exam, a mammogram and tests of blood pressure, cholesterol and blood sugar.

All the women in the study who received an initial exam were offered a free second exam a year later. As the time for the follow-up appointment approached, 50 women received postcard reminders that the free clinical exam was due. The other 51 women in the study got both postcards and a visit from a community health worker (called a “promotora” in Spanish).

“The promotora visited the women in their homes and asked if they had received the postcard reminder and if they had scheduled an appointment at the clinic,” Hunter says. “If a woman had not yet scheduled an appointment, the promotora discussed any barriers that prevented the woman from going to the clinic, and then facilitated the scheduling of an appointment.”

If any of the women they visited missed a scheduled appointment, the promotoras tried to contact them up to three times to encourage them to make another clinic appointment.

Overall response was low for both groups. Only 56 percent of the women returned to the clinic for their second annual exams. Twenty-four (48 percent) of the women who only got the postcard returned to the clinic for the second exam, Hunter says. However, 33 (65 percent) of those who got both a postcard and a visit from the promotora came in for their exam.

A promotora attempted to make a final visit to each participant eight weeks after the postcard was mailed to give them educational materials about chronic diseases and information about local health resources.

The results bolster the case for community health workers, Hunter says. Promotoras should be trained in health issues, the organization of the local health care system, social support and skills in maintaining trust and confidentiality, she says.

The research was supported by the Prevention Research Centers Program, Centers for Disease Control and Prevention awarded to the University of Arizona.

This story is also available online at www.cfah.org/hbns/news/outreach07-16-04.cfm.