The community health worker (promotora) model is used because promotoras are effective disseminators of information, and act as the bridge between governmental and non-governmental systems and the communities they serve. Community health workers also act as change agents within their naturally occurring social networks.
Using promotoras ensures that the many social and cultural characteristics of low-income people can be drawn upon to improve the appropriate utilization of health care services. These social and cultural characteristics can be defined as strong family support through the many interdependent ties of the extended family and the network of comadres and compadres (co-mothers and co-fathers), which are part of the family unit. The strength of these family ties help or hinder efforts to improve health behaviors because the information shared by the family is believed over that of a health care professional. For example, one study reported that Hispanics rarely turn to health care professionals for health-related information but instead seek out peers or authority figures within their own social networks. Therefore, if misinformation is held by a figure of respect within the family network, it is likely to be passed onto others, thereby reinforcing the misinformation and resulting in negative consequences on the current and future health status of the family. It is logical to assume, then, that in order to transmit information and affect behavior change in Hispanics a peer-based educational model that respects the social order of the culture must be utilized. This project proposes the use of community health workers or promotoras as the most efficient model for long lasting change in our communities.
The promotora model is based on previous research and pilot interventions that establish the validity of this model. Examples in the United States of successful community health worker models are the Navajo Community Health Representatives and the migrant farm worker programs of the 1950s and 1960s, respectively. Internationally, the World Health Organization's (WHO) Declaration of Alma-Alta, in 1978, stated a key strategy for the delivery of basic health care services is the use of community health workers.
Promotora services are delivered, for the most part, through home visits and group presentations, but also include health promotion strategies that impact knowledge, attitudes, and practices on a community level. To reach the unreachable, the promotoras go where people congregate. This could be health fairs, church and neighborhood meetings, factories, laundromats, gas stations, and grocery stores, among other locations.
Promotoras are trained by the Executive Director and various local, state, and federal agencies such as the Arizona Department of Health Services, the American Lung Association, the National Heart, Lung and Blood Institute, and the Arthritis Foundation to promote prevention-based lifestyles.