Abstract A26: Best practices for implementing a promotora-led cancer screening intervention in Latino communities
Authors: Haughton Jessica , Torre Carolina Lopez de la , Elder John P. , Ayala Guadalupe X. , Arredondo Elva M. 
Published: May 2016

Purpose: The effectiveness of promotoras (community health workers) as health educators and navigators among Latino populations is widely recognized. The Affordable Care Act created important opportunities to increase the role of promotoras in preventive health, particularly in cancer education and screening. Faith in Action/Fe en Acción is a faith-based randomized controlled trial aimed to increase cancer screening (cervical, breast, colon, and skin) among churchgoing Latinas. This presentation describes the recruitment, training, and role of promotoras for a cancer screening intervention targeting multiple levels of the Social Ecological Model. In addition, best practices for promotora-led interventions are shared along with benefits of and challenges in implementation.

Procedures: Sixteen promotoras were recruited, hired, and trained to implement a two-year cancer screening intervention in eight Catholic churches in San Diego, California. At the individual level, promotoras were responsible for recruiting participants for and leading multiple series of six workshops promoting cancer screening for breast, cervical, colorectal, and skin cancers. At the interpersonal level, promotoras were trained to implement four motivational interview calls with study participants over the course of the program. At the organizational level, promotoras gave announcements at mass, included workshop information in church bulletins, and hosted booths at church ministry fairs. At the environmental level, promotoras gathered information about local clinics and screening resources. With the assistance of project staff, promotoras compiled lists and health care resources for program participants. In addition, promotoras attended workshops on the Affordable Care Act to obtain information about health insurance access for church members.

All promotoras received 6 weeks of training, totaling 24 hours. Training sessions were culturally specific, faith-based, and included didactic lessons, interactive activities, role play, and motivational interviewing. Promotoras were compensated $10 an hour for five hours of work each week during the course of the two-year intervention.

Results: Across all eight churches, promotoras taught 650 cancer screening workshops. Sixty-two percent of study participants attended at least one of the six workshops offered and 49% completed the six-workshop series. At the interpersonal level, completion of motivational interviewing calls ranged across churches from 32-76%, averaging 61%. Of the 16 promotoras who were hired, 8 (50%) completed the two-year intervention. Of the 8 who did not complete the program, 6 found other employment offering more hours, 1 moved out of the area, and 1 was terminated for poor performance (e.g. arriving late to workshops, not completing required tasks).

Conclusions: The resources, training, and time needed to prepare promotoras for their roles across the Social Ecological Model are often overlooked. Many promotoras have little formal work experience and require additional training in time management, organization, and goal setting. Some of the challenges inherent in working with promotoras include lack of resources to pay promotoras more than part-time, finding the right candidates for the position, and the need for frequent training and support. However the benefits outweigh the challenges, both for the project's success and the promotoras' personal benefit. Promotoras' knowledge of the church and community allowed the project to reach a large number of people and connect them with local resources. In addition, the project provided promotoras with leadership skills, strengthened their connection to the community, and gave them valuable skills that could be transferred to future employment opportunities.

Citation Format: Jessica Haughton, Carolina Lopez de la Torre, John P. Elder, Guadalupe X. Ayala, Elva M. Arredondo. Best practices for implementing a promotora-led cancer screening intervention in Latino communities. [abstract]. In: Proceedings of the Eighth AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 13-16, 2015; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2016;25(3 Suppl):Abstract nr A26.