ERIC EJ871128: Neighbors United for Health

2009·0.08 MB·English

by  ERIC

Community, Care Setting, and Worksite Initiative
neighbors united for Health
Wayne W. Westhoff, Jaime Corvin, and Irmarie Virella
ABSTRACT
Modeled upon the ecclesiastic community group concept of Latin America to unite and strengthen the bond between
the Church and neighborhoods, a community-based organization created Vecinos Unidos por la Salud (Neighbors
United for Health) to bring health messages into urban Latino neighborhoods. The model is based on five tenants,
and incorporates Latino subjective norms to strengthen the bonds of group members with similar interest, lifestyles,
language and acculturation.
Westhoff WW, Corvin J, Virella I. Neighbors united for health. Am J Health Educ. 2009;40(6):317-319.
InTroDuCTIon and relying on evidence based programs, tion created Vecinos Unidos por la Salud
The Latino population remains the promotores can be used effectively in clinics (Neighbors United for Health) to bring
fastest growing segment of the U.S. popula- and community organizations, including health messages into urban Latino neigh-
tion.1-3 As Latinos become assimilated; their churches and ethnic clubs, to share health borhoods. The Vecinos Unidos por la Salud
lifestyles, food choices and related behaviors information using informal chats (charlas) model is based on five tenants. The model:
impact their health status. Latinos comprise in their own language and within the context (1) is driven by the local community and
a culturally, demographically and geographi- of their familiar surroundings. guided by a bottom-up/top-down approach,
cally diverse population, including persons Promotores and charlas are rooted in the (2) utilizes evidenced based health education
of Central and South American, Cuban, Do- Latin American culture, especially among programs, materials and trainings, (3) has
minican, Mexican, Puerto Rican, and Spanish neighbors within small towns and villages trained promotores and group leaders who
descent. The U.S. Census reports that Hispan- in the region. Drawing on the strengths of serve as program champions, (4) empow-
ics are the largest minority group.4 the Latino culture, small ecclesiastic com- ers groups to organize themselves, and (5)
Community health promoters (promo- munity groups (Comunidades Eclesiales de ensures a consistent structure among groups.
tores) are increasingly providing services for Base) came out of the religious movement in The model also incorporates Latino subjec-
health organizations because of their unique Latin America to keep the Church alive and tive norms to strengthen the bonds of group
ability to link the Latino community with flourishing as liberation theology opened members with similar interest, lifestyles,
health care services. The literature supports the doors of the Church to the poor and language and acculturation.11 As program
the unique role of promotores in amplifying oppressed. Neighbors were encouraged to champions, trained promotores and leaders
community care networks, giving social sup- meet in small groups, usually comprised
port and education to community members, of extended family and neighbors, to pray,
assisting access to care and stimulating com- reflect on a spiritual reading and share their Wayne W. Westhoff is an assistant professor in
munities to action.5-10 daily life events. the Department of Global Health, University
Integrating promotores into a community of South Florida, MDC 56, Tampa, FL 33612;
based prevention program for Latinos is DEvElopIng a moDEl For rEaCH- E-mail: [email protected]. Jaime Corvin
typically successful because promotores come Ing unDErSErvED laTInoS is an assistant professor in the Department of
from similar backgrounds as the target pop- Modeled upon the ecclesiastic commu- Global Health, University of South Florida,
ulation. They are neighbors, siblings, parents nity group concept to unite and strengthen MDC 56, Tampa, FL 33612. Irmarie Virella is
or friends who speak the same language and the bond between the Church and neighbor- a health educator for Fundación Familia Sana,
know the culture. After undergoing training hoods, a local community-based organiza- Tampa, FL 33617.
American Journal of Health Education — November/December 2009, Volume 40, No. 6 317
Wayne W. Westhoff, Jaime Corvin, and Irmarie Virella
from within the neighborhood encourage up approach, while being informed and Disseminating health information to the
participation and disseminate culturally guided from the top down. community followed a sequential process.
appropriate health messages in Spanish. First, the neighborhood groups discussed
This paper describes the basic tenants of the an EvIDEnCED-BaSED program their interests and topics they wished to learn
model and discusses one community-based With a strong foundation in evidence- more about. The leader and orientadora en
organization’s experience implementing based practice, the community-based orga- salud then met with the community-based
the model. nization promoted curriculum proven effec- organization’s health educator to discuss the
tive in improving health outcomes for use feasibility of obtaining health information
a CommunITy DrIvEn ConCEpT in this program. Evidence-based programs on the topic and the availability of evidence
A chronic disease prevention program have been shown to be effective through based programs to guide the group. At the
successfully met its goals and objectives by research, are often easier to implement, typi- next monthly leader meeting, the new idea
using promotores, charlas and the Vecinos cally have instructions on the application was shared. If there was interest, the com-
Unidos por la Salud model. The community- and can avoid the cost and error of develop- munity-based organization either purchased
based organization had previously employed ing assessment tools. Thus, evidence-based training material or developed it, and leaders
promotores to provide health classes in clin- manualized curricula and programs for use and orientadoras en salud were trained in the
ics, churches and clubs. Success rates were with chronic illness in small groups were health topic and prepared to present with
acceptable, yet feedback from attendees used to guide Vecinos Unidos por la Salud their neighborhood groups.
and promotores indicated that there was a groups. Group leaders and orientadora en
Organizing a Group
lack of family orientation due to the set- salud were trained to implement these pro-
A truly community driven intervention,
ting and environment. At the suggestion grams in their groups.
all aspects of the group (i.e. location, number
of the community, promotores began to
of participants, leader, time, agenda) were
host groups in their home or the homes of a TraInED lEaDEr
organized by the group, themselves. Many
participants. Within a short period of time, Identifying a key group leader was
groups rotated meetings from home to home,
dropout rates decreased and the number of important for the sustainability of Vecinos
a practice encouraged because it gave each
participants increased. Vecinos Unidos por Unidos por la Salud. The leader was a vol-
member the opportunity to be host. Group
la Salud groups often included immediate unteer, yet they benefited from the experi-
size varied from five to 15. However, experi-
and extended families and close friends ence and knowledge gained from working
ence showed that the greater the number, the
who previously met to chat about various with the organization. Additional training
harder it was for the group to start and finish
topics before being “formally” made into a was encouraged (i.e., Red Cross, YMCA) to
on time. Meetings were run by the leader with
group. For the participants, the group was support their self-esteem and knowledge
assistance from the orientadora en salud. To
not new, but rather gave new meaning to base when presenting with the orientadora
prepare for the meeting, the orientadoras
coming together and a centralized theme to en salud. The group leader was someone
en salud and the leaders met regularly to
drive meetings. Once the group recognized known by all group members, likely a leader
discuss new topics, select tools, complete as-
that they had been “formalized,” a promotor among them in the past, and knew enough
sessments, meet with the community-based
employed by the community-based orga- about participant’s health history to focus on
organization and community partners, and
nization explained the benefits of coming personal and meaningful discussions.
to discuss concerns.
together to discuss health topics. The pro- The relationship between the leader and
motor was introduced as the orientadora en the orientadora en salud was important A Consistent Structure
salud, which implies that the person not only since the program drew its strength from In keeping with the tenants of the model,
promotes health but also provides informa- their unified roles as leader and educa- groups followed a consistent structure.
tion, guidance, leadership and trust to move tor. All leaders and orientadoras en salud Meetings typically began with an opening
the community to become oriented towards met monthly with the community-based ice-breaker—exercise, dance, or other activ-
a healthy lifestyle. organization for training, giving group ity decided upon by the group and informed
In this new Vecinos Unidos por la Salud leaders the opportunity to interact with by the topic. This led directly into a 45-min-
partnership, groups were responsible for as- other leaders and to see what each group ute health lesson presented as a charla. The
sessing the needs of members and organizing was doing. New health topics that were lesson was direct, factual and supported
groups while the community-based organi- relevant, community driven and focused by evidence-based materials. Handout
zation was responsible for providing training on current issues were discussed. Training information was available. To wrap up the
for leaders and the necessary resources and material was reviewed, and the integration meeting, a healthy snack was provided by the
materials. Thus, from its inception, Vecinos of skits, songs and other tools were created group leader. While at times, the prepared
Unidos por la Salud was driven by a bottom or shared at monthly meetings. food was not always considered healthy,
318 American Journal of Health Education — November/December 2009, Volume 40, No. 6
Wayne W. Westhoff, Jaime Corvin, and Irmarie Virella
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American Journal of Health Education — November/December 2009, Volume 40, No. 6 319