[OP-ED]: A Latino health-outreach program is a reminder that it’s all in the name
If culture can be used as a currency to understand and serve a community, it can also be a trap, if the culture is painted with too broad a brush. We think we “know” the so-called Hispanic community -- generalizing to certain tropes about language, love of family, deference to authority figures, etc. -- and we rarely stop to question whether our initial assessments still hold true.
For instance, a decade ago, the hot medical news was the emerging use of “promotoras” -- Spanish-speaking Latina community volunteers who worked with medical organizations to coordinate health outreach activities in their neighborhoods -- as a cutting-edge tactic to produce better outcomes in predominantly Mexican populations suffering from obesity, diabetes and other ailments.
The idea, which was patterned after organizations across Latin America who had been using trained community members to bring health awareness to remote populations, became popularized in Mexico in the 1970s. From there it crossed the border, and in the 1990s the Centers for Disease Control and Prevention started using the model to reach out to America’s rising Hispanic immigrant population.
Promotoras programs have been known to be particularly effective with Spanish speakers, and specifically with female heads of families -- at least it has always been assumed so.
It made a certain amount of sense: Hispanics speak Spanish, women trust other women’s opinions on caring for family, therefore Latino families can be successfully served by promotoras.
But as is always the case when we make broad assumptions about big, diverse populations, it’s not quite so clear-cut.
Researchers at the University of Illinois at Urbana-Champaign have found that Mexican-born women living in three nonmetropolitan communities in Illinois with large Latino populations were biased against promotoras because, to many, this word sounds more like “unwanted salespeople” or “promoters” engaged in for-profit enterprises than legitimate volunteer health liaisons.
It turns out that health volunteers in the field were wasting precious time explaining what a promotora does and assuring people they weren’t looking to sell anything.
The University of Illinois paper, recently published in the journal Health Promotion Practice, is believed to be the first study to explore Latinas’ differing semantic, perceptual and cultural interpretations of the term.
As someone who has been intimately familiar with this form of grass-roots health outreach aimed at Spanish-speaking women, I can admit that this misunderstanding would never have occurred to me.
“Our findings were unexpected given the frequency with which promotoras are being used in Latino health studies,” co-author and applied family studies professor Angela R. Wiley said in a post to the blog of the University of Illinois News Bureau. “Based upon the responses we obtained in the focus groups, we now know that successful implementation of [promotora projects] will require us to work with these communities to broaden their perception of the term or use terminology that they report more clearly denotes a volunteer community health worker role.”
Uncovering such crucial tidbits of information speaks to the power of research programs that seek to partner with at-risk communities instead of just implementing strategies on them. And it throws a much-needed spotlight on the importance of being open to continually learning about communities that are supposedly linguistically and culturally “well-known.”
Andiara Schwingel, a lead co-author of the paper and a community health professor, said in an email interview that because the university’s health promotion programs aim to work with the communities they serve, rather than taking the “we know best” approach, the researchers were able to listen and learn.
“When we started recruiting Latinos to engage with us in this research, we realized that they were not understanding what we were talking about -- especially when we talked about promotoras -- not the same way we understand it,” Schwingel said. “We then stepped back and decided to conduct focus groups to understand how they perceive health promotion for Latinos, terms that they relate with.”
It’s a relatively small thing, the phrasing of a slogan or the title of a program, but the impact can be significant. This promotoras finding is a potent reminder that “cultural competency” is a dynamic thing, a state of understanding than can evolve and require new perspectives.
And, of course, yet another example of the need to see our minority populations as groups of individuals with varied needs and circumstances, instead of as large, homogenous categories.