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Key Findings: The Promotora de Salud Model Promotes Positive Health Behavior Change

The Journal of Women’s Health  has published a new study that examines the use of the Promotora de Salud model for educating Hispanic women about folic acid. In this study, Centers for Disease Control and Prevention (CDC) and other scientists found that small group education sessions and one-on-one connections between promotoras and Hispanic women in the communities they serve can help to increase awareness, knowledge, and consumption of folic acid. These findings can inform public health officials who may want to develop programs to help prevent serious birth defects of the brain and spine (neural tube defects) in Hispanic communities. You can read the scientific summary of the article.

What are Promotoras?
  • Promotoras are lay health workers who serve the communities in which they live.
Who can be a Promotora?
  • Promotoras are typically members of the population being served, often in Hispanic communities, and they act as a bridge between hard-to-reach populations and the healthcare system.
What are Neural Tube Defects?
  • Neural tube defects are serious birth defects of the brain and spine.
  • The two most common neural tube defects are spina bifida (affects the spine) and anencephaly (affects the brain).
  • Neural tube defects happen during the first month of pregnancy.
  • In the United States, Hispanic women are more likely to have a baby born with a neural tube defect than non-Hispanic women.
What is Folic Acid?
  • Folic acid is a synthetic (man-made) form of folate, a B vitamin that is present naturally in foods. Folic acid is added to vitamins and some foods.
  • Many, but not all, neural tube defects can be prevented by consuming 400 micrograms of folic acid every day.
  • It is important that women of reproductive age consume 400 micrograms of folic acid every day by taking a multivitamin with folic acid in it, and by eating foods that are fortified with folic acid, such as some breakfast cereals and other cereal grain products, in addition to eating a diet rich in natural folate.
  • If a woman has enough folate in her blood before and during early pregnancy, from taking vitamins and eating fortified foods, it can help prevent neural tube defects.

About This Study

Researchers conducted a training with promotoras from one county in each of four U.S. states with large populations of Hispanic women: North Carolina, Florida, Texas, and Illinois. The promotoras learned why it is important for women of reproductive age to consume folic acid, and they received materials to use during education sessions with women in their communities.

The promotoras recruited Hispanic women to participate in an education session. Before the session, participants were asked what they knew about the beneficial effects of folic acid to prevent certain birth defects, the recommendations to consume folic acid, and what types of vitamin and mineral supplements they were currently consuming. At the end of the session, the women received a 90-day supply of multivitamins containing folic acid.

The promotoras followed up with participants two months later, and again at four months, where they conducted a final evaluation.

Main Findings from This Study

This study found that among women who received the initial education session and the follow-up sessions, the number of women who reported consuming folic acid from vitamins or multivitamins increased, and they had a better understanding that folic acid can help prevent neural tube defects. Among 1,756 participants across four community sites, 1,426 (about 8 in 10) completed all portions of the study. The most notable findings include the following:

  • The proportion of women who reported that they consumed a folic acid vitamin supplement increased from 1 in 20  to 11 in 20 of the participants.
  • The proportion of women who reported taking a vitamin or mineral supplement every day went from about one-quarter to almost two-thirds of the participants.
  • A majority of women said that they were taking the vitamin supplement because the promotora had recommended it.

This study showed the positive impact that the Promotora de Salud model can have on knowledge and behavior change, which can improve health outcomes. This model can help organizations successfully reach Hispanic women of reproductive age in a culturally appropriate manner.

Key Findings Reference

Flores AL, Isenburg J, Hillard CL, deRosset L, Colen L, Bush T, Mai CT. Folic Acid Education for Hispanic women: Application of The Promotora de Salud Model. J Womens Health. 2017 [published online ahead of print].

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