"Promotores" offer support to Latinos living with type 2 diabetes

When Lizette Martinez meets with diabetes patients, she offers them something health care providers cannot – connection with a peer – and that has made a big difference in how they manage their disease.

“Several of my patients who were unable to get their diabetes under control for years have lowered their HbA1c levels (a measure of glucose in the blood) and lost weight since I’ve been seeing them,” she says.

Martinez, who grew up in Chicago’s predominantly Latino neighborhoods, is one of seven promotores, Spanish-speaking community health workers, at Alivio Medical Center.

“A lot of patients visit their primary care doctors but feel more comfortable talking to a member of the same community,” she says. “Promotores are able to spend more time with them than other health care providers and, because we’re from the same community, we know the other issues they face that can complicate their disease.”

Alivio’s Compañeros en Salud program, which links type 2 diabetes patients with promotores, is part of a three-year study that will measure the impact of community health workers on outcomes for diabetic patients. The program is conducted through Peers for Progress, an initiative of the American Academy of Family Physicians Foundation that promotes peer support as a key component of health, healthcare and disease prevention around the world. It is funded by the Bristol Myers Squibb Foundation’s Together on Diabetes^™ initiative.

Together on Diabetes is working with 26 grantees in more than 60 communities in the United States – and others in China and India – to pursue integrated and scalable approaches to achieving optimal and equitable outcomes for people living with type 2 diabetes.

Alivio serves about 3,800 adults with diabetes. Since the Peers for Progress/ Alivio study began in August 2012, the promotores have reached most “high priority” patients – those with high HbA1c levels, psychosocial distress or whose physicians think they may have other needs the program can help address. Additionally, promotores have been able to reach most of the remaining “normal priority” patients, showing that promotores can be an important strategy for reaching all with diseases like diabetes, not just those who join a program.

In addition to elevated HbA1c levels, patients contend with other disease management-complicating factors as well, including lack of insurance coverage, language barriers, transportation and child care issues. Some feel like they have nowhere to turn for help.

Promotores contact their patients at least once a month, either in person or by telephone. They provide diabetes information and educational materials and also help them navigate health care and social services systems and provide ongoing encouragement and emotional support.

“Frequently people who are underserved or disadvantaged are alienated from the healthcare system,” says Ed Fisher, Ph.D., global director of Peers for Progress and professor of health behavior at University of North Carolina, Gillings School of Global Public Health.

“Peer support provides a linkage between the health care system and the underserved population through people drawn from the community who not only provide support, but spread messages and encourage healthy living patterns.”