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Introduction

Manual Contents

Introduction

Page Contents

The Role of the Community Health Worker

Community health workers (promotores) play a key role in promoting better health in Latino communities. They help people learn about health issues and show them ways to live healthier lives. Without them, many Latinos might not receive such vital information.

Successful community health workers have special qualities. They know their communities well. They are dedicated to improving the health of their communities. They enjoy teaching others, feel comfortable in front of a group, and know how to work with a group. They are also:

  • Good listeners
  • Nonjudgmental
  • Caring
  • Pleasant
  • Patient
  • Approachable
  • Fair
  • Openminded
  • Helpful
  • Confident
  • Willing to try new ways to improve their own health

Let's Hear From You!

We thank you for your interest and efforts to help Latinos take steps to protect their hearts. We invite you to give us your feedback on how you are using the manual in your community. To share the Your Heart, Your Life activities, please register at the Web site at http://www.nhlbi.nih.gov/health-pro/resources/heart/hispanic-health-manual/.

Your feedback will help promote the expansion of the project in the United States and abroad and contribute to the growth of the Salud para su Corazón network. Establishing a large network is important to keep the project going strong!

You may also send your feedback to:

Salud para su Corazón Initiative
NHLBI Division for the Application of Research Discoveries
Building 31, Room 4A10
31 Center Drive, MSC 2480
Bethesda, MD 20892-2480

Or you may e-mail your feedback to Gloria Ortiz, R.N., M.S.N., at alvaradm@nhlbi.nih.gov.

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“Your Heart, Your Life” Helps Communities: Testimonials From Community Health Workers

“The manual helps me give my community the information they need about heart health. I can give them the information in the language they understand where they can hear, see, touch, and taste to learn better and act upon what they learn.” — Esperanza Vásquez, Promotora with 10 years of experience, Centro San Vicente, El Paso, TX

“I find that the ‘Your Heart, Your Life’ manual is a simple and practical tool that allows participants to make heart healthy lifestyle changes.” — Odelinda Hughes, Promotora with 14 years of experience, Centro San Vicente, El Paso, TX

“In our community there is lack of information or there is misinformation. It is awesome to have one tool to bring promotores in for training and to join other programs across the country that impart the same information. Personally, it has helped me. I lost 20 pounds and have kept them off for the last 4 years.” — Sandra Varela, CalWORKs Resource Specialist, San Joaquin Delta College, Stockton, CA

“I value the manual as a gift of life.” — Otíla García, Promotora with 13 years of experience, Gateway Community Health Center, Laredo, TX

“The manual made me become the promotora I want to be. I am more confident when I work with the community and present the sessions.” — Marta Garcia, Promotora with 3 years of experience, North County Health Services, San Marcos, CA

“These instructional materials and the promotores are significant factors in families' participation in their own health.” — Mary Luna Hollen, Ph.D., R.D., Director of Promotores Program, School of Public Health, University of North Texas Health Science Center, Fort Worth, TX

“The ‘Your Heart, Your Life’ manual is an inspiration to lay health workers, to our Latino/Hispanic families; it is an example of cultural competence that goes beyond adequate scientific information delivery. It is a philosophy of prevention; it is about enjoying a healthy lifestyle for our hearts.” — Hector Balcazar, Ph.D., Regional Dean and Professor, Health Promotion and Behavioral Sciences, University of Texas School of Public Health at Houston, El Paso Regional Campus, El Paso, TX

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Organizations

The following organizations support and recommend the use of this manual:

  • Latino Caucus of the American Public Health Association
  • Lay Health Workers/Promotores National Network, Inc.
  • National Council of La Raza
  • National Hispanic Council on Aging
  • National Hispanic Medical Association
  • New Mexico Community Health Workers Association
  • Regional Center for Border Health, Inc.
  • United States-Mexico Border Health Commission
  • Vision y Compromiso Network of Promotoras
  • The Way of the Heart: The Promotora Institute

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Salud para su Corazón Network

The following partners implemented pilot projects using the “Your Heart, Your Life” manual in various U.S. Latino communities:

  • Center for Hispanic Policy and Advocacy, Providence, RI
  • Centro San Bonifacio, Chicago, IL
  • Centro San Vicente, El Paso, TX
  • El Concilio – Council for the Spanish-speaking, Stockton, CA
  • Gateway Community Health Center, Laredo, TX
  • Hands Across Cultures Corporation, Espanola, NM
  • Mariposa Community Health Center, Nogales, AZ
  • Migrant Health Promotion, Progreso, TX
  • Neighborhood Healthcare, Escondido, CA
  • North County Health Services, San Marcos, CA
  • University of North Texas Health Science Center at Fort Worth, School of Public Health, Fort Worth, TX

These pilot projects confirmed that the “Your Heart, Your Life” manual effectively helps people to improve their heart health. The projects also showed that the manual can be implemented using the following community strategies:

  1. Training lay health educators.
  2. Conducting educational heart health activities in the community.
  3. Educating patients about how they can improve their control of risk factors for heart disease and helping patients make changes for healthy lifestyles.

The results of the pilot projects revealed the need to add an evaluation component to the manual, which is found in Session 12. Many of the modifications to this manual resulted from the implementation and evaluation of pilot projects.

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Acknowledgments

The “Your Heart, Your Life” manual was first published in 1999. This updated 2008 version involved the dedication of many people. NHLBI gratefully acknowledges the contributions of promotores, families, groups, and organizations to the success of the “Your Heart, Your Life” manual.

Special Recognition

NHLBI extends special recognition to the following:

  • The promotores de salud for their insight, deep commitment, and full endorsement. Their community work has made a difference in people's lives.
  • The community-based organizations, community health centers, and other users for their critical role in demonstrating the value of the manual in a variety of settings, and for different audiences. These groups have shared a wealth of knowledge and have provided valuable direction in the enhancement
    of the manual.
  • Amanda Aguirre, M.A., R.D., Executive Director of the Regional Center for Border Health, Inc.; Tuly Medina and Mariajose Almazan, Coordinators of the National Promotores Conference; and the Lay Health Workers Promotores National Network, Inc., for providing a “meeting ground” for using the manual to train promotores at nine annual National Community Health Workers/Promotores Conferences. Their guidance and support served to continually promote and expand the project nationwide and internationally.

May the enhanced version of the “Your Heart, Your Life” manual lead to a new cycle of action that will strengthen and sustain heart health in the Latino community.

Reviewers

NHLBI recognizes the contributions of the following reviewers:

  • Cecilia Ahumada-Navarro, Assistant Coordinator, Mariposa Community Health Center, Nogales, AZ
  • Teresa Andrews, M.S., Promotores Health Literacy and Leadership Training Specialist, Rural Community Assistance Corporation, West Sacramento, CA
  • Hector Balcazar, Ph.D., Assistant Dean and Professor, Health Promotion and Behavioral Sciences, University of Texas School of Public Health at Houston, El Paso Regional Campus, El Paso, TX
  • Maria Banuelos, Cardiovascular Program, North County Health Center, San Marcos, CA
  • Jeri Beaumont, R.D., Senior Nutrition Program Director, Division on Aging, Union County, Elizabeth, NJ
  • Gladys Cate, Public Health Analyst, Office of Minority and Special Populations, Bureau of Primary Health Care, Health Resources and Services, Administration, Rockville, MD
  • Yanira Cruz, President and CEO, National Hispanic Council on Aging, Washington, DC
  • Gail DeKovessey, Bergen County Division of Community, Development, Hackensack, NJ
  • Carmen Dorio, NJCEED Program, Community Medical Center – Community Health Services, Toms River, NJ
  • Susan Fountain, Rutgers Cooperative Research and Extension in Mercer County, New Brunswick, NJ
  • Judith Fradkin, M.D., Director, Diabetes, Endocrinology, and Metabolic Diseases Division, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD
  • Joanne M. Gallivan, M.S., R.D., Director, National Diabetes Education Program, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD
  • Marta Garcia, Promotora, Cardiovascular Program, North County Health Center, San Marcos, CA
  • Otíla García, Promotora Coordinator, Gateway Community Health Center, Laredo, TX
  • Odelinda Hughes, Promotora Educator, Centro San Vicente, El Paso, TX
  • Jann Keenan, Ed.S., President, The Keenan Group, Inc., Experts in Health Literacy, Ellicott City, MD
  • Sue Lachenmayr, M.P.H., CHES, Older Adult Health and Wellness, Division of Aging and Community Services, New Jersey Department of Health and Senior Services, Trenton, NJ
  • Janet Lucero, Certified Diabetes Educator, Las Clinicas del Norte, Ojo Caliente, NM
  • Eva Moya, L.M.S.W., Consultant, Health and Human Services/Affairs, El Paso, TX
  • Maria Gómez Murphy, M.A.I.A., President and CEO, The Way of the Heart: The Promotora Institute, Nogales, AZ
  • Rosie Piper, Health Promotion Manager, Mariposa Community Health Center, Nogales, AZ
  • Lourdes Rangel, Director, Special Projects, Gateway Community Health Center, Laredo, TX
  • Rosalba Ruíz, M.D., Coordinator, United States-Mexico Diabetes Project, Pan American Health Organization, U.S.-Mexico Border Field Office, El Paso, TX
  • Sandra Gómez Varela, CalWORKs Resource Specialist, San Joaquin Delta College, Stockton, CA
  • Esperanza Vásquez, Promotora Educator, Centro San Vicente, El Paso, TX

NHLBI Salud para su Corazón Team

  • Gloria Ortiz, R.N., M.S.N., Coordinator, Minority Health Education and, Outreach Activities, Division for the Application of, Research Discoveries, Bethesda, MD
  • Robinson Fulwood, Ph.D., M.S.P.H., Chief, Enhanced Dissemination and, Utilization Branch, Division for the Application of, Research Discoveries, Bethesda, MD
  • Janet de Jesus, M.S., R.D., Nutrition Education Specialist, Division for the Application of, Research Discoveries, Bethesda, MD
  • Gloria Ortiz, International Program Officer, Division for the Application of, Research Discoveries, Bethesda, MD
  • Victor R. Olano, M.P.H., Public Health Advisor, Division for the Application of, Research Discoveries, Bethesda, MD
  • Laina P. Ransom, M.B.A., Publication Production Manager, Division for the Application of, Research Discoveries, Bethesda, MD
  • Madeleine Wallace, Ph.D., Public Health Analyst, Division for the Application of, Research Discoveries, Bethesda, MD
  • Terri Williams, M.S.A., Publication Production Manager, Division for the Application of, Research Discoveries, Bethesda, MD

Contributors

Amalia Cabib, Professional Translator of Original Manual, Bethesda, MD,
IQ Solutions, Inc., Rockville, MD

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About the “Your Heart, Your Life” Manual

“Any training that does not include the emotions, mind, and body is incomplete; knowledge fades without feelings.” — Anonymous

To teach the “Your Heart, Your Life” sessions, the following materials are needed:

  • “Your Heart, Your Life” manual. Spanish version is NIH Publication No. 08-4087. English version is NIH Publication No. 08-3674.
  • “Your Heart, Your Life” picture cards. NIH Publication No. 08-3275.
  • The Ramirez family fotonovelas, five brief stories on how to prevent heart disease, found in the Appendix.
  • A video series of 60-second heart health dramas (telenovelas), available in Spanish only. NIH Publication No. 55-886.
  • “Act in Time to Heart Attack Signs” video in Spanish, for Session 2. NIH Publication No. 56-078N. English version is NIH Publication No. 56-042N.

The “Your Heart, Your Life” manual is part of the Salud para su Corazón initiative sponsored by NHLBI. Salud para su Corazón develops the tools and strategies to promote heart health among Latino individuals, families, and communities.

Other Salud para su Corazón materials include:

  • “Bringing Heart Health to Latinos: A Guide for Building Community Programs.” A guide for health planners and community-based programs to establish a successful heart health promotion project for a Latino community. – NIH Publication No. 98-3796.
  • “From Heart to Heart: A Bilingual Group Discussion Kit.” A how-to guide for conducting discussion groups (charlas) on heart health at churches, community centers, and other sites. The guide comes with a video of two educational programs in Spanish (“Por amor al Corazón [For the Love of Your Heart]” and “Cocinar con su Corazón en mente [Cooking With Your Heart in Mind]”). – NIH Publication No. KT-018.
  • “Delicious Heart Healthy Latino Recipes.” A bilingual cookbook that gives heart healthy versions of traditional Latino dishes. – NIH Publication No. 08-4049.
  • “Healthy Home, Healthy Heart Series.” Six easy-to-read bilingual booklets on heart healthy living:
    • Are You at Risk for Heart Disease? – NIH Publication No. 08-6351
    • Keep the Beat: Control Your High Blood Pressure – NIH Publication No. 08-6352
    • Do You Know Your Cholesterol Levels? – NIH Publication No. 08-6353
    • Do You Need To Lose Weight? – NIH Publication No. 08-6354
    • Protect Your Heart Against Diabetes – NIH Publication No. 08-6355
    • Enjoy Living Smoke Free – NIH Publication No. 08-6356

Ordering information for these materials appears in the Appendix.

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How To Use This Manual

Community Health Workers

This manual is for you! The “Your Heart, Your Life” manual can be used to train community health workers. After you've been trained, you can conduct your own trainings and teach others how to be community health workers.

The “Your Heart, Your Life” manual consists of 12 sessions that include step-by-step instructions on how to teach 11 fun and educational sessions to community residents or patients. Each session is taught in motivational and interactive ways to keep the attention of the group members. Each session helps people learn about what they can do to prevent heart disease. The manual includes worksheets and handouts for project participants (group members) to take home to read and share with their family and friends.

It also includes a special session for community health workers on how to evaluate completed projects. This session helps community health workers determine how successful they have been in implementing their training and educational activities and helping community residents adopt heart healthy habits. The Appendix features special training activities and teaching tips and explains how to start a project in your community.

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About the Sessions

Each session covers a different topic related to heart health. The sessions generally follow the same structure, which will be explained next. Each session also includes “More Information” boxes, which have additional facts on selected health topics to help you answer questions from group members.

Length of Sessions

Most sessions last about 2 hours. Session 5, “Be Heart Smart: Keep Your Cholesterol in Check,” and Session 7, “Protect Your Heart: Take Good Care of Your Diabetes for Life,” last a little longer.

Based on requests from promotores and other users of the previous manual, two new sessions have been added: Session 7 and Session 12, “Use Evaluation To Track Your Progress.”

Evaluation

Session 12, “Use Evaluation To Track Your Progress (Especially for Promotores),” is designed to guide promotores and project evaluators in the planning, implementation, and evaluation of the project. The purpose of the session is to provide ideas for tracking project activities and tools for measuring changes in participants' behaviors and clinical values. You can use the ideas and tools to:

  1. improve the quality of the project,
  2. show that your activities work, and
  3. provide information to institutions that support your project through funding, referrals, and in-kind contributions.

Supermarket Visits

You may want to take your group on a grocery store tour between Sessions 9 and 10. Call your local clinic, local medical center, or the American Heart Association. Ask if they have a registered dietitian who conducts tours on shopping for a healthy diet. You can also check with the manager at your local grocery store or call the grocery store offices to see if there are registered dietitians on staff who offer store tours.

Glossary

Community health workers may find it helpful to have a glossary of terms or more information on cardiovascular topics covered in this manual. The NHLBI Diseases and Conditions Index, http://www.nhlbi.nih.gov/health/dci/index.htm, contains information on diseases, conditions, and procedures related to heart disease.

Session Outline

Each session begins with a summary page that explains:

  • What you want group members to do or learn
  • Materials and supplies that you will need
  • Worksheets and materials that you will hand out
  • The session outline

Each session also includes five major parts:

  • Part 1 – Introducing the Session
    • Welcome the group members.
    • Review the information from the last session.
    • Ask the group members to talk about their pledges.
    • Explain what you will talk about in today's session.
  • Part 2 – Conducting the Session
    • Present new information.
    • Lead the group in fun and educational activities.
    • Ask the group members questions.
    • Let the group members ask questions about what they have heard.
  • Part 3 – Review of Today's Key Points
    • Ask questions to help the group members review what they just learned.
    • Emphasize the important points.
  • Part 4 – Weekly Pledge
    • Help group members come up with a pledge to make a healthy lifestyle change that relates to the information they have learned during the session.
    • Give several examples of pledges that are specific and realistic.
    • Share the personal value. The value helps encourage participants to keep their pledges and gain confidence so they can make lasting lifestyle changes.
  • Part 5 – Closing
    • Tell the group members that you enjoyed the session, and wish them luck in meeting their pledges.
    • Thank the group members for attending the session.
    • Ask the group members what they thought of the session.

Symbols

Symbols are used throughout the manual to let you know quickly what comes next:

  • Do an activity.
  • Use a picture card.
  • Give out a handout.
  • Help group members create a pledge for heart health.
  • Give out a recipe.
  • Do a training activity.

Picture Cards

The “Your Heart, Your Life” picture cards can be used with the manual to help you present information for each session. When you see the picture card symbol in the manual, you will know to show a picture that relates to the information you will be talking about. On the back of each picture card is a script in English and Spanish that you can read aloud while you show the picture card.

Breaks and Refreshments

You should take a short break about halfway through each session. You may want to use the time to do some easy stretches. Another option is to serve a small healthy snack with water during the break. Snack ideas include light yogurt; baked, unsalted tortilla chips; and fruit or vegetables with low-fat dip. Or you can prepare a dish from one of the recipes in this manual and have group members taste it.

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Getting Started

At Least 6 Weeks in Advance

  1. Find a location. Find a place to teach the Your Heart, Your Life sessions in your area that people can get to easily. Call local clinics, schools, churches, and community centers. Reserve a room for a time when community members can attend.
  2. Tell people about the project. Let community leaders and others know that you are offering the course. Ask clinic personnel, clergy, and caseworkers to recommend it.
    • Say:
      These are some of the benefits of the course:
      • The course can help participants and their families find out their own risk for heart disease and learn how to lead healthier lives.
      • Participants will learn low-cost cooking techniques as well as how to eat healthy foods, prevent heart disease, become more physically active, keep a healthy weight, take care of diabetes, and quit smoking.
      • The course is also for participants who have risk factors for heart disease or are under the care of a doctor because of heart disease. This course will guide participants to take steps to protect and improve their heart health.
      • Participants will learn that, whatever your age or current health status, it is never too late to take steps to protect your heart.
  3. Advertise the sessions. Post flyers at health fairs and in community sites, such as clinics, grocery stores, churches, and other places in your community. (sample flyer) Place course announcements in local media outlets.
  4. Class size. A small group of about 10 to 12 people is best. Try to get about 20 people to sign up, because some may not show up for the class, and others may drop out.

At Least 1 Week Before Each Session

  1. Read through the sessions, picture cards, and handouts. Read through these materials two or three times to be prepared.
  2. Carefully read the information that you will present to the group members. Practice what you will say in front of a mirror or to a friend or family member. Be sure to use the picture cards. Also practice making a few healthy changes in your own life.
  3. Review the instructions for each activity. Make a list of things you need to do before the session, such as making a food display or getting a VCR and TV monitor. For some sessions, you will need to create lists of places where people can get their blood pressure, blood glucose (test for diabetes), or blood cholesterol checked.
  4. Pay attention to the “More Information” boxes. This extra information will help you answer questions from the group.
  5. Ask a health educator, registered dietitian, nurse, or doctor to explain any information you do not understand. Contact these health professionals at your local hospital or neighborhood clinic.
  6. Review the list of handouts, materials, and supplies you will need for each session.
    • Make enough copies of the handouts for all group members.
    • Gather all the materials and supplies needed to conduct the session.

The Day of the Session

  1. Review the list of materials, supplies, and handouts. Make sure that you have everything.
  2. Arrive 30 to 60 minutes ahead of time. This will allow you to set up the room, VCR, and TV monitor.
  3. Tell group members when sessions will meet and how often.

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Working With Your Group

Leading the Group

  • Get to know the members of your group. They may have different backgrounds, interests, and needs.
  • Use words and terms that are familiar to the people in your group. A banana is known as a “plátano” to some and as a “guineo“ to others. Oranges may be called “naranjas” or “chinas.” Strawberries may be known as “fresas” or “frutillas.”
  • Encourage group members to ask questions. Asking questions helps group members apply the information to their own lives and remember what they have learned.
  • Keep the sessions flowing smoothly so everyone is interested and involved.
    • Be ready to deal with people who talk too much. Thank these people for sharing their opinions. Then quickly ask if anyone else has something to share.
    • Help members who do not read or write well in a way that will not bring attention to them.
    • Offer help, but do not force anyone to accept help.
    • Change the activity to a group discussion.
  • Be observant. Watch for clues from group members who do not understand and try to give the information in a different way if you see these clues:
    • Puzzled looks
    • Wrinkled foreheads
    • Looking away from you
    • Being quiet

Motivating Group Members

  • Praise or reward group members' efforts in order to keep them motivated.
    • Give praise when it is deserved. This gives more meaning to what you are teaching.
    • Praise people in front of others. This can help them stay committed.
  • Encourage group members to share their opinions.
    • Show interest in group members and what they have to say.
    • Be patient. Some people may not speak because they have never been asked to share their opinions in a group setting.
    • Try to involve everyone in the discussion and activities, but do not force anyone to speak. People will speak up when they become used to the group.
  • Encourage participants to take small steps toward change.
    • People are more likely to develop new habits if you promote small changes slowly. This brings more success.

Getting People To Come

  • Remind the group members that it is important to come to all the sessions. Tell them that they will:
    • Learn something new at each session.
    • Help family members.
    • Socialize and meet people.
  • Ask people to team up and call one another as a reminder to attend the sessions. This encourages people to attend.
  • Remind them about the meeting time and length of classes.

Answering Hard Questions

Remember that it's okay not to know all the answers! Say that you will have the correct answer by the next session. Call a local health educator, registered dietitian, or nurse to find out the correct information.

Keeping People on Track

Give the group the correct information when a group member gives incorrect or incomplete information. Give the person credit for any part of his or her answer that is correct. Say that people often hear incorrect information and believe it to be true. Tell the group members that this is one important reason why they are taking the course—to get correct information.

And Finally. . .

Have a good time. You are doing an important service for yourself and your community. Thank you!

Go to Overview

Go to Session 1


Information on this page is taken from the English print version of “Your Heart, Your Life, A Community Health Worker's Manual.” U.S. Department of Health and Human Services, National Institutes of Health, National Heart Lung and Blood Institute, NIH Publication No. 08-3674, Originally Printed 1999, Revised May 2008.

Last Updated March 2012

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