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CHW Health Disparities Initiative

NHLBI-HRSA Partnership to Improve Hispanic/Latino Heart Health in Community Health Centers on the U.S.-Mexico Border

Overview

Rates of heart disease are high among people who live on the U.S. side of the border with Mexico.1 In addition, one in four people in this region lives in poverty.2 In response to these issues, the NHLBI and the Health Resources and Services Administration (HRSA) implemented the NHLBI’s Salud para su Corazón (SPSC) heart health education and outreach program in the border area from 2002 through 2005.

Implementation Strategies

The purpose of the NHLBI-HRSA partnership was to address the high rate of heart disease among Hispanic/Latino patients in border areas, using promotora-led education in primary care settings. SPSC projects were implemented in four community health centers (CHCs) on the U.S-Mexico border:

  • El Paso, TX
  • Laredo, TX
  • Nogales, AZ
  • San Marcos, CA

The initial SPSC program was designed for community education sessions, so the NHLBI-HRSA projects tested whether the program could also work in clinical settings. These projects linked lifestyle changes to improved heart health.

The NHLBI-HRSA partnership to improve Hispanic/Latino heart health in CHCs had three main goals:

  • Increase heart disease knowledge and heart healthy behaviors among Hispanic/Latino patients in primary care settings.
  • Decrease patients’ high blood pressure, blood cholesterol, and blood sugar.
  • Increase the involvement and support of local agencies in CHC heart health education and outreach.

To achieve these goals, promotores in each CHC:

  • Trained new promotores, using the Your Heart, Your Life manual.
  • Monitored patients’ clinical measures.
  • Followed up with patients to help them follow their treatment plans and make lifestyle changes.

Evaluation and Outcomes

  • A total of 131 trained promotores conducted heart health community education and activities for over 4,000 people.
  • Self-reported data from CHC patients who received SPSC sessions of the Your Heart, Your Life curriculum showed positive changes in participants’ health behaviors (related to cooking and eating a heart healthy diet, reducing salt and sodium intake, reducing cholesterol and fat intake, and increasing physical activity)3 at 3 and 6 months.
  • Changes were in patients’ clinical measures were noted. For example, in a sample of 106 patients, the percentage of participants with high blood pressure fell 17 percent from baseline to 6 months. The percentage of patients with high systolic blood pressure (140 mmHg or more) decreased from 12 percent at baseline to 9 percent at 3 months and 8 percent at 6-month follow-up.3
  • Due to the success of the promotora-led programs, HRSA decided to support two similar programs involving community health workers in primary care clinics that serve African Americans in public housing, as well as two CHCs that serve Filipino Americans in Hawaii.

Lessons Learned

The CHCs enhanced the original SPSC program in the following ways:

  • The CHCs made some modifications, such as hosting informal support groups and physical activity classes.
  • Through phone calls and home visits, promotores actively supported and coached families making heart healthy lifestyle changes.
  • The CHCs established partnerships in their communities that helped sustain their projects beyond the NHLBI funding period.
  • The NHLBI and HRSA Interagency Agreement provided support for the CHCs and promotores.

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1 PAHO. (2007). Health in the Americas, 2007: United States-Mexico Border Area. external disclaimer

2 United States-Mexico Border Health Commission. (2010). Healthy Border 2010: An agenda for improving health on the United States-Mexico border.external disclaimer

3 Balcazar, H., Alvarado, M., Cantu, F., Pedregon, V., & Fulwood, R. (2009). A promotora de salud model for addressing cardiovascular disease risk factors in the U.S.-Mexico border region: A community-based Latino cardiovascular disease prevention and outreach model. Preventing Chronic Disease, 6(1), A02.

Last Updated: June 2014