At the Border Crossing Boundaries: Community Health Workers/Promotores in the HEART of a Community-Based Randomized Trial

The Health Education Awareness and Research Team (HEART) is a university and community partnership at the US-Mexico border (El Paso, Texas) funded by the National Institutes of Health National Center on Minority Health and Health Disparities. The HEART pilot assessed the outcomes of a Community Health Worker/Promotor (CHW/P) intervention based on the Salud Para Su Corazon curriculum. HEART took a community-based participatory research (CBPR) approach to a randomized controlled trial (RCT). A Community Health Advisory Council was formed early in the project to guide the project; this was coordinated by HEART partner Centro San Vicente in coordination with all HEART partners. In the early stages of the project, CHW/Ps gave input based on their own expertise; helping to enhance both the intervention and research design overall. The CHW Program at El Paso Community College, a partner in HEART, helped to support this effort and others to give voice to local CHW/P interests. A cornerstone of the project was a four month RCT where community members were assigned to an intervention group with CHW/Ps or a group without CHW/P contact. Utilizing RCT methodologies within the context of CBPR placed contrasting paradigms together. As challenges were identified, the multidisciplinary team, including university and community partners, CHW/Ps, and others, dialogued to identify issues and solutions. This pilot provided an opportunity to learn about partnership processes including in this case, the importance of learning about each others roles and respecting agency boundaries. This and other lessons learned are the focus of this paper.