Promotoras role in improving health outcomes and data collection: Findings from a diabetes self-management program among Latino patients

La Clinica de la Raza is an urban community health clinic located in Oakland, CA, serving mainly low-income Latino patients. With funding from the Robert Wood Johnson Foundation we developed a clinical promotora-based diabetes self-management program for patients with uncontrolled diabetes (HbA1c>8) or with poor social support. From 2003 –2006, 366 patients were recruited to participate in the intervention utilizing promotoras to provide telephone counseling, teach diabetes classes, and lead walking and support groups. Promotoras were trained in the Stages of Change Model to help patients set goals and problem solve.

Promotoras documented patients' behavioral changes every 3 months and assisted in data collection regarding Stages of Change of four self-management goals and self-efficacy. Progress was documented on flow sheets available to provider and nutrition counselor at each patient visit. This information was also useful at promotora-provider case conferences. Health outcomes for patients' HbA1c, blood pressure and BMI were measured every six months and LDL cholesterol every year. Promotoras played an important role in patients completing lab work and explaining to patients the significance of lab results. Paired t-tests on 142 patients, pre/post test design, showed statistically significant reductions in HbA1c at six months (-0.36, p=.015) and one year (-0.48, p=.004) and between women and men (-0.78 vs. 0.11, p=.01). The presentation will detail challenges and successes of promotoras working as part of the clinical health team providing diabetes self-management and documenting patients' progress.