186253 Population health status in colonias near McAllen, Texas: Can promotoras make a difference in health services utilization

Tuesday, October 28, 2008: 12:30 PM

Martha Conkling, PhD MSPH , Department of Global Health, Emory University, Atlanta, GA
Craig H. Blakely, PhD MPH , Department of Health Policy and Management, School of Rural Public Health, College Station, TX
James N. Burdine, DrPH , Center for Community Health Development, School of Rural Public Health, College Station, TX
Miguel A. Zuniga, MD, DrPH , Department of Health Policy and Management, Texas A&M Health Science Center, McAllen, TX
     
Purpose: This study describes the health status and health care utilization of the population living in selected colonias surrounding McAllen, Texas and evaluates the impact of promotoras on health care utilization.

Methods: Study data comes from a household survey of 1452 individuals, conducted over two time periods between 2002 and 2005. This cross-sectional study used a sampling design stratified by colonia cluster and age, i.e. adult or child. Primary sampling units were defined as individuals. Health utilization data, including visits to health care providers, preventive screenings, health status measures (SF-8 and chronic disease score) and promotora availability/need were predicted by characteristics of the population, their health history, enabling characteristics and if they had contact with a promotora.

Results. This population is undereducated, (65% < high school education), poor (91% below federal poverty level), and underinsured (61% adults, 24% children). The 14% of the population who had used a promotoras advice made 4.37 doctor visits in the last year and had 3.17 preventive screenings. The perception that healthcare access is a problem decreased 50% for dental, 40% for medical services if promotora advice/information was used. Unemployment decreased the odds of knowing promotoras were available by more than 73%.

Conclusions: Promotoras are increasing health service access in this area. Those who have used the information or advice of a promotora were less likely to see dental and medical health service access as a problem and had more preventive screenings. Also, when people know promotoras are available they seek them out for assistance.

Learning Objectives:
1. To articulate how promotoras are beginning to make a difference in McAllen colonias through the Integrated Health Outreach System (IHOS) demonstration project. 2. To list regression techniques that can be used to evaluate health access data including count data collected by self report of health care provider visit data. 3. To describe this population in terms of the SF8. 4. To assess why this study suggests CHWs are promoting preventive services and beginning to increase health services access. 5. To articulate why this research has important policy implications for developing this workforce.

Keywords: Access to Health Care, Community Health Advisor

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: This evaluation was the content of my dissertation. I am currently doing more evaluation research as a post-doc fellow and have made oral presentations at APHA in the past.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

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