Healthy Start Programa Madrina: A promotora home visiting outreach and education program to improve health among latino pregant women

Background: Perinatal health disparities continue to persist among low-income, Latinas. A promotora program was designed, implemented and evaluated (1996-2005) to improve perinatal health service utilization and perinatal health outcomes in an underserved, low-income, Latino community in northeastern PA. It is still operational today. In this program, promotoras were both bi-lingual and bi-cultural, indigenous women who participated in a comprehensive 115 hour training program to connect low-income pregnant Latinas with needed perinatal support and health promotion services. This model was based on the promotora model used in Mexico. Social support theory guided program design. The objectives of the program were to provide outreach, case management and health education to low-income pregnant Latino women in the project area with high rates of inadequate prenatal care and adverse birth outcomes. Pregnant women were identified through outreach, and an intervention to help them access prenatal care by providing them with support and health education services such as medical interpretation, insurance, health education as well as emotional support was designed/implemented. Using multiple methods of evaluation, ten year program results show that the program was successful at linking pregnant Latinas (N=2,053), to perinatal health care health education and support services, as well as decreasing barriers to prenatal care. Outcome electronic birth record data (N=1,566) indicates that HSPM participants had fewer babies born early and with low birth weight compared to births in a non-participant group. Implications for practice and research are discussed, as well as strengths and limitations.