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John P. Elder
University of La Verne
Erica T. Sosa
Barbara Baquero
University of Iowa
Carmela Alcntara
Columbia University
Health promotion programs for Latinos can play a key role in increasing their awareness and early detection of prevalent diseases. However, these programs must integrate
cultural factors and also recognize the significant diversity among Latinos. Thus, the
current article provides practitioners with an understanding of health promotion for
Latinos by building upon the work of Elder, Ayala, Parra-Medina, and Talavera (2009).
Relevant pathways and future directions for health promotion for Latinos are also
discussed.
Keywords: Latinos, health promotion, conceptual frameworks, health interventions
(Dominguez et al., 2015). Unfortunately, Latinos also continue to experience mental health
disparities, in comparison to their White/
European American counterparts (AguilarGaxiola et al., 2012; Cook, McGuire, & Miranda, 2007; Rosales Meza, & ArellanoMorales, 2014; U.S. Department of Health &
Human Services [DHHS], 2001; Vega, Rodriguez, & Gruskin, 2009). Latinos with mental
disorders are less likely than White/European
Americans to utilize mental health services
(Alegra et al., 2008). Once they enter treatment, they are also more likely to receive services that are inadequate than White/European
Americans (Alegra et al., 2008; Cook et al.,
2007), resulting in premature termination
(DHHS, 2001).
Health and mental health disparities among
Latinos are the product of complex genetic,
biological, psychosocial, and economic factors.
Communication barriers that are due to organizational and structural malfunctions within
health care settings, as well as barriers within
medical encounters create health disparities
among Latinos (Betancourt, Carrillo, Green, &
Maina, 2004; Betancourt & Flynn, 2009). Although health care reform, such as the Patient
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ARELLANO-MORALES ET AL.
promotion for Latinos. Because health promotion programs for Latinos vary based upon their
needs and geographical location, we provide
examples of culturally-tailored health interventions from four distinct regions of the U.S. (e.g.,
South Carolina, Pennsylvania, Texas, California) and health areas that are amenable to
change (e.g., physical activity, nutrition, diabetes, depression). However, unlike Elder et al.
(2009), the current article discusses issues of
mental health and the role of transnational ties
and its effect upon the health and mental health
of Latinos.
Health Promotion Frameworks
Health promotion programs for Latinos can
play a key role in increasing their awareness and
early detection (Cristancho, Peters, & Garces,
2014; Vega et al., 2009). While these programs
aid in reducing health disparities among Latinos, enacting healthy behavioral changes is difficult (Castro et al., 2008). Conditions for optimal health behavior are often difficult for many
Latinos, particularly those with stressful living
situations. Nonetheless, health promotion programs for Latinos are possible and their efficacy
is dependent upon the provision of health information that motivates and sustains changes in
health behavior (Alcalay et al., 1999; Balcazar
et al., 2006; Castro et al., 2008; Cristancho et
al., 2014; Elder et al., 2009).
Castro et al. (2008) indicate that such change
must occur within a culturally relevant manner
through the use of program activities that build
upon their cultural strengths and mobilize interpersonal and environmental resources within an
integrated manner. These strengths can include
cultural values such as familismo, personalismo, respeto, and confianza (Buki, Salazar, &
Pitton, 2009; Torres et al., 2013). Health promoters cannot assume that the messages and
materials developed for mainstream audiences
are effective for every individual (Torres et al.,
2013). Rather, the design of health promotion
interventions for Latinos should be grounded on
the contemporary health needs and desires of
the local community. Empirically- based health
promotion research and empirically validated
interventions for Latinos should guide these efforts to promote healthy behavioral change
(Castro et al., 2008). In addition, these programs
must adjust program activities based upon lev-
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HEALTH PROMOTION
85
Year
2005
2009
2009
Model
Borrell
(Framework for the Effect of
Racial Identity among
Latinos)
Table 1
Frameworks to Examine Latino Health
Identifies socio-environmental
factors that influence
childrens health.
Informs the development of
effective, economically
feasible health interventions
that will have long-term
effects on socio-environmental
factors.
Aids in the conceptualization and
design of culturally tailored,
multi-level diabetes prevention
interventions for racial/ethnic
minority populations.
Aims
Applications
Key Factors
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ARELLANO-MORALES ET AL.
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HEALTH PROMOTION
and materials are designed for relatively educated individuals with high English literacy.
Furthermore, Spanish materials that are direct
translations from English are often inappropriate, since they lack linguistic and cultural relevance. Other Spanish translations tend to be
written at a high reading level, yielding them
inappropriate for low-level readers (Elder et al.,
2009). In addition to the content of a message,
its feel must be consistent with the values of
familismo, simpata, and allocentrism, with a
tone and images that are relevant to these dimensions (Sampson et al., 2001). To address
these issues, Buki et al. (2009) developed a
Checklist of Design Elements for the Development of Cancer Education Print Materials for
Latina/o Audiences (CEMLA). Using socialcognitive theory, the CEMLA provides a costeffective systematic and practical tool to develop culturally and linguistically appropriate
cancer education materials for Latinos.
Health Communication Channels
of Communication
The third input variable within health promotion programs for Latinos is the channel or
medium of communication (McGuire, 1989).
Multiple communication channels are employed, such as face-to-face communication, bilingual mass media, and other mediums. For
instance, mass media have included telenovelas
(soap operas), public service announcements,
radio programs, motivational videos, and telephones. In addition, other mediums have included the use of brochures, recipe booklets,
photonovelas (stories using photographs), and
workbooks to increase their awareness of risk
factors and health knowledge (Balcazar et al.,
2006; Castro et al., 2008; Cristancho et al.,
2014; Elder et al., 2009).
Health Communication Audience
The fourth input variable is the audience or
the receiver of the communication (McGuire,
1989). Audience characteristics that frame the
health promotion effort for Latinos include cultural sensitivity and recognition of the diversity
of Latinos (Ramirez et al., 1999). For many
Latinos, behavioral change will occur within the
context of the family, since they are often primary sources of social support, particularly
87
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HEALTH PROMOTION
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89
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HEALTH PROMOTION
91
Adelante (Steps Forward), a 12-week intervention, to promote nutrition and physical activity
through the use of promotoras. The intervention
design also integrated social ecological strategies endorsed by the CDC Task Force on Community Preventive Services. Pasos Adelante
significantly decreased self-reported body composition, blood pressure, and cholesterol (Staten
et al., 2012). In traditional destination communities, available resources, community capacity,
and large Latino communities facilitate the implementation of evidence-based interventions
and successful application of large community
trials. This evidence suggests that promotoras,
strong community ties, and culturally specific
strategies, are important factors to consider
when designing and implementing interventions
for Latinos (Ayala & the San Diego Prevention
Research Center Team, 2011; Keller & Cantue,
2008).
Diabetes Control Interventions
Given the high rates diabetes in South Texas,
especially among Mexican Americans, interventions in this area are critical. The Starr
County Border Health initiative included two
interventions along the Texas-Mexico border
(Brown & Hanis, 2014). The yearlong intervention included 12 weekly educational sessions
and biweekly support groups, whereas the
8-week intervention included eight 2-hr educational sessions, three 2-hr support groups, and
guidance from a nurse case manager. One
unique feature of this intervention was the inclusion of a research dietitian, nurse, and promotora within its intervention teams. In contrast
to other studies, the promotoras were primarily
for logistical support and recruiting study participants because formative research suggested
that study participants preferred for health professionals to provide the educational sessions
rather than the promotoras.
Outcomes of the Starr County Border Health
Initiative were promising. Participants who attended at least half of their sessions decreased
A1C by an average of 1.7 percentage points
compared with an average of four percentage
points among the highest attendees. High participation was partially attributed to program
implementation in Spanish (90% of the sample
selected Spanish as their preferred language);
the provision of transportation, flexible sched-
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ARELLANO-MORALES ET AL.
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HEALTH PROMOTION
93
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within local, state, and federal levels (Aguilar-Gaxiola et al., 2002, 2012).
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Abstracto
Programas de promocin de la salud para los Latinos
pueden tener un papel clave en el aumento de su
conocimiento y la deteccin temprana de las enfermedades prevalentes. Sin embargo, estos programas
deben integrar factores culturales y reconocer la significativa diversidad entre los Latinos. Por lo tanto, el
presente artculo ofrece profesionales con un marco de
la promocin de la salud para los Latinos a travs del
trabajo conducido por Elder et al. (2009). Tambin se
discuten las marcos pertinentes y la futura orientaciones
de promocin de la salud para los Latinos.
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Received February 24, 2015
Revision received September 17, 2015
Accepted October 7, 2015