Evidence for long-term impact of Pasos Adelante: using a community-wide survey to evaluate chronic disease risk modification in prior program participants.

Effective community-level chronic disease prevention is critical to population health within developed and developing nations. Pasos Adelante is a preventive intervention that aims to reduce chronic disease risk with evidence of effectiveness in US-Mexico residing, Mexican origin, participants. This intervention and related ones also implemented with community health workers have been shown to improve clinical, behavioral and quality of life indicators; though most evidence is from shorter-term evaluations and/or lack comparison groups. The current study examines the impact of this program using secondary data collected in the community 3-6 years after all participants completed the program. A proportional household survey (N = 708) was used that included 48 respondents who indicated they had participated in Pasos. Using propensity score matching to account for differences in program participants versus other community residents (the program targeted those with diabetes and associated risk factors), 148 natural controls were identified for 37 matched Pasos participants. Testing a range of behavioral and clinical indicators of chronic disease risk, logistic regression models accounting for selection bias showed two significant findings; Pasos participants were more physically active and drank less whole milk. These findings add to the evidence of the effectiveness of Pasos Adalente and related interventions in reducing chronic disease risk in Mexican-origin populations, and illustrate the use of innovative techniques for using secondary, community-level data to complement prior evaluation research.

Understanding the success of promotoras in increasing chronic diseases screening.

The purpose of this qualitative study was to elicit information on why a promotora (or, community health worker (CHW)) increased adherence to chronic disease screening among women along the U.S.-Mexico border. After completion of the intervention, women and clinic staff who participated in the promotora phase of a randomized, controlled study answered structured, open-ended questionnaires. Clinicians from two non-participating clinics were also interviewed. Content analysis found that the promotora's roles included health education and the facilitation of routine and follow-up care. Clients appreciated the promotora's socio-cultural characteristics, as well as her personal skills and qualities, and described her as a trained, natural helper whose personalized support removed barriers to health care and helped women to take care of themselves. Most clinicians recommended working with a CHW to increase adherence to chronic disease prevention practices. A CHW can play a crucial role on a health care team and interventions should tap into this resource.