September 23, 2011

Promotoras (or peer health educators) are individuals from a specific community who serve as a link between the members of their community and the health care system. These individuals are trained to provide education on health issues of importance to the community as well as referrals to a variety of services, such as disease screening and treatment, primary care services, and social services. There are many terms used for peer health educators (e.g., lay health advisor, community health worker, lay community educator, natural helper, outreach worker), with “promotora” specifically referring to women who are native Spanish speakers conducting outreach to other Spanish-speaking women they know or may associate with. Although the peer education model is used for both men and women, most peer health education programs target women, regardless of what term is used to describe the outreach activities, given the traditional roles of women as guardians of the health of their family and healers in the community.

The use of promotoras/peer health educators is not restricted to just Spanish-speaking populations. Most programs that target communities considered, by the health care system, to be “hard to reach” use the promotora model as a means to deliver health-related messages and/or services through community-based outreach programs. The women are individuals who are trusted by the community or who will be able to gain that trust. There are many examples of programs that target women of different ethnicities (e.g., lay health advisors to increase breast cancer screening among African American women), different age groups (e.g., peer educators to reduce smoking on high school, college, and university campuses), and individuals with a specific health need (e.g., diabetic health promoters to educate other diabetics about nutrition and special health care needs) or a risk behavior (e.g., drug users in recovery employed as outreach workers to reduce disease transmission among active drug users). Some programs use community health advisors to increase screening for diseases such as breast and cervical cancers among women living in rural settings, where access to health care services may not be convenient or easy.

While promotora or peer educator models for community-based health promotion activities may have started out as a means to reach populations not seen in the health care system, they have evolved into models that incorporate theories of community empowerment, adult learning, and leadership development. Some promotora programs view the training of a cadre of health promoters as a means to increase community involvement with the local health system and to help individuals develop leadership skills so they can advocate on behalf of the community they represent. The promotora serves as a “bridge” between the formal health system and the community by providing services to residents in a culturally appropriate manner, while increasing the ability of the health system to provide health care in ways that respect the culture and health beliefs of the population.

The key to the success of promotora models for providing health education and health promotion services is that the promotoras are recruited from the neighborhoods where services are needed; the women generally have extensive social networks, are often already turned to for health advice, and may serve a leadership role within the community (e.g., the owner of a local business, the spouse of a local religious leader, a community organizer). Research has shown that promotoras have certain characteristics that contribute to their success, including compassion, a sense of connectedness to the community, and a commitment to community service.

SEE ALSO: Gender, Healers

Suggested Reading

  • Eng, E., Parker, E., & Harlan, C. (1997). Lay health advisor intervention strategies: A continuum from natural helping to paraprofessional helping. Health Education & Behavior, 24(4), 413—417.
  • Ramos, I. N., May, M., & Ramos, K. S. (2001). Environmental health training of promotoras in colonias along the Texas—Mexico border. American Journal of Public Health, 91(4), 568—570.
  • Schulz, A. J., Israel, B. A., Becker, A. B., & Hollis, R. M. (1997). “It’s a 24-hour thing…a living-for-each-other concept”: Identity, networks, and community in an urban village health worker project. Health Education & Behavior, 24(2), 465—480.
  • Scott, B. S. (2003). Latina promotoras educate farmworkers. Closing the gap, January/February. Washington, DC: Department of Health and Human Services, Office of Minority Health Resource Center.


Category: P