Before Rosela Juarez, a 29-year-old Los Angeles mother of two, discovered the promotora (health advocate) program in 1998, she says, "I thought I was only a housewife-that that was my whole life and my only future."

But since finishing her promotora training, Juarez has spoken to audiences of her peers more than 400 times about such topics as self-esteem, values and sexuality, domestic violence, and child abuse.

A major challenge for Juarez was gathering the confidence she needed to talk in front of a group. "I'd prepare and prepare and prepare, and that helped me know I could do it," she says. Now, three and a half years later, Juarez speaks passionately about her role as promotora: "The program has totally changed my life," she says, "it gave me the opportunity to have a profession and go into the community and be someone important."

The training program

Begun in 1991 by Planned Parenthood Los Angeles (PPLA), the aim of the Promotoras Comunitarias Training Program was to find a way to reach the Latino community with information about reproductive health and increase access to health care. Then in 1995, PPLA teamed up with the Hathaway Family Resource Center and promotoras began educating neighbors about a wider range of health issues.

Today promotora training includes 14 units totaling 160 hours. The first half of the training covers health issues; the second half builds communication, leadership, and listening skills, and cultural sensitivity.

The promotoras

Promotoras make presentations on reproductive health, communication, parenting, and other issues related to the well-being of the family. They give talks at schools, churches, private homes, and community centers and serve as resources for their neighbors-if they don't know an answer to a question, they know how to find out.

After their training, promotoras commit to leading two sessions a month, though most do many more, says Melinda Cordero, director of the Promotora Program at PPLA. Promotoras are paid $25 for each class they teach. Together they reach about 15,000 families a year.

Most promotoras are stay-at-home moms, with financial support coming from the men of the family, but some hold other jobs and give promotora presentations as a community service. The promotora experience has launched some into full-time employment. For example, when the USC Medical School needed outreach workers for its asthma project, they hired promotoras, women with the skills, confidence, and community connections to do the job.

Ongoing support

Carolina Ramirez is one of the five lead promotoras who support the 32 in the field. She moved from El Salvador when she was 15, married young, and had four children, never finishing high school. She thrives on her new leadership role.

Her job, she says, is to do whatever is necessary to make sure promotoras have classes to teach and are prepared to teach them. Some promotoras, for example, don't speak any English, so she might go with them to help set up classes. She observes their classes and gives them feedback on their work. She's there to help them with challenging questions or difficult referrals. She's there to listen.

"We try to support promotoras not only as workers but as women," says Cordero. "That's been very effective for us and often life-changing for them."

Promotoras can attend weekly support sessions and monthly trainings. There's a holiday party in the winter and a park visit in the summer. Promotoras become part of each others' lives. If a promotora needs to talk about a problem with her husband, there's someone there, says Cordero. If she needs help with the rent, the others just might hold a raffle or take up a collection.

Keys to success

• Lots of support: Cordero says PPLA learned early on that the key to success was to provide lots of support-professional and personal-during the training and after. "If what it took was to bring the materials a woman needed for a presentation to her house so she didn't have to take the bus, I'd do it," says Cordero. "Most of the women are getting out of their houses for the first time and stepping into a professional role. It's a big step and they need support."
  
  
• Focus on women: "Our model," says Silvia Esqueda, who manages the program at Hathaway, "is that if you train Latina women and help them in their personal and professional process then you're helping the whole family because the woman has crucial role in her children's education."
  
  
• Peer education: Promotoras are effective because they come from the same class and culture as the families they are trying to reach.

Results

An evaluation of the Promotoras Project showed that participants in their classes increased their knowledge of health issues and the promotoras themselves used more preventive health measures for their families.

"The mother is the base of the family," says Esqueda, "and if she's exposed to new approaches or attitudes, she's going to share them with her family. And that is a great instrument for change."

"We provide a lot of encouragement in talking with children," says Esqueda, "and you see women start thinking about being different kinds of parents. You see them getting more involved in their children's schools and spending quality, focused time with their children."

For Ramirez, who says her training has given her new skills and new opportunities, being a promotora has also improved how she parents her children: "It's a different confidence I have with them now," she says. "I can talk to them openly about so many things. And because they've been along to trainings with me, they're different too. Sometimes I'll lose my temper and yell and they'll say 'Mommy you're not supposed to yell.' And we can laugh about it."

Program facts

• Course length: 160 hours, two times a week, over about five months
  
  
• Teachers: Professional health educators
  
  
• Cost: $50,000 to train and support a group of 10 promotoras for a year. Funding comes from county and federal family support and public health funds and from private foundations.
  
  
• Languages: Spanish
  
  
• Contacts: Melinda Cordero, Planned Parenthood Los Angeles, 323-223-4462; Silvia Esqueda, Hathaway Family Resource Center, 323-257-9600