Promotoras in Mental Health: Comparison of English, Spanish and Portuguese Literature

Monday, July 11, 2011

Jeanne-Marie Stacciarini, PhD, RN1
Gloria Uicab, PhD2
Denize Bouttelet Munari3
Bruna França Martins de Araujo, RN3
Ana Cristina Rosa, BSN1
Melissa Ortiz4
(1)College of Nursing, University of Florida, Gainesville, FL
(2)Facultad de Enfermeria, UADY, Merida, Mexico
(3)College of Nursing, Federal University of Goiás, Goiânia, Brazil
(4)Health Education and Behavior, University of Florida, Gainesville, FL

Learning Objective 1: Identify how promotoras working in mental health are described in the literature.

Learning Objective 2: Discuss main strengths and limitation of promotoras working in mental health arena, described in the English, Spanish and Portuguese literature.

Purpose: Promotoras are lay health workers and community insiders who can mobilize and empower hard-to-reach populations and support health programs. The purpose of this literature review was to identify contributions of promotoras in the mental health arena.  Specific aims were: 1) Describe promotoras’ roles, training and intervention outcomes related to mental health activities in 3 languages: English, Portuguese and Spanish and 2) Discuss strengths and limitations of the mental health literature on promotoras.

Methods: This is an integrative review of literature published between 1995 and 2010, including quantitative and qualitative studies as well as “grey” publications in English (n = 12), Spanish (n = 21) and Portuguese (n = 27).

Results: The roles of promotora as educator, advocate and case manager were described in all three languages. Although promotoras training was cited, the search revealed a lack of training continuity. Promotoras’ ability to motivate positive mental health behaviors and serve as a resource was a common thread in the English literature. Training manuals were abundant in the Spanish literature but outcome effectiveness was limited. In the Portuguese literature, promotoras’ own mental health issues were found; promotoras reported feeling overwhelmed, disempowered, frustrated, and emotionally burdened in their roles. Interventions varied and included but are not limited to home visits, community presentations and referrals.

Conclusion: The use of promotoras in the mental health field is relatively new in the US. Promotoras collaborate closely with key leaders in their communities and can successfully deliver mental health promotion, early interventions and chronic disease management. Lack of systematic training and promotoras’ own mental health burdens are acknowledged in the literature as substantially important factors contributing to their effectiveness in mental health work.