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Clinic-based and community-based strategies can promote the use of key preventive services by Latina women
Latina women and their young children use fewer preventive health services and have a higher incidence of preventable diseases than whites. Clinic-based and community-based strategies such as use of promotoras, lay health advisors recruited from the Latino community, can increase the use of key preventive health services by Latina women, conclude Melanie Wasserman, Ph.D., of Brown University, and coinvestigators. Their review of interventions that enroll Latina women into preventive reproductive health services (prenatal care, cervical cancer screening, and child immunizations) reached three conclusions. First, every medical encounter is an opportunity to increase use of preventive services by Latina women. Second, promotoras can impact the use of preventive health services, and, third, their effectiveness can be improved.
Several studies demonstrated interventions to reduce missed opportunities. One showed that Pap screening among Latinas could be increased by use of professional interpreters. Another showed that Latino children's immunizations could be improved by having nurses tag the charts of children eligible for specific vaccines. Of particular importance, given the mobility of the Latino population, is asking patients for updated contact information at each clinic visit to facilitate reminder/recall interventions. These reminders, whether in person, by phone, or by letter, increased use of prenatal care, Pap screening, and immunizations. Positive results were also obtained with in-clinic education through videos shown in waiting rooms or during prenatal care visits.
Promotora interventions tended to be well received by Latina women in their reproductive years. Studies also showed that promotoras can positively increase preventive health services use and appear well suited for smaller community applications. Finally, promotoras appear to be only as good as the health systems that they represent. Thus, approaches that combine community-based (promotora, media) outreach with improvements in health care delivery may be more effective. The study was supported in part by the Agency for Healthcare Research and Quality (HS13864).
See "Use of preventive maternal and child health services by Latina women: A review of published intervention studies," by Dr. Wasserman, Deborah Bender, Ph.D., M.P.H., and Shoou-Yih Daniel Lee, Ph.D., in the February 2007 Medical Care Research and Review 64(1), pp. 4-45.
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