Putting ones self first even when it comes to health care is a foreign concept to many Hispanic women.
With the help of 13 Hispanic promotoras, or community health workers, Karen DAlonzo, PhD, RN, APNC, a researcher and nurse practitioner at the Willetts Health Center at Rutgers Douglass Campus, and a Rutgers College of Nursing professor, responded to the need by developing a pilot activity intervention program.
DAlonzo has trained 13 promotoras to lead classes and serve as instructors and role models for women in the Hispanic immigrant community in New Brunswick, N.J. Launched at the end of March in the form of community activity classes, the program has been designed to improve womens health and fitness and to promote self-care.
Keeping women engaged is as much a goal of the program as the exercise.
Family issues tend to interfere with such activities, and these women have a sense of guilt, DAlonzo says. They find it hard to put themselves ahead of their families, and theres a gender issue here, too.
DAlonzo will be measuring retention in the program and studying physiological factors, such as blood pressure, body mass index, weight, and body fat, before and after the program, to assess change. We want the women to get fit and remain active, while learning how to cope effectively with family responsibilities, DAlonzo adds.
Change basic beliefsKaren D’Alonzo, RN
The major barrier the promotoras will face with the immigrants is marianismo, says DAlonzo, which is the female counterpart of machismo in men.
She explains marianismo as the belief that women must put their families well-being and care ahead of their own.
Engaging in exercise or other self-care behaviors is in direct opposition to this belief and is something Latino women are not used to doing.
As these immigrants assimilate into American culture, they are under stress from a lack of social and family support, the language barrier, living in a new country, and, in some cases, working outside the home for the first time in their lives. Usually, only the nuclear family emigrates, so there isnt an extended family for support, DAlonzo says.
Immigrant women often feel confused after they become part of the American healthcare system. Healthcare providers tell them to take care of themselves and not to worry so much about the kids, DAlonzo says. Its a real culture clash.
Educate the educators
Thirteen women from the Latina community completed a six-week training program under DAlonzos direction. Guest speakers included Eddie Gallon, EMT from Newark, who taught CPR and first aid; and Magda Diaz, lead promotora from the New Jersey Community Health Institute at UMDNJ in Stratford, who presented a lecture about promotoras in the healthcare system. The women also attended low-impact and aqua aerobics classes.
Participants will learn activities they can do at home, DAlonzo says. They are not going to have to buy a lot of equipment. They will learn how to use practical items from home to exercise, such as a large can of tomatoes as weights and chairs for support.
Seeds blossomPromotoras can best understand the needs of Hispanic women.
The seeds for this program were planted last spring when DAlonzo interviewed 28 women in a focus group format. They discussed their attitudes about and barriers toward physical activity and exercise, and DAlonzo used the data to design the classes.
Her theory is that the 13 promotoras, who are from the same community as the immigrants, can best understand and address some of the issues that keep Latinas from being physically active. This is community-based participation research, she says. These women will help to implement the physical activity intervention and lead the exercise groups.
The promotoras will oversee a class of between 8 to12 women and will conduct three physical activity/exercise classes a week over a 12-week period. One promotora will be in charge of each class with support from one to two others. The promotoras will help these women to monitor their progress toward fitness. The classes are held in select schools in New Brunswick.
DAlonzo was awarded a three-year $274,104 grant from the National Institute of Nursing Research at the National Institutes of Health to conduct two studies examining young Latinas attitudes toward physical activity.
She is doing the study in partnership with the Salvation Army New Brunswick Corps. Womens health, especially in the Latina community, has been a longstanding interest of DAlonzo, who has received a number of research grants over the years in this area.
These women are the first of two groups in the program. During the first session, half the women will be in the physical activity class and the other half will be in the control group. In the fall, the control group will take the class.
Eventually, when she determines the overall return on investment, DAlonzo wants to do this study on a larger scale and compare results. This is an empowerment program, DAlonzo says. These women dont often have a sense of empowerment in their lives, so this will be a good experience for them.
The Hispanic paradox
Ironically, Latinas often are healthier when they first come to the U.S. than a year or so after theyve been here.
DAlonzo says that they arrive with much healthier profiles low rates of heart disease, hypertension, most types of cancer (other than cervical cancer), depression, anxiety, and substance abuse.
After eating American portions and fewer healthy foods like fruits and vegetables, which are more expensive, they have the same health issues as Americans.
DAlonzo refers to this as the Hispanic paradox and says that Hispanics need to try to preserve their healthy habits. DAlonzo hopes that through these classes women will learn that caring for themselves is essential to caring for their families.