Promotoras engage Hispanic community in diabetes awareness and prevention

Milagros Martinez, who moved to New Castle from Puerto Rico, remembers her grandfather, who struggled with diabetes for many years.

“He had diabetes from the age of 16 and later in life had both legs amputated,” she said.

Martinez is reaching out to people in her community to help them avoid what her grandfather went through. She is working with the Promotoras, a group of specially trained volunteers who connect with people in the Hispanic community to help them prevent or successfully manage diabetes.

The Promotoras group was founded in 2008 to educate women to be community health workers and promote cancer screenings in the Hispanic community. Juanita Ramos is the Promotoras coordinator at Christiana Care.

“Over the years the Promotoras have proven to be dedicated and effective volunteers who play an important role in the Healthy Families program in bringing outreach and education directly to the people,” said Nora Katurakes, RN, MSN, OCN, Community Outreach and Education manager at the Helen F. Graham Cancer Center & Research Institute.

Hispanics are almost twice as likely as non-Hispanic whites to develop diabetes, according to the Centers for Disease Control and Prevention. Initiatives focused on helping people in a vulnerable group have a significant positive impact on population health.

Through funding from the Harrington Trust, the Promotoras program was expanded to include outreach on diabetes and mental health. Promotoras learn about healthy eating and exercise, checking glucose and taking medications as directed. Dressed in bright pink T-shirts, they reach out to educate friends, neighbors and family members and distribute information on preventing diabetes and its complications.

“Depression and diabetes often go hand-in-hand,” said Lorraine Nowakowski-Grier, MSN, APRN-BC, CDE, a diabetes nurse practitioner and educator who developed a four-part diabetes program to train the Promotoras to work effectively in their communities.

“The Promotoras play a pivotal role in diabetes outreach. If people do not have the resources to manage their diabetes they wind up the hospital,” she said.


Luisa Ortiz-Marquez, Christiana Care Community Health Outreach & Education program manager, and Promotora Milagros Martinez provide diabetes group education to a class at Christiana Care.

The Promotoras’ first outreach event was a food festival last summer at Holy Angels church in Newark, which has more than 800 Hispanic families in the congregation. People who needed help were connected to Medicaid or other resources.

Now they are reaching out in the community every day, looking for opportunities to talk about diabetes and prevention.

Promotora Rosa Juarez of Newark said she encourages neighbors to cut sugar and fat from their diets and eat more greens, because obesity is linked to diabetes. She said people in the community are eager to learn more about ways to stay healthy.

“As soon as we get into a conversation, the questions come,” said Juarez.

“The Promotoras program teaches volunteers to reach the nucleus of the community, where often  information doesn’t reach because of barriers like income and language. At the same time, they actively educate their families, friends and neighbors,” said Luisa Ortiz-Marquez, Healthy Families/Promotoras program manager. “We know that the program is working because on average we have had about 150 people arrive at our offices because of the Promotoras.”

Promotoras volunteers receive formal training from key staff, including Community Outreach Coordinator Juana Ramos, that prepares them to talk effectively about diabetes awareness and prevention with neighbors, friends and family.

“Health outcomes — particularly for the underserved — are impacted mostly by what we do in the community rather than just in the clinical setting,” said Omar Khan, M.D., MHS, FAAFP, physician leader of Christiana Care’s Primary Care & Community Medicine Service Line and medical director of the Eugene du Pont Preventive Medicine & Rehabilitation Institute. “We are partnering with our neighbors to provide education, outreach and robust linkages to the variety of programs at Christiana Care.”