Community Health Workers and Promotores/Promotoras – Bridging the Health Literacy Gap

by Russell Bennett, MBA, CHIE

Over the years, I’ve had the pleasure of working with community health workers (CHWs), known in Spanish as “promotores” or “promotoras.” These workers play a critical role in the community as patient educators, advocates, mentors, and outreach workers. In addition, they help bridge the health literacy gap between patients and healthcare providers.

Being Part of the Community
Most CHWs are part of the community they serve. This helps them win patients’ trust and makes them more effective in all they do.

Serving as Translators
Patients often don’t know the words and concepts their providers use. This health literacy gap makes it hard for them to follow medical advice. CHWs serve as cultural and linguistic translators, putting these words and concepts into language the patients understand.


Using Teach-Back to Check Understanding

Patients may be unwilling to ask their provider questions or request clarification. For their part, providers may smile and ask, “Did you understand?” Seeing a nod or hearing a “yes” from a patient, they may go on to the next patient, assuming the first patient understood and will follow their advice.

CHWs help make these interactions more effective and help ensure that patients’ voices are heard. They often ask patients the teach-back questions that providers don’t have time to ask. For instance: “When you get home, how are you going to take this medicine that the doctor prescribed?”


Improving Social Determinants of Health

Increasingly, CHWs deal with health literacy around social determinants of health. They help identify housing, jobs, food, education, transportation, and other social factors that affect a person’s ability to care for their own health. For instance, they may arrange transportation or childcare so that patients can get to health visits.

CHWs ensure that patients use healthcare services appropriately. This reduces patient no-shows, hospital readmissions, and use of emergency services. Meanwhile, it improves the continuity of care. All of this leads to better health outcomes and lower healthcare costs.

An Example: COVID Testing

For instance, CHWs can play a key role in COVID testing. They can raise awareness about testing in the community. At test sites, they can greet the public, explain the testing process, and even give the test. Plus, they can follow up with people who test positive, explain health and safety guidelines, and help them get the resources they need (such as food, medicine, and housing for family members).


Bridging the Health Literacy Gap

Ultimately, as a doctor friend of mine says, CHWs help translate medicalish into English, Spanish, and other languages. They continually raise the level of patient health literacy – not only about their specific health issue or challenge, but also about healthy living in general. At the same time, they educate providers on the importance of communicating clearly and getting patient feedback. Thus, they serve as a critical link in the healthcare continuum.

Listen to Russell Bennett, share his experience with Danny van Leeuwen about promotores and promotoras in a podcast here.


About the Author

Russell's headshot

Russell Bennett, MBA, CHIE, is an IHA consultant. As a U.S. native who lived in Mexico for 30 years, he is bicultural and bilingual in English and Spanish. He has expertise in health literacy, social determinants of health, patient engagement, vaccine confidence, and strategy/marketing.


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