Examining Promotora Engagement Strategies In a Delivery of a Health Intervention for Latinx Families of Children with Intellectual and Developmental Disabilities

Background and Purpose: Training community health workers (promotoras, in Spanish) has emerged as a culturally responsive approach to delivering health promotion interventions in minoritized communities. Research shows that promotoras-delivered interventions for Latinx families of children with intellectual and developmental disabilities (IDD) are effective in improving outcomes for both caregivers and children. However, little is known about the specific strategies that promotoras use to engage families in the intervention. To address this gap, this study examines and refines previously identified engagement strategies using a deductive qualitative exploratory analysis of data from a promotora-delivered health promotion randomized controlled trial (RCT) for Latinx families of children with IDD.

Methods: Data were drawn from a two-site RCT of a 10-session, culturally tailored health promotion intervention for Latinx families of children with IDD in Texas and Illinois. Intervention covered topics on caregivers' well-being, nutrition and dietary routines, physical activity, and managing home and community environment. All five promotoras (three in Texas and two in Illinois) were first generation Latina caregivers of youth and young adults with IDD who were bilingual in English and Spanish and had mentorship or leadership experience supporting other Latinx families of children with IDD. From the 20 participants in the intervention arm with completed and transcribable sessions, we purposively sampled 12 participants (six English-speaking and six Spanish-speaking) for data analysis. Using a deductive reflexive thematic analysis, we analyzed the interview transcripts in their original language. Codes were refined iteratively, and themes were revised as needed to incorporate newly identified codes until thematic saturation was reached.

Findings: After achieving thematic saturation, the refined promotoras engagement strategies were a) demonstrating cultural humility; b) respecting the sociocultural environment of the family; c) providing affirmation and encouragement; d) drawing from personal experience; e) reinforcing the purpose and value of the intervention; f) brainstorming and problem-solving; and g) supporting caregivers in staying accountable. Strategies were interconnected conceptually, as promotoras drew on multiple strategies to facilitate discussion throughout the sessions. Engagement strategies were illustrated with examples and quotes.

Conclusion and Implications: As ethnic diversity continues to increase in the United States, culturally tailored service delivery approaches, such as the promotoras model, play an important role in promoting health equity among minoritized populations. Findings suggest that promotora-participant engagement involves an integration of multiple relational strategies with an emphasis on cultural responsiveness from the promotoras, moving beyond just protocol adherence. The refined engagement strategies may inform future promotoras training efforts aimed at improving caregiver engagement and retention in interventions and programs serving Latinx families of children with IDD.