Peer Counselors Helping Less Literate Latinos Become Healthier


By Barbara Thomas
Rafael Perez-Escamilla Ph.D.
Health providers in Connecticut have found a way to bridge gaps in treating the Latino population – through the use of peer counselors – and it’s making a significant difference in their health.
The Hispanic Health Council in Hartford recently completed a study that examined the impact of home-based peer counseling on behavioral, metabolic and health outcomes among inner-city Latino/as with Type 2 diabetes.
The randomized, controlled trial was conducted in conjunction with the University of Connecticut and Hartford Hospital, whose physicians referred patients to the study. Services were tailored to meet the needs and abilities of each participant.
“We saw significant differences in the A1C levels (a measure of blood glucose) of patients who worked with peer counselors compared to those who didn’t,” Sofia Segura-Perez, associate director of the Community Nutrition Unit at the Hispanic Health Council said.
The major challenges, health care professionals say, are barriers such as language, literacy, poverty and stress. “Our clients, especially the elderly, only speak Spanish and it’s difficult for them to understand health care,” said Seguara-Perez.
They also have low levels of literacy, she said, making it hard for them to follow instructions, even in their native language.
To help their patients comply with taking their medications, the HHC uses pictures. “We put up pictures of their medications with a moon for night, a sun for morning,” Segura-Perez said.
“Peers helped the patients understand, took them to the supermarket, prepared meals, took them on walks, showed how to monitor blood glucose levels and how to take proper medication at the right time of day,” said Rafael Perez-Escamilla Ph.D., a professor of epidemiology and the director of the Office of Community Health at the Yale School of Public Health.
Perez-Escamilla is the lead investigator for the research study. He believes that community advocates and properly trained peer counselors hold the key to meeting the challenges of diabetes management, and other health conditions, for the Latino population.
Patients have difficulty understanding why they need to comply with their medication regime, and peer counselors help with that, Perez-Escamilla said.
“Some people may be taking 20 different medications for various conditions, including clinical depression,” he said.
Poverty is another major barrier.
“The population is very poor and they don’t have access to specialized care, only basic care,” Perez-Escamilla said. “The message is health reform.”
If a patient does not have health insurance, buying the necessary medications is a problem, as is access to nutritional food, Segura-Perez said.
At the Hispanic Health Council, staff members tell patients about local food pantries and Foodshare, she said, as well as the federally-funded Supplemental Nutrition Assistance Program (SNAP), formerly known as food stamps.
“Only 30 percent of those who are eligible apply,” Segura-Perez said. “It’s a lengthy application, people have to wait in long lines, and they may not have transportation to get to an appointment.”
Those who live by themselves and are not receiving Social Security benefits may only qualify for $15 a month and feel the process is not worth it, she said.
Financial difficulties contribute to stress, another factor for the Latino community.
“We found high levels of stress in the elderly,” Segura-Perez said. “They don’t have the social support system that people think they have. They’re the ones taking care of others – many are caring for their grandchildren – so they don’t take care of themselves.”
The Hispanic Health Council also offers a program on stress management, she said.
Perez-Escamilla said he has been working on the peer counselor study for five years, the last year of it being hands-on.
Once the study is complete his goal is to inform policy makers about the efficacy of peer counseling, his hope being that peer programs will merit funding.
The Community Health Center (CHC), a health provider with 13 sites statewide, has also seen the benefits of peer counselors.
“Peer support counselors are deployed into the community,” said Dr. Daren Anderson, vice president and chief quality officer for Community Health Center. “We also hold group sessions involving patients who help each other, along with health providers and nurse educators.
“We take a comprehensive patient-centered approach,” he added. “Our staff is mostly bilingual and we also have medical transcribers.”
For those who are uninsured or underinsured, the CHC helps patients get access to insurance and offers discounted or free medications, Anderson said.