The Impact of Promotora Community Education and Text Messaging on Lowering Exposure to Environmental Toxins to Reduce Breast Cancer Risks and Reproductive Harm.

Introduction Promotoras, lay health educators, are effective facilitators in improving health outcomes for Latinas in under-resourced communities. The Iris Cantor-UCLA Women's Health Education and Research Center, in collaboration with Worksite Wellness Los Angeles, a non-profit organization, developed a training program in which Promotoras educated their family, friends, and community members on lowering the risk of breast cancer and reproductive harm by reducing exposures to toxins. Promotoras participated in four 90-minute weekly Zoom training sessions focused on the hidden hazards of environmental toxins related to reproductive health and breast cancer. Participants educated by Promotoras attended two educational sessions. The study aimed to determine if augmenting the educational training conducted by Promotoras with a digital text messaging component for the participants assigned to an intervention group resulted in higher knowledge, self-efficacy gains, and advocacy engagement than participants in a control group. Methods  Promotoras and participants completed surveys that evaluated knowledge gains, behavior changes, self-efficacy, and advocacy engagement related to lowering exposures to toxins to reduce risks of breast cancer and reproductive harm. After completing the training, each of the 21 Promotoras recruited and educated 8-10 participants, who included family, friends, and/or community members. Once educated, participants were randomized into two groups: a control group and an intervention group. The intervention group received text messages to reinforce behavior change and provide ongoing education. The control group did not receive text messages or other reinforcements. Both Promotoras and participants were incentivized with gift cards. Results A total of 239 participants were educated by the Promotoras through 42 group sessions. Although results were not statistically significant, the 129 participants in the intervention group demonstrated more promising overall behavior changes related to reducing exposure to toxins as compared to the 114 participants in the control group. Participants in both groups demonstrated an increase in knowledge of 67% to 84% in filtered tap water being safer than bottled water, and 65% to 88% in knowledge of exposure to plastic and cleaning products with fragrances linked to problems during pregnancy.  The 24 Promotoras recruited were of primarily Mexican origin (54%, 13), with 42% (10) having completed high school and 42% (10) in the lowest income bracket of $0 to $10,350. Once trained, 13 Promotoras' knowledge of toxins related to household toxins increased by 185%. There were 10 Promotoras whose confidence in their ability to reduce exposures increased by 249%. In terms of educating, confidence of seven Promotoras increased by 63%. Advocacy engagement grew exponentially, with petition signing increasing from 8.3% to 63% (2-15), and the percentage of Promotoras who had or intended to contact elected officials rose from 8.3% to 54% (2-13). Conclusions The Promotoras and participants deepened their knowledge, adopted healthier and safer behaviors in reducing exposures to toxins, and strengthened their commitment to advocacy. The foundation of this model is based on peer support combined with an evidence-based curriculum following best practices. The findings highlight the effectiveness of culturally and linguistically tailored health education led by trusted community members.