Journal of Immigrant and Minority Health

, Volume 16, Issue 2, pp 280–289 | Cite as

Evaluation of Amigas Latinas Motivando el Alma (ALMA): A Pilot Promotora Intervention Focused on Stress and Coping Among Immigrant Latinas

  • Anh N. TranEmail author
  • India J. Ornelas
  • Georgina Perez
  • Melissa A. Green
  • Michelle Lyn
  • Giselle Corbie-Smith
Original Paper


Recent immigrant Latinas are at increased risk of poor mental health due to stressors associated with adapting to life in the United States. This study evaluated Amigas Latinas Motivando el Alma, a promotora intervention to reduce stress and promote health and coping among recent immigrant Latinas. Using a pre- and post-test design, we evaluated mental health outcomes, specifically, in promotoras. Promotoras’ knowledge levels related to role of promotora and stress management increased, depressive symptoms and stress levels decreased, and coping responses and perceived social support increased as well. Results suggest that promotora programs may be an effective way to improve mental health in recent immigrant Latinas.


Latino Immigrant Mental health Stress Promotora 



“ALMA - Amigas Latinas Motivando el Alma” or “Latina Friends Motivating the Soul” is an inter-university Duke University-University of North Carolina-GlaxoSmithKline Health Disparities Initiative. It is supported by a grant from the North Carolina GlaxoSmithKline Foundation of Research Triangle Park, NC. This research was also supported by grants from the National Center for Research Resources, a component of the National Institutes of Health (NIH) (UL1RR024128 and UL1RR0257470, and NIH Roadmap for Medical Research. The authors would like to express their gratitude to Susan Yaggy for her leadership in the initial conceptualization of ALMA and to our Community and Academic Advisory Committees for their continual guidance throughout the development, implementation and evaluation of ALMA. We are also appreciative to Dr. Mike Bowling for lending his expertise during the data analysis phase and to David Andrews, Esther Majani, and Rachel Page for their assistance in data entry and preliminary analyses. Finally, we extend our most sincere thanks to all of the ALMA participants for their time, energy and dedication. We are humbled by their commitment to better their own health and that of other women in their community.


  1. 1.
    Massey DS. New faces in new places. New York: Russell Sage Foundation; 2008.Google Scholar
  2. 2.
    Ding H, Hargraves L. Stress-associated poor health among adult immigrants with a language barrier in the United States. J Immigr Minor Health. 2009;11(6):446–52.PubMedCrossRefGoogle Scholar
  3. 3.
    Ornelas IJ, et al. Challenges and strategies to maintaining emotional health. J Fam Issues. 2009;30(11):1556.CrossRefGoogle Scholar
  4. 4.
    Ornelas I, Perreira K. The role of migration in the development of depressive symptoms among Latino immigrant parents. Soc Sci Med. 2011;73(8):1169–77.PubMedCentralPubMedCrossRefGoogle Scholar
  5. 5.
    Vega WA, et al. Lifetime prevalence of DSM-III-R psychiatric disorders among urban and rural Mexican Americans in California. Arch Gen Psychiatry. 1998;55(9):771.PubMedCrossRefGoogle Scholar
  6. 6.
    Shattell MM, et al. Depression in Latinas residing in emerging Latino immigrant communities in the United States. Hisp Health Care Int. 2009;7(4):190–202.CrossRefGoogle Scholar
  7. 7.
    Rios-Ellis B, et al. Critical disparities in Latino mental health: transforming research into action. White Paper. Institute for Hispanic Health. National Council of La Raza; 2005.Google Scholar
  8. 8.
    Shattell MM, et al. Mental health service needs of a Latino population: a community-based participatory research project. Issues Ment Health Nurs. 2008;29(4):351–70.PubMedCrossRefGoogle Scholar
  9. 9.
    Sullivan MM, Rehm R. Mental health of undocumented Mexican immigrants: a review of the literature. Adv Nurs Sci. 2005;28(3):240.CrossRefGoogle Scholar
  10. 10.
    Nadeem E, et al. Does stigma keep poor young immigrant and US-born black and Latina women from seeking mental health care? Psychiatr Serv. 2007;58(12):1547.PubMedCrossRefGoogle Scholar
  11. 11.
    Shattell MM, et al. A cognitive-behavioral group therapy intervention with depressed Spanish-speaking Mexican women living in an emerging immigrant community in the United States. Adv Nurs Sci. 2010;33(2):158.CrossRefGoogle Scholar
  12. 12.
    Cabassa LJ, Zayas LH. Latino immigrants’ intentions to seek depression care. Am J Orthopsychiatry. 2007;77(2):231–42.PubMedCentralPubMedCrossRefGoogle Scholar
  13. 13.
    U.S Department of Health and Humans Services. Office of the Surgeon General, Substance Abuse and Mental Health Services Administration. Mental Health: culture, race, and ethnicity. A supplement to mental health: a report of the surgeon general (SMA)-013613. 2001.Google Scholar
  14. 14.
    Mann AS, Garcia AA. Characteristics of community interventions to decrease depression in Mexican American women. Hisp Health Care Int. 2005;3(2):87–93.Google Scholar
  15. 15.
    Carlson BE, McNutt LA, Choi DY. Childhood and adult abuse among women in primary health care. J Interpers Violence. 2003;18(8):924.PubMedCrossRefGoogle Scholar
  16. 16.
    Kelly U. Intimate partner violence, physical health, posttraumatic stress disorder, depression, and quality of life in latinas. West J Emerg Med. 2010;11(3):247–51.PubMedCentralPubMedGoogle Scholar
  17. 17.
    Brabeck KM, Guzman MR. Exploring Mexican-origin intimate partner abuse survivors’ help-seeking within their sociocultural contexts. Violence Vict. 2009;24(6):817–32.PubMedCrossRefGoogle Scholar
  18. 18.
    Hochhausen L, Le HN, Perry DF. Community-based mental health service utilization among low-income Latina immigrants. Community Ment Health J. 2011;47(1):14–23.PubMedCrossRefGoogle Scholar
  19. 19.
    Stacciarini JMR, O’Keeffe M, Mathews M. Group therapy as treatment for depressed Latino women: a review of the literature. Issues Ment Health Nurs. 2007;28(5):473–88.PubMedCrossRefGoogle Scholar
  20. 20.
    Wang PS, et al. Twelve-month use of mental health services in the United States: results from the National Comorbidity Survey Replication. Arch Gen Psychiatry. 2005;62(6):629.PubMedCrossRefGoogle Scholar
  21. 21.
    Watkins EL, et al. Assessing the effectiveness of lay health advisors with migrant farmworkers. Fam Community Health J Health Promot Maint. 1994;16(4):72–87.Google Scholar
  22. 22.
    Squires A, O’Brien MJ. Becoming a promotora: a transformative process for female community health workers. Hisp J Behav Sci. 2012;34(3):457–73.CrossRefGoogle Scholar
  23. 23.
    Ayala GX, et al. Outcome effectiveness of the lay health advisor model among Latinos in the United States: an examination by role. Health Educ Res. 2010;25(5):815–40.PubMedCentralPubMedCrossRefGoogle Scholar
  24. 24.
    Navarro AM, et al. Por La Vida model intervention enhances use of cancer screening tests among Latinas. Am J Prev Med. 1998;15(1):32–41.PubMedCrossRefGoogle Scholar
  25. 25.
    Rhodes SD, et al. Lay health advisor interventions among Hispanics/Latinos: a qualitative systematic review. Am J Prev Med. 2007;33(5):418–27.PubMedCrossRefGoogle Scholar
  26. 26.
    Eng E, Parker E. Natural helper models to enhance community’s health and competence. In: DiClemente RJ, Crosby RA, Kegler M, editors. Emerging theories in health promotion practice and research. San Francisco: Wiley; 2002. p. 126–56.Google Scholar
  27. 27.
    Plescia M, Groblewski M, Chavis LT. A lay health advisor program to promote community capacity and change among change agents. Health Promot Pract. 2008;9(4):434–9.PubMedCrossRefGoogle Scholar
  28. 28.
    Green M, et al. Amigas Latinas Motivando el ALMA (ALMA): development and Pilot Implementation of a Stress Reduction Promotora Intervention. Calif J Health Promot, in press.Google Scholar
  29. 29.
    Jorm A, et al. Actions taken to cope with depression at different levels of severity: a community survey. Psychol Med. 2004;34(2):293–9.PubMedCrossRefGoogle Scholar
  30. 30.
    Ennis SR, Rios-Vargas M, Albert NG. The Hispanic Population: 2010. Washington, DC: US Census Bureau Report No. C2010BR-04; 2011.Google Scholar
  31. 31.
    Kasarda JD, Johnson JH. The economic impact of the Hispanic Population on the state of North Carolina. Chapel Hill: Frank Hawkins Kenan Institute of Private Enterprise; 2006.Google Scholar
  32. 32.
    Corbie-Smith G, et al. Development of an interinstitutional collaboration to support community-partnered research addressing the health of emerging Latino populations. Acad Med. 2010;85(4):728–35.PubMedCrossRefGoogle Scholar
  33. 33.
    Radloff LS. The CES-D scale: a self-report depression scale for research in the general population. Appl Psychol Meas. 1977;1(3):385–401.CrossRefGoogle Scholar
  34. 34.
    Soler J, et al. Validation study of the Center for epidemiological studies-depression of a Spanish population of patients with affective disorders. Actas Luso-Españolas de Neurología, Psiquiatría y Ciencias Afines. 1997;25(4):243.PubMedGoogle Scholar
  35. 35.
    González Ramírez MT, Landero Hernández R. Factor structure of the Perceived Stress Scale (PSS) in a sample from Mexico. Span J Psychol. 2007;10(1):199–206.Google Scholar
  36. 36.
    Cohen S, Kamarck T, Mermelstein R. A global measure of perceived stress. J. Health Soc Behav. 1983;24(4):385–96.PubMedCrossRefGoogle Scholar
  37. 37.
    Zimet GD, et al. The multidimensional scale of perceived social support. J Pers Assess. 1988;52(1):30–41.CrossRefGoogle Scholar
  38. 38.
    Carver CS. You want to measure coping but your protocol’s too long: consider the brief cope. Int J Behav Med. 1997;4(1):92–100.PubMedCrossRefGoogle Scholar
  39. 39.
    Perczek R, et al. Coping, mood, and aspects of personality in Spanish translation and evidence of convergence with English versions. J Pers Assess. 2000;74(1):63–87.PubMedCrossRefGoogle Scholar
  40. 40.
    SAS 9.2. (SAS Institute, Inc.: Cary, NC, 2011).Google Scholar
  41. 41.
    Fox J, Kim-Godwin Y. Stress and depression among Latina women in rural southeastern North Carolina. J Community Health Nurs. 2011;28(4):223.PubMedCrossRefGoogle Scholar
  42. 42.
    Gill H. Latinos in North Carolina: a growing part of the state’s economic and social landscape. Immigration Policy Center. 2012.Google Scholar
  43. 43.
    Griner D, Smith T. Culturally adapted mental health interventions: a meta-analytic review. Psychother Theor Res Pract Train. 2006;43(4):531–48.CrossRefGoogle Scholar
  44. 44.
    Guarnaccia PJ, Parra P. Ethnicity, social status, and families’ experiences of caring for a mentally ill family member. Community Ment Health J. 1996;32(3):243–60.PubMedCrossRefGoogle Scholar
  45. 45.
    Taylor Piliae RE, et al. Change in perceived psychosocial status following a 12 week Tai Chi exercise programme. J Adv Nurs. 2006;54(3):313–29.PubMedCrossRefGoogle Scholar
  46. 46.
    Harris AHS, et al. Effects of a group forgiveness intervention on forgiveness, perceived stress, and trait anger. J Clin Psychol. 2006;62(6):715–33.PubMedCrossRefGoogle Scholar
  47. 47.
    Deckro GR, et al. The evaluation of a mind/body intervention to reduce psychological distress and perceived stress in college students. J Am Coll Health. 2002;50(6):281–7.PubMedCrossRefGoogle Scholar
  48. 48.
    Willert MV, et al. Changes in stress and coping from a randomized controlled trial of a three-month stress management intervention. Scand J Work Environ Health. 2009;35(2):145–52.PubMedCrossRefGoogle Scholar
  49. 49.
    Remor E. Psychometric properties of a European Spanish version of the Perceived Stress Scale (PSS). Span J Psychol. 2006;001:86–93.Google Scholar
  50. 50.
    Ramírez MTG, Hernández RL. Factor structure of the Perceived Stress Scale (PSS) in a sample from Mexico. Span J Psychol. 2007;1:199–206.Google Scholar
  51. 51.
    Meyer B. Coping with severe mental illness: relations of the brief COPE with symptoms, functioning, and well-being. J Psychopathol Behav Assess. 2001;23(4):265–77.CrossRefGoogle Scholar
  52. 52.
    Farley T, et al. Stress, coping, and health: a comparison of Mexican immigrants, Mexican-Americans, and non-Hispanic whites. J Immigr Health. 2005;7(3):213–20.PubMedCrossRefGoogle Scholar
  53. 53.
    Muñoz RF, et al. Prevention of depression with primary care patients: a randomized controlled trial. Am J Community Psychol. 1995;23(2):199–222.PubMedCrossRefGoogle Scholar
  54. 54.
    Bonilla J, et al. A revised Spanish version of the beck depression inventory: psychometric properties with a Puerto Rican sample of college students. J Clin Psychol. 2004;60(1):119–30.PubMedCrossRefGoogle Scholar
  55. 55.
    Cabassa LJ, Zayas LH, Hansen MC. Latino adults’ access to mental health care: a review of epidemiological studies. Adm Policy Ment Health Ment Health Serv Res. 2006;33(3):316–30.CrossRefGoogle Scholar
  56. 56.
    Surkan PJ, et al. The role of social networks and support in postpartum women’s depression: a multiethnic urban sample. Matern Child Health J. 2006;10(4):375–83.PubMedCrossRefGoogle Scholar
  57. 57.
    Guarnaccia PJ, Martinez I, Acosta H. Mental health in the Hispanic immigrant community: an overview. In: Gonzales M, Gonzales-Ramos G, editors. Mental health care for new Hispanic immigrants: innovative approaches in contemporary clinical practice, vol. 3, issue 1–2; 2005. p. 21–46.Google Scholar
  58. 58.
    Wyatt K. State budget cuts decimate mental health services. In: Washington Post. March 9, Associated Press, March 9, 2011.

Copyright information

© Springer Science+Business Media New York 2012

Authors and Affiliations

  • Anh N. Tran
    • 1
    Email author
  • India J. Ornelas
    • 2
  • Georgina Perez
    • 1
  • Melissa A. Green
    • 3
  • Michelle Lyn
    • 1
  • Giselle Corbie-Smith
    • 4
  1. 1.Division of Community Health, Department of Community and Family MedicineDuke University Medical CenterDurhamUSA
  2. 2.Department of Health ServicesThe University of WashingtonSeattleUSA
  3. 3.Sheps Center for Health Services ResearchThe University of North Carolina at Chapel HillChapel HillUSA
  4. 4.Department of Social Medicine and Department of MedicineThe University of North Carolina at Chapel HillChapel HillUSA

Personalised recommendations