12/19/2025
One of the challenges of managing a chronic condition is first knowing that you have the condition.
More than 615,000 adults in Arizona have diabetes, a condition that causes blood sugar to rise and can lead to serious medical problems. In addition, about 1 in every 4 Arizona residents has prediabetes, a health condition that can lead to Type 2 diabetes if left untreated. Most people with prediabetes — almost 90% of them — don’t even know they have it.
Making healthy lifestyle choices can help lower the risk of developing diabetes and help manage the condition for those who do have it. It also helps to have the support of health care professionals who can offer guidance and treatment options. Yet health care can be difficult to access, especially for people who live in rural communities, who don’t speak English or who don’t have health insurance.
That’s where the power of promotores, or community health workers, steps in. Promotores help bridge the gap for people with limited access to health care. They are members of the communities they serve, able to address medical concerns while sharing similar cultural values and language. According to the U.S. Bureau of Labor Statistics, there were more than 60,000 community health workers in the United States in 2021.
Sheila Soto helps lead a group of promotores in Arizona. She is an assistant research professor and the director of Community Engagement and Outreach Programs at the Mel and Enid Zuckerman College of Public Health at the University of Arizona. Part of her work includes shepherding the university’s Primary Prevention Mobile Health Units, which offer free preventive health screenings in communities across the state.
There are three mobile health units from the University of Arizona that crisscross the central and southern part of the state to provide free preventive health screenings. “We’ve seen that it’s been the most successful way of doing outreach and engagement with the community,” Soto said.
Soto and her team tailor the mobile health unit visits based on the needs of each community. Once one of the outfitted van parks and opens for the day, people line up, come in and complete a registration form, sharing details about their personal health history and family history.
Then the promotores gather vital information, such as blood pressure measurements and blood glucose levels. Based on those results, more testing might include a lipid panel test to check blood cholesterol levels or an A1C to measure average blood sugar levels from the past two to three months.
One of the goals of the program is “to try to reduce the number of people who rely on the emergency room as their main form of health care,” Soto said. “We do this through prevention and through helping people manage chronic diseases.”
She said that the program is effective because the promotores, who take part in continuous training, understand the communities they’re serving.
“I want to make sure that they look like the communities they’re serving, that they understand the same experiences that our community has gone through, that they can share and talk about social drivers of health,” Soto said. The promotores also have a passion for their work, willing to work long days and weekends to care for people who might not otherwise receive medical attention.
“There are individuals that haven’t seen a provider in over 20 or 30 years,” she said. Having access to community health workers who can help break down some barriers makes it easier for people to start getting some level of care.
Andrea Contreras is one of those health workers. She said that it’s rewarding to build relationships and trust within the communities she serves.
“Trust is built with humility and openness,” Contreras said. “Building trust with our community often leads to additional opportunities to provide screening events, while cultivating and fostering new collaborative partnerships.”
Some people seeking care have never had their blood glucose levels checked before, Soto said. They might have no idea that they have diabetes or prediabetes. Understanding the effects of diabetes is important because over time it can cause serious complications, including heart disease, stroke and kidney disease.
If their A1C level is high, the community health worker will explain why it’s urgent for them to follow up with a health care professional.
In other cases, there might be people who have already been diagnosed with diabetes. “They might not want to take their medication, or they can’t afford to get their medication,” Soto explained, “so the conversation switches to how to manage your diabetes.” The promotores can counsel those patients on ways to eat healthier, to fit in more physical activity and to find ways to take medication.
In addition, the promotores are prepared for the more difficult conversations that might come in the Latino culture, she said.
“A lot of people are scared of having diabetes because of the complications that can come with it,” Soto said. “We struggle with people just preferring not to know.” In those cases, the community health workers can talk about lifestyle changes and medications that can help prevent more serious consequences, such as peripheral artery disease and kidney disease.
Building relationships with people throughout the community builds trust in the health care system, Soto added, and ultimately leads to reaching more people.
“That community building is just so important because they’ll go and tell their family members, ‘Hey, I went to this mobile health unit, and they’re really nice to me and gave me this information,’ ” she said. And that can lead to more people being helped in communities that need more resources and access to lifesaving health care.
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