title: Institutional barriers and strategies to health promotion: perspectives and experiences of Cape Verdean women health promoters.
abstract: BACKGROUND
  Health promoters are critical resources in improving health care access and in providing culturally-responsive health education and interventions to members of medically underserved communities. Little is known about the barriers that impede their health-promoting practices and the strategies used to overcome these barriers.
  
  
  METHODS
  In-depth, semi-structured interviews were conducted with nine Cape Verdean women health promoters to examine their perspectives on barriers and strategies to health promotion.
  
  
  RESULTS
  Findings revealed how their health promotion practice is influenced by a host of institutional barriers, including insufficient program funding, restrictive institutional policies, and a lack of culturally and linguistically appropriate health resources. Adaptive and resistant strategies used to counterbalance these barriers included forming supportive internal and external alliances, having a good mentor, and "making noise."
  
  
  CONCLUSIONS
  A complete and effective model of health promotion must embrace not only individual-level factors, but also macro-level factors, thus emphasizing the need for institutional change to enhance health-promoting practices.
authors.affiliation: Harvard School of Public Health, Department of Society, Human Development, and Health and Dana Farber Cancer Institute, Center for Community-Based Research, Boston, MA, USA. Maria_dejesus@dfci.harvard.edu
authors.forename: Maria
authors.initials: M
authors.lastname: De Jesus
mesh_terms: D000328:Adult; D001900:Boston; D003142:Communication; D054521:Cultural Competency; D003469:Culture; D054242:Emigrants and Immigrants; D005260:Female; D006266:Health Education; D006293:Health Promotion; D006297:Health Services Accessibility; D054624:Health Status Disparities; D006801:Humans; D007802:Language; D008507:Medically Underserved Area; D011634:Public Health; D036301:Qualitative Research; D040241:Social Marketing; D012944:Social Support; D016387:Women's Health