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." Discussion 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. © Springer Science+Business Media, LLC 2008.

Barriers Health promotion Strategies Cape Verdean immigrant women Health promoters

cultural anthropology Culture Boston Medically Underserved Area health care planning health promotion Communication health disparity Health Status Disparities interpersonal communication human social support language Cultural Competency cultural competence qualitative research United States Humans Emigrants and Immigrants female women's health Article adult health education migration Social Marketing Health Services Accessibility public health health care delivery