Small Business Innovations Research Grant


Positive, culturally sensitive experiences in prenatal care can have a long-term impact on the health and use of healthcare services by Hispanic women and their families. 

A culturally appropriate, empowerment-based lay educator model designed to address individual, community and provider needs unique to prenatal care could help generate cost-savings to the healthcare system, improve quality of care, and address multiple needs of this growing population. 

Community-Based Participatory Research

El Pueblo TWS Partner

The study team used a mixed method design with a community-based participatory research process.  A diverse and experienced community advisory board of health professionals, researchers, and promotoras helped guide the study team through both phases of research. Latino community members also provided feedback through field-testing in different geographic locations during all phases of product development.

See Community Advisory Board

 (Grant No. 1R43MD002713-01) 

Study Team

Dr. Sarah Verbiest, Director of the University of North Carolina's Center for Maternal & Infant Health at the UNC School of Medicine collaborated with Dr. Auger as her company's Research Institution Partner for Phase I and 2. 


Mélida Colindres, President & Founder of INTER-AM English & Spanish Communications, was a key member of the study team. She and Dr. Auger have been partners in the development and testing of the TWS Method and the De Madre A Madre photonovels since their inception.

See Research Team

Phase I Aims

Through this pilot study, we wanted to: 

  1. Gain a better understanding of health professionals’ perceptions of the use of lay educators and group education approaches for prenatal education
  2. Develop a better understanding of system issues that facilitate or hinder implementing these service delivery strategies in healthcare systems that serve low-income and uninsured Latinas

The study team achieved these aims through a series of key informant interviews with health care administrators (n=16) and a pilot electronic survey of health care professionals (n=104).

Phase 2 Aims

Through this study, we wanted to:

  1. Develop and field-test a bilingual Teach-With-Stories (TWS) prenatal lay educator outreach training and evaluation program package.
  2. Determine the effectiveness of the participatory TWS prenatal education program for Latinas led by trained lay health educators (LHE) as compared to the outcomes of a control match group receiving usual care on birth outcomes and utilization, such as prenatal, post-partum, well-baby, and emergency visits.

A Plan-Do-Study-Act (PDSA) cycle methodology was used to develop and refine the TWS prenatal care photonovels and training materials. 


TWS Phase 2 Poster Presentation

 Phase I Results

For a summary of the survey findings:  Improving Prenatal Care for Hispanic Mothers: Health Professional Perspectives

 Phase 2 Results 

For a summary of the Phase 2 findings:

Participatory Group Prenatal Education Using Photonovels: Evaluation of a Lay Health Educator Model with Low-Income Latinas

See also Poster Presentation at 2012 NIH National Summit on Reducing Health Disparities.

Teach-With-Stories Phase 2 Results

2012 NIH POSTER Phase 2 Results (pdf)