Making Connections: Cultural Brokering Programs Help Bridge the Gap between Providers and the Community

April 21, 2009
Sean Johnson

FOCUS Multicultural Healthcare, March 2009, Volume 5, Issue 1

Cultural brokers can be an effective resource for physicians and other healthcare professionals who treat an ethnically and culturally diverse patient population.

Cultural brokers can be an effective resource for physicians and other healthcare professionals who treat an ethnically and culturally diverse patient population. They act as liaisons, guides, mediators, and facilitators, enhancing communication between physicians and their patients.

The use of an intermediary to facilitate the transfer of information between two or more parties has long been the standard in many industries. These facilitators, called brokers, are an intricate part of the financial and real estate industries, because their knowledge makes them an excellent conduit between buyers and sellers, and providers and consumers of services. When it comes to translating industry rules and lingo into layman’s terms or being able to make sense of a situation that might be hard for an outsider to understand, brokers can be the “glue” that keeps everyone on the same page.

Consider then the communication barriers that often face healthcare providers and their patients. Healthcare professionals have seen a steady increase in the diversity of their patient population as the United States strives to live up to its reputation as a cultural melting pot (though some observers have likened our society more to a stew-like mixture of cultures). Of course, some geographic areas have seen a more dramatic shift in diversity than others, but as time goes on, it’s inevitable that patient populations will change. Thus, it’s important for healthcare providers to understand the diverse belief systems that their patients may have toward health, wellness, and healing, just as it is important that patients trust the medical advice given to them by their doctor. In addition, language barriers can create problems and miscommunications, which can be problematic in many ways, for example when it comes to medication adherence. So, if there seems to be a growing gap between healthcare providers and patients due to various cultural differences, why shouldn’t the healthcare industry take advantage of brokers? That’s the question that some organizations have answered by enacting programs to define the role of a cultural broker.

The National Center for Cultural Competence (NCCC), whose mission is to “increase the capacity of health care and mental health care programs to design, implement and evaluate culturally and linguistically competent service delivery systems to address the growing diversity and persistent health disparities,” is one of the organizations dedicated to helping define the role of the cultural broker. With the help of government funding, the NCCC was able to develop the idea of cultural brokering programs by implementing this role into select community health centers. Tawara Goode, Director, National Center for Cultural Competence, Georgetown University Medical Center, says “We uniquely looked at the concept of cultural brokering and realized that it can be important in bridging the gap between healthcare institutions and individuals as well as healthcare institutions and communities. The NCCC documented cultural brokering programs from across the country with funds from the Health Resources and Services Administration and worked with community health centers to help them develop cultural brokering programs. That was very exciting work, so we have extended the concept to look at cultural brokering, and in particular, children with disabilities and special healthcare needs—and how we can use cultural brokering with this population. So, cultural brokering is not ‘population-specific,’ but we think it is an essential tool and approach, and one way of addressing disparities.”

Naturally, the needs for individual healthcare organizations can differ greatly. Those who have a very diverse population or deal exclusively with minority patients stand to benefit greatly from using a cultural broker in their day-to-day activities. “A community health center that we worked with in Washington, DC decided it wanted to redefine some of its positions to ask staff to assume the role of cultural brokering because it was so important,” says Goode. “Given the immigrant and refugee population that they were seeing, they needed that community liaison to be out there and to really help bring people in and support them in the provision of care.” By having someone they can relate to, patients can be more at ease and feel a certain comfort level knowing that their cultural broker is there to support them.

By implementing these programs, the NCCC has gained valuable experience and has consequently been a primary source of information dissemination covering the benefits of cultural brokers. An extensive, 30-page monograph, Bridging the Cultural Divide in Health Care Setting: The Essential Role of Cultural Brokering Programs, can be downloaded for free through the NCCC’s website and includes information to help you become more familiar with the role of a cultural broker, and how you can implement this position into your healthcare setting.

Although the concept may be new to some, cultural brokers have been active in the healthcare setting for some time, acting under various titles. “Many organizations use cultural brokers and may refer to this function differently,” says Goode. “For example, promotoras is a concept and approach within many Latino communities. ‘Health navigator’ is another term that is sometimes used.” In addition to relying on their knowledge of the communities in which they live, many promotoras also have extensive formal training and experience that they can apply in their roles as liaisons, guides, and facilitators. Promotoras have also been employed to great success in planned parenthood, diabetes care, cardiovascular disease, and telemedicine.

The role of a cultural broker, no matter the title, has great potential in the healthcare field. However, as is the problem with many programs in their beginning stages, as the evidence on their efficacy continues to emerge, it may be hard to sustain them. “The issues are how do we train them, how do we support them financially, and how do we sustain it?” says Goode. The NCCC is here to help. Among the information included in Bridging the Cultural Divide in Health Care Settings: The Essential Role of Cultural Broker Programs is a chapter dedicated to implementing and sustaining this role, which contains checklists and instructions on how to go about successfully incorporating this role into one’s practice. In addition, those interested in learning about the successes of cultural brokering programs should access the materials listed above. Like anything, it will take time in the short term to successfully implement a cultural broker; however, in the long term, providers can expect better communication and a better relationship with their patients, and, consequently, improved patient care.

More on Cultural Broker Programs

  1. Bridging the Cultural Divide in Health Care Settings: The Essential Role of Cultural Broker Programs
  2. The Culture Broker Role: Ideas from Rehabilitation Models
  3. Immigrant Adolescents Behaving as Culture Brokers: A Study of Families from the Former Soviet Union
  4. Clinical Nurse Specialists as Cultural Brokers, Change Agents, and Partners in Meeting the Needs of Culturally Diverse Populations

More about Promotoras

  1. The Promotora Telemedicine Project: Combining Technology and Cultural Sensitivity to Improve Diabetes Care in a Medically Underserved Community
  2. Promotoras in Planned Parenthood
  3. Promotoras in Diabetes Care
  4. A Promotora de Salud Model for Addressing Cardiovascular Disease Risk Factors in the US-Mexico Border Region
  5. The Role of Promotoras and Community Health Workers in Language Access and Cultural Competence Families