Physician Learning Program, University of Alberta Faculty of Medicine and Dentistry, Edmonton, Alberta, Canada.
Multicultural Health Brokers Cooperative, Edmonton, Alberta, Canada.
BMJ Open. 2023 Sep 13;13(9):e073318. doi: 10.1136/bmjopen-2023-073318.
Diabetes and obesity care for ethnocultural migrant communities is hampered by a lack of understanding of premigration and postmigration stressors and their impact on social and clinical determinants of health within unique cultural contexts. We sought to understand the role of cultural brokering in primary healthcare to enhance chronic disease care for ethnocultural migrant communities.
Participatory qualitative descriptive-interpretive study with the Multicultural Health Brokers Cooperative in a Canadian urban centre. Cultural brokers are linguistic and culturally diverse community health workers who bridge cultural distance, support relationships and understanding between providers and patients to improve care outcomes. From 2019 to 2021, we met 16 times to collaborate on research design, analysis and writing.
Purposive sampling of 10 cultural brokers representing eight different major local ethnocultural communities. Data include 10 in-depth interviews and two observation sessions analysed deductively and inductively to collaboratively construct themes.
Findings highlight six thematic domains illustrating how cultural brokering enhances holistic primary healthcare. Through family-based relational supports and a trauma-informed care, brokering supports provider-patient interactions. This is achieved through brokers' (1) embeddedness in community relationships with deep knowledge of culture and life realities of ethnocultural immigrant populations; (2) holistic, contextual knowledge; (3) navigation and support of access to care; (4) cultural interpretation to support health assessment and communication; (5) addressing psychosocial needs and social determinants of health and (6) dedication to follow-up and at-home management practices.
Cultural brokers can be key partners in the primary care team to support people living with diabetes and/or obesity from ethnocultural immigrant and refugee communities. They enhance and support provider-patient relationships and communication and respond to the complex psychosocial and economic barriers to improve health. Consideration of how to better enable and expand cultural brokering to support chronic disease management in primary care is warranted.
由于缺乏对移民前和移民后压力源及其对独特文化背景下健康的社会和临床决定因素的影响的理解，民族文化移民群体的糖尿病和肥胖症护理受到阻碍。我们旨在了解初级保健中的文化中介作用，以增强民族文化移民群体的慢性病护理。
在加拿大城市中心的多元文化健康经纪人合作社进行了参与式定性描述性解释研究。文化经纪人是语言和文化多样化的社区卫生工作者，他们缩小文化差距，支持提供者和患者之间的关系和理解，以改善护理结果。在 2019 年至 2021 年期间，我们进行了 16 次会议，以合作研究设计、分析和写作。
从代表八个不同主要当地民族文化社区的 10 名文化经纪人中进行了有针对性的抽样。数据包括 10 次深入访谈和两次观察会议，通过演绎和归纳分析来共同构建主题。
研究结果突出了六个主题领域，说明了文化中介如何增强整体初级保健。通过基于家庭的关系支持和创伤知情护理，经纪人支持医患互动。这是通过经纪人（1）在社区关系中的嵌入，对民族文化移民群体的文化和生活现实有深入的了解；（2）整体、背景知识；（3）协调和支持获得护理；（4）文化解释以支持健康评估和沟通；（5）解决心理社会需求和健康的社会决定因素；（6）致力于随访和家庭管理实践。
文化经纪人可以成为初级保健团队的关键合作伙伴，为来自民族文化移民和难民社区的糖尿病和/或肥胖症患者提供支持。他们增强和支持提供者与患者的关系和沟通，并应对复杂的心理社会和经济障碍，以改善健康。考虑如何更好地使文化中介发挥作用并扩大其规模，以支持初级保健中的慢性病管理是值得的。
