A participatory approach to health care communication promotes dialogue between the provider and the patient. As Zarcadoolas, Pleasant and Greer wrote, “The participatory approach redefines exactly who should be considered an expert." Who do you think the expert is; the patient or the healthcare provider?
In an expert-oriented model of health communication, it is assumed that the medical professional has superior knowledge and experience and that the patient has inferior knowledge and experience. In a participatory model, the focus is on listening to the patient, on entering conversations with knowledge of cultural context, and engaging in back and forth dialogue between provider and patient in order to build a mutual understanding.
The participatory model can become strained when the patient does not have adequate English proficiency, when the patient is unable or unwilling to communicate sensitive health information, or when the provider lacks adequate cultural or linguistic knowledge.
Cultural brokers help to bridge cultural and linguistic divides between patient and provider in order to optimize health outcomes for the patient.
Cultural Brokers And The Participatory Communication Model
Cultural brokers exist within a category of healthcare advocates alongside interpreters and translators, but with a few key differences. An interpreter or translator provides linguistic support only, such as when English is not someone’s first language. The interpreter or translator acts as a language conduit between provider and patient. In an expert-driven environment, you might find interpreters and translators but you may not be as likely to find a cultural broker.
Bronheim describes the cultural broker as a liaison, a cultural guide, a mediator and, in some instances,
“…a catalyst for change to assist health care providers and organizations in adapting policies and practices to the cultural contexts of patient populations and communities served."
The cultural broker goes beyond the mechanics of what is being said and includes the “why” and the “how” of what is being said, for the benefit of both the provider and the patient.
A Great Example Of A Cultural Broker In Action
Zarcadoolas et. at. provided an excellent example of the role of a cultural broker in their chapter, Highlighting the Role of Cultural Literacy, Part 2, Diabetes and Native Americans.
The issue at the center of the case study presented was the nutritional health of Native Americans, specifically when it came to the prevention of diabetes. Health professionals serving these populations were noticing a startling upward trend in diabetes prevalence, especially when compared with the general population.
One of the culprits of this trend was poor diet. Western food guides and food pyramids were not culturally relevant to these Native American groups, as many of the foods included on the charts they did not eat and the proportions of certain foods was not what they were accustomed to eating. As Zarcadoolas et. at. pointed out, there were issues of both health literacy and cultural misalignments at the root of the problem.
Enter Kibbe Conti, a dietician and diabetes educator who worked primarily with Native American populations. Conti realized that the traditional, Western nutritional models were not serving her patient’s needs. Her participatory fact-finding approach included speaking with tribal leaders and tribe members about the issue in order to expand her own cultural context and develop a culturally sensitive nutritional model. Conti worked with this group to develop the Four Winds Nutrition Model which,
“…reflects Lakota and other Plains Indians’ historic food choices… A quickly noticeable difference between the USDA’s food pyramid and the Four Winds Nutrition Model is the removal of the dairy group as a distinct group because dairy was not historically in the Plains Indians’ diet."
Not only did this new nutritional model honor the culture and history of the target populations, but also it was careful to name foods readily available to them in their own communities. Conti exemplified the role of the cultural broker by deeply considering the cultural context of the target population and creating tools and communications that respected and reflected that context while keeping specific health objectives in mind.
Cultural Broker, Liaison, and Mediator
Another role a cultural broker can play is to act as liaison and mediator between patient and provider. A patient may experience shame or embarrassment when in a doctor’s office, due to a reluctance to counter the opinions of a respected medical professional, and may not give and get the information he needs while seeing the provider.
If you would like to learn more about these roles, check out this great talk from Mental Health American of Middle Tennessee called: Working effectively with mental health interpreters.
In order for diverse populations to be served well and enjoy the best health outcomes, consideration must be given not only to the translation of words, but to the interpretation of the meaning behind those words.
As Zarcadoolas et. al wrote, “Culture is language, patterns of behavior, beliefs, identity, customs, traditions, and other modes of expression." Zarcadoolas et. al. put it simply when they wrote that "...culture is common sense."
In the participatory model of health care delivery, time and space is created to allow for conversations and understanding to unfold around cultural differences and preferences. The best healthcare providers and treatment programs build in the time and space to foster mutual understanding.
The intersection of the provider’s common sense and the patient’s common sense is a complex opportunity for conflict or clarity to arise. Cultural brokers stand at that intersection, nimbly playing whichever role they are called to: translator, mediator, cultural guide, interpreter or a combination of all.
Bronheim, S. (2011). Promising practices: Cultural brokers help families and providers
bridge the cultural gap. National Center for Cultural Competence, Georgetown University Center for Child and Human Development: Washington, DC.
Zarcadoolas, C., Pleasant, A. F., & Greer, D. S. (2006). Advancing health literacy: A
framework for understanding and action. San Francisco, CA: Jossey-Bass.
Working effectively with mental health interpreters, MHA of Middle Tennessee.