National Center for Cultural Competence

NHSC PROVIDERS LINK APPALACHIAN COMMUNITIES AND CARE

The Southern Ohio Health Services Network, also called the Network, instituted policy and practices to increase access to health care and mental health services and to recruit and retain a cadre of NHSC clinicians committed to rural Appalachian communities. The Network required physicians to live in the communities they serve, which fostered closer ties, mutual respect, and trust between providers and families. The Network also created an array of supportive services including schoolbased health clinics, multidisciplinary teams, integrated mental health services, and community-based social work services. All were responsive to the needs and preferences of the families and communities. Such policy and practices promoted cultural brokering as an essential component in the delivery of health care and mental health services within this Network. Kim Patton, the Network’s executive director, states that the physicians are more attuned to their patients’ life—from the foods they eat to their values, beliefs, and perceptions about health and illness. Of the 43 physicians in the Network’s system, 15 are NHSC providers, and many stay on with the Network after their service period expires. Providing health care using a community-focused, culturally competent approach has helped create this continuum and improve access to services within these Appalachian communities.

BREAST HEALTH AWARENESS BAG BENEFITS GENERATIONS OF WOMEN

In Washington, DC, the Howard University Cancer Center offers a Breast Health Awareness bag to teen girls who participate in the “ Project Early Awareness” breast health education program. Cultural brokering is an essential aspect and adds to the success of this program. The health education model uses a young cancer survivor, Kimberly Marks, as a cultural broker who is credible with, and leaves a lasting impression on, young women participating in this program. “They know I’m only a little bit older than them,” Marks says. “It makes my experience more real to them.” Participants receive a bag after they have learned breast cancer detection skills. This bag includes a breast self-exam shower card, a plastic breast model, and other educational information. It also contains a card that their mothers, grandmothers, or other female relatives can complete and send back for a free gift. The materials found in the bag serve as useful health education information for the girls and for other women in their families.

Benefits to the Patient/Consumer

Patients/consumers who have positive experiences with cultural brokers will be more likely to continue to access services, which potentially improves health outcomes and reduces health disparities.
Patients/consumers will recognize the health care setting’s commitment to deliver services in a manner that respects and incorporates their cultural perspectives.
Patients/consumers may be motivated to seek care sooner when they know that providers understand and respect their cultural values and health beliefs and practices.
Patients/consumers may be able to communicate their health care needs more effectively and better understand their diagnoses and treatment.
Patients/consumers who benefit from this approach may also encourage others within their community to access and use services. This approach has the potential to positively impact the health of the entire community.

Another important benefit of cultural brokering is the potential to increase retention of NHSC providers. They make a career commitment to serve vulnerable populations because it is a positive experience that gives them a sense of fulfillment.