Guiding Principles for Cultural Broker Programs in Health Care Settings

Health care organizations should carefully consider the values and principles that frame their approach to the provision of services and supports and that govern their participation in community engagement. A major value of cultural and linguistic competence involves extending the concept of self-determination beyond the individual to the community (Cross et al, 1989; Goode, 2001). Communities have the inherent ability to recognize their own problems, including the health of their members, and to intervene appropriately on their own behalf (Goode, 2001). The NCCC adopted the following principles for community engagement (Brown, Perry, & Goode, 2003) based on this value:

• Communities determine their own needs.
• Community members are full partners in decision-making.
• Communities should economically benefit from collaboration.
• Communities should benefit from the transfer of knowledge and skills.

The values that govern community engagement are commensurate with those of cultural brokering. Similarly, the following principles are essential to developing and sustaining effective cultural broker programs.

CULTURAL AND LINGUISTIC COMPETENCE GUIDE CONNECTIONS WITH COMMUNITY When patients at La Clinica Latina at the Ohio State University Medical Center first see clinic co-director Cregg Ashcraft, M.D., they see a non-Hispanic male physician and assume he doesn’t speak Spanish. Ashcraft, who grew up in Mexico, and later practiced there and in many Latin American countries, says his bilingual skills are essential to providing primary and preventive health care to a Latino population that is mostly undocumented and low income. He requires that Spanish-speaking clinicians provide the array of services offered by this clinic. Many of the providers and staff represent the patients’ diverse countries of origin. This diversity acknowledges group differences among the Latino population. Ashcraft says his language skills and experience guide his effort to “ understand as best as I can the situation that people are in.” Ashcraft has assumed the role of cultural broker,both as a physician in his clinical practice and as an administrator influencing policy supporting the use of cultural brokers.

Cultural brokering honors and respects cultural differences within communities. There is a high degree of diversity within any given community. This diversity may not be readily apparent to individuals and organizations that seek to provide services to these communities. Cultural broker programs must be attentive to how community members identify themselves. Self-identity is influenced by historical, social, economic, generational, and other cultural factors. It is essential that health care organizations: recognize and respond to cultural differences within communities, including those whose members speak the same language; acknowledge the strengths of bicultural and multicultural practitioners and staff; and be knowledgeable of group differences including how individuals self-identify. Honoring and respecting diverse characteristics and the complexity of these dynamics are inherent in providing culturally and linguistically competent service delivery.