Information is property of the National Center for Cultural Competence, Georgetown University Center for Child & Human Development
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 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.
Cultural brokering is community driven.
A major principle of cultural competence and community engagement is the recognition that communities determine their own needs. Health care settings that have structures and personnel to gauge the strengths, perceived needs, and preferences of diverse communities are well positioned to integrate a cultural brokering program. This process, commonly referred to as asset mapping, assists the health care setting in identifying community members who have a natural instinct for listening to, leading, and organizing their peers and who can function more effectively as cultural brokers at multiple levels.
Cultural brokering is provided in a safe, non-judgmental, and confidential manner.
Health care settings must ensure that cultural brokering programs are conducted in a safe, non-judgmental, and confidential manner. This requirement means that each aspect of this principle is incorporated into the organizational philosophy, infrastructure, and practice model. This includes, but is not limited to, articulating values and principles and establishing procedures to ensure that providers, staff, cultural brokers, and patients/consumers understand and accept this approach to service delivery.
- Building a community network of cultural brokers/medical interpreters. The MATCH program conducts medical interpreter training for individuals speaking South Asian languages who work with the Hmong refugees. An interpreter training curriculum, “Bridging the Gap,” developed by the Cross Cultural Health Program in Seattle, WA, has been adapted for the Laotian languages of Hmong, Lao, and Mien. This curriculum, “Connecting Worlds,” has sections that are taught in these Laotian languages
- Leadership and workforce development. Campesinos sin Fronteras hires women trained as promotoras into leadership and administrative positions for the migrant health program in Yuma, AZ. Grant writing and development skills are taught to women who are interested in the administrative aspect of health education. They learn professional skills in communicating with health care foundations, government health agencies, and other collaborators, such as the Yuma County Division of Health and Human Services and the University of Arizona College of Public Health
A COMMUNITY’S SELF-IDENTITY INFLUENCES COMMUNICATION AND OUTREACH
Having grown up in East Los Angeles and being only the second child in her extended family to go to college, long-time community health advocate Sandy Bonilla always considered herself a “ Chicana* from the barrio.” A former youth violence and drug prevention consultant to the U.S. Department of Health and Human Services in Washington, DC, who spent years doing outreach in Latino communities, Bonilla returned to California to work at Casa de San Bernardino, Inc., a nonprofit, county-funded health center in a low-income neighborhood. About 60% of the Latino population in the community is second- and third-generation Mexican and call themselves Chicano,* a term that has social and national significance for Mexican Americans, particularly in the West and Southwestern United States.
Bonilla felt her childhood experiences and years spent working with Latino non-profit community groups easily prepared her for grassroots work with youth at high risk in this neighborhood. She quickly realized, however, that, unlike her work in Washington, DC, communities, she had to be careful not to use the terms Latinos and Hispanics interchangeably in this particular neighborhood, as Chicanos perceived Latino as someone from Latin America and Hispanic as someone with Spanish blood. Her colleagues also told her not to use the term Mexican American, because Chicanos associated Mexican with the growing number of Mexican immigrants in the community with whom they say they compete for low-wage jobs. Terminology used to self-identify was also important for other individuals of color in the community. Bonilla says, “You don’t say African American here. It has an academic connotation. You say Black.” Understanding and using the terms that the community uses to identify itself was an important factor in taking the first steps to communicate successfully with teens and other project participants in the community.
Knowledge, Skills and Awareness for Cultural Brokers
Cultural brokers require a set of competencies that enable them to work cross-culturally and that include, but are not limited to, awareness, knowledge, and skills as described below.
Awareness. Cultural brokers are aware of (1) their own cultural identity, (2) the cultural identity of the members of diverse communities, and (3) the social, political and economic factors affecting diverse communities within a cultural context.
Knowledge. Cultural brokers innately understand (1) values, beliefs and practices associated with illness, health, wellness, and well-being of cultural groups; (2) traditional or indigenous health care networks within diverse communities; and (3) medical, health care, and mental health care systems (e.g., health history and assessment, diagnostic protocols, and treatment and interventions).
Skills. Cultural brokers have a range of skills that enable them to (1) communicate in a cross-cultural context, (2) communicate in two or more languages, (3) interpret and/or translate information from one language to another, (4) advocate with and on behalf of patients/consumers, (5) negotiate health care and other service delivery systems, and (6) mediate and manage conflict. Commensurate with the conceptual framework of cultural competence, the knowledge and skill levels of cultural brokers are also along a continuum. Knowledge acquisition is not a discrete process; instead, it evolves over time leading to levels of proficiency.
COMMUNITY CHARACTERISTICS
Effective cultural brokers are cognizant of the multiple factors impacting community diversity. These factors include, but are not limited to the following: geographic location, population density, population stability, age distribution of population, social history, intergroup relationships, and the social, political, and economic climates of communities served (Goode, 2001).
INDIVIDUAL AND GROUP CHARACTERISTICS
Other factors influencing diversity among individuals and groups are race and ethnicity, language, nationality, clan or tribal affiliation, acculturation, assimilation, age, gender, sexual orientation, educational literacy, social economic status, political affiliation, and religious and spiritual beliefs (modified from James Mason, Ph.D., NCCC senior consultant).
