Cultural Barriers and Health: Umbrella Multicultural Health Cooperative

The Workplace Integrated Demonstration Projects (WID), launched by the Foundation for Advancing Family Medicine, were grant initiatives designed to strengthen the comprehensive primary care workforce through training, mentorship, and coaching. These projects aimed to expand interprofessional teams, enhance primary care practices, and develop curricula to improve the delivery of comprehensive care.

Cultural barriers are significant challenges for new immigrants and refugees. The British Columbia-based Umbrella Multicultural Health Cooperative (UMHC) has launched the “Equity in Practice” initiative through the support of the Foundation for Advancing Family Medicine’s Workplace Integrated Demonstration (WID) Projects Grant funded by Employment and Social Development Canada. This initiative builds on the UMHC’s existing Cross-Cultural Health Brokers (CCHB) model to expand its capacity to address the unique health and wellness needs of Canada’s ethnically diverse and multilingual population. 

CCHBs are bilingual/bicultural health workers who are crucial in bridging language and cultural gaps. These brokers support the vital connection between patients and health care systems, assisting individuals from their communities access medical and social services. Brokers do more than translate—they act as a bridge between patients and the health care system, helping with navigation, accessing specialists, labs, and imaging, and advocating on patients’ behalf. The UMHC’s innovative model integrates the CCHB role into a primary care team to provide more equitable care to immigrants and refugees who face barriers to the health care system. 

Structured by the Learning Health Systems framework, Phase One of the project, “Data to Knowledge,” focused on hiring and onboarding new CCHBs and developing an evaluation framework tailored to team-based primary care. The CCHBs work with people in four ethnocultural communities: Middle Eastern (Arabic-speaking), Iranian/Afghan (Farsi/Pashto/Dari speaking), Latin American (Spanish speaking), and Eritrean (Tigrinya/Amharic speaking). With the expansion of CCHB capacity from one to two brokers per community (with one being part-time), the project aimed to refine their collaboration to form a highly functional team. 

Phase Two, “Knowledge to Practice,” moved from theory to practice, integrating CCHBs into the team and emphasizing relationship-based care. Workshops modelled team-based care, enhancing understanding and collaboration within the team, and developed workflows for standard processes like prescription refills. This phase included coaching in team-based care to improve role clarity and cooperation in group settings. Facilitated workshops focused on learning about communication and health equity, improving team cohesion, and adapting to feedback for more efficient engagement. This collaborative effort has enhanced team function through modelled practices during training and workshops. 

This project’s impact is profound, fostering connection within the team and facilitating discussions on identity, community, and policy development focused on respect, reciprocity, and relationships. This initiative has enabled the UMHC to better serve its community and articulate the benefits of expanded CCHB capacity to stakeholders. This comprehensive approach, underpinned by the values of health equity and racism-free practices, sets a benchmark for delivering culturally sensitive health care.