9º World Congress on Health Information and Libraries

Salvador, Bahia - Brazil, September, 20 to 23 - 2005


4th Regional Coordination Meeting of the VHL

September, 19 to 20 - 2005

Levelling the Playing Field for the Underserved in Highly Multicultural Societies: The Role of Cross-Cultural Knowledge Brokers.


Background: Due to accelerating immigration, Canada is becoming an increasingly remarkable example of highly multicultural society. Toronto alone is home to more than a hundred ethno-linguistic groups. The Canadian health care system, however, is not ready to meet the needs and expectations of newcomers, including their information needs. Providers are busy and ill-equipped to deal with patients from diverse cultural backgrounds. Newcomers, in turn, face major problems accessing, navigating and negotiating the health care system. Innovative approaches are needed to bridge across cultures and reach out to those most in need.

Objective: This paper reports and elaborates on the implementation and evaluation of ‘Levelling the Playing Field’, a pilot intervention employing trained ‘personal health coaches’ who worked essentially as knowledge brokers to assist underserved patients from a variety of ethno-linguistic backgrounds in their effort to access health services.

Methods: The inte rvention was tested with a group of 46 underserved cancer patients. Personal coaches helped patients identify needs, access information, and use supportive care services. The intervention was evaluated in terms of increased patients’ knowledge, improved patient-provider interaction, and patient satisfaction. Triangulation was used to compare and contrast quantitative and qualitative evaluation data.

Results: Poverty, language and other cultural aspects represented significant barriers for most patients. An overwhelming majority of participants were highly satisfied with the ‘personal health coach’ intervention.

Conclusions: This intervention is a significant example of how new, creative strategies can support health care users, at risk of being marginalized due to language barriers and ‘cultural remoteness’, in their effort to navigate an unfamiliar health care system. As globalization increases the need to build health care systems able to serve highly multicultural populations, the importance of lessons learned working across cultures at the local level increases.