Why use an intercultural mediator?
Instead of doulas who are unskilled, the WHO recommends using trained intercultural mediators. Intercultural mediators are used to improve the accessibility and quality of health care for migrants and refugees, by reducing cultural and linguistic barriers.
The intercultural mediation between health care providers and refugee/migrant patients can:
- Facilitate communication.
- Improve the therapeutic relationship by enhancing intercultural understanding.
- Increase patient participation in health promotion and education programs.
- Reduce the perceived level of discrimination.
- Contribute to adapting health services to the cultural characteristics and needs of refugees and migrants.
- Build trust and facilitating the therapeutic relationship.
The different roles performed by intercultural mediators in health-care interventions:
- Linguistic facilitation – Interpreting and transmitting messages in one-to-one meetings between health-care providers and patients who do not share a common language.
- Bridging sociocultural gaps – Intercultural mediators perform this function by explaining and contextualizing messages and situations for both participants; they may also explain the sociocultural values and norms underlying their language, behavior or practices. They may also be involved in planning, designing, implementing and evaluating interventions tailored to the needs of refugees and migrants.
- Preventing conflict and supporting resolution – The issues may relate to divergent views of health and healing, and highlight the possibility that cultural values related to topics such as informed consent, truth-telling and end-of-life decision-making may be incommensurable.
- Supporting integration and empowerment and providing advocacy – Intercultural mediators function as agents of integration by providing information to refugees and migrants on the existing social and health services and their rights and entitlements to these services; they help refugees and migrants to interact with these public services.
- Building trust and facilitating the therapeutic relationship – This role may include assisting both patients and health-care providers to make the most of the health care encounter, for example through encouraging the patient to ask questions and prepare for the consultation and suggesting communication or other strategies to the health-care provider to facilitate the interaction.
- Providing psychosocial support, health education/counselling and co-therapy –Different types of psychosocial support are frequently provided by intercultural mediators, including general psychosocial support, acting as liaison inside and outside medical settings (including accompanying patients to different administrative/ therapeutic meetings and administrative and practical help. Health education and health promotion can be provided by group sessions led by an intercultural mediator, one-to-one meetings, and by adaptation of health education material. In mental health consultations, intercultural mediators are sometimes involved as co-therapists, for example taking part in group therapy or engaging in role play with the patient.
The World Health Organization, 2019, Health Evidence Network Synthesis Report 64 - What are the roles of intercultural mediators in health care and what is the evidence on their contributions and effectiveness in improving accessibility and quality of care for refugees and migrants in the WHO European Region? https://apps.who.int/iris/bitstream/handle/10665/327321/9789289054355-eng.pdf