Empowering trusted intermediaries to navigate the complex challenges of COVID-19 vaccination in ethnocultural communities

Context: Cultural health brokers are intermediaries between community and formal systems bridging cultural, linguistic, and knowledge gaps.

Objective: Understanding how brokers addressed the evolving complexity of COVID-19 vaccination in their communities through sensemaking, a continuous process to establish situational awareness to support understanding and action.

Study Design and Analysis: We partnered with twenty-eight brokers capturing their self-reflections and our weekly group 90 minute discussions from Sept. 16 to Dec.16, 2021 as they navigated COVID-19 vaccination controversies in their communities. Reflections were captured in the SenseMaker platform, a mixed-methods data collection tool and the weekly sessions were recorded, transcribed and managed in NVivo. Inductive and deductive coding, iterative triangulation with the Broker reflections and our analytical and reflexive thinking constructed themes.

Setting/Population: The multicultural health brokers co-operative of community cultural health brokers with immigrant and refugee lived experience, Edmonton, Canada serving 10 000 people from diverse ethnolinguistic communities.

Intervention: Real time outreach, information sharing, resource creation and pop-up clinics.

Outcome measures: 277 Real-time narrative data collection and self-interpretation in the Sensemaker platform, a mixed-method data collection tool. Transcripts of five final sessions focused on synthesis of learnings.

Results: Intermediaries work in contextually and culturally appropriate ways, leveraging trust with diverse fields they bridge, and mobilizing action by exaptation from previous experience in crisis navigation. There were four entwined components to navigation of the evolving complexity of COVID-19 vaccination: trust, relationships, creation of safe spaces for collective sensemaking and solution finding, and leveraging cultural and social capital to address challenges and barriers to meeting peoples’ needs. Brokers worked to reduce decisional conflict and misinformation to support people making informed, values-congruent decisions.

Conclusions: Supporting trusted intermediaries with existing relationships, solutions, and infrastructure will advance ongoing pandemic response and recovery efforts, and future emergency planning to strengthen the resilience of health systems.