Intercultural mediators' role in the creation of person-centered care

Background: The number of people seeking asylum in Sweden reached a record level by 2015. Inequalities in the healthcare of migrants can lead to poor health outcomes and an unsatisfactory health meeting. Language translation is considered the minimum that should be offered to ensure the care recipients access to a good, safe and satisfactory care. Culture also has an impact on the recipient's experience of healthcare and consists of much that is unconscious and constantly changing in interaction with the individual's lived experience. Efforts to bridge the gap between migrant healthcare recipients and healthcare providers whom usually belong to a majority population, include the application of culturally competent care and strategies for "culture brokering". These methods do not however consider the lack of insight into the care recipient's cultural frame of reference. An Intercultural Mediator (IM) is themselves a migrant who, based on common denominators such as language, gender and shared experience of being immigrant can act as an intermediary or bridge builder during the healthcare meeting. Mediation can be used to highlight the care recipient's lifeworld story and promote a person-centered care that is not precluded by pre-defined opinions and stereotypes concerning the impact of culture, but instead addresses the person's vulnerability, resources and personal abilities. Aim: The aim of this study is to investigate IM's specific role and how the IM can contribute to a more person-centered care in the context of the healthcare meeting of short duration within in-patient settings. Method: The study is based on ethnography conducted through participatory observation, informal dialogue at a healthcare clinic and hospital in Malta. Results: The results are based on four categories describing IM's role in the creation of person-centered care for migrant care recipients; Being a fellow human, creating a bridge between care recipients and care providers, being a part of the team and balancing power situations and creating cultural awareness. Conclusions: An IM is an important addition to healthcare agencies. IM utilizes the dyadic conversation preceding the healthcare meeting to establish trust and prepare the care recipient for the encounter. During the triadic meeting with the care recipient and caregiver, the IM interprets and ensures that the participants understand each other. The IM's presence creates space for the migrant care recipient to express his needs based on his everyday reality and cultural reference frame. In highlighting the care recipient's story, the IM is able to contribute to a more person-centered healthcare meeting, which may result in a better outcome. However, the lack of organisation of mediation services, lack of cultural awareness amongst care providers as well as exclusion from the healthcare practitioners' community of practice may hinder the effectiveness and stability of mediation services