Experience, communication and trust: the role of cultural health navigators in mediating refugee families' access to health literacy and pediatrics care

This dissertation explores findings from a year-long investigation of the context-driven practices, strategies and beliefs of five multilingual Cultural Health Navigators (CHNs) working in a local pediatrics clinic serving large numbers of refugee families from a variety of cultural backgrounds who are experiencing a range of healthcare challenges. Grounded in a methodology of engagement (Grabill, 2010), this inquiry systematically documents and analyzes the range of ways in which the CHNs assist refugee families and their healthcare providers, their rationale for the decisions made and actions taken, and their concerns about the challenges they encounter. I show that while much of what the CHNs do to assist refugee families and their healthcare providers is routine and can be expected, CHNs also tend to manage complex work involved in mediating refugee families’ interactions with healthcare providers and the healthcare system in ways that cannot always be anticipated in advance. Through a close analysis of their practices and reflections, I show how their various interactions, actions and decisions are responsive to specifics of the situation at hand, informed by their lived experiences as CHNs and immigrants/refugees, and influenced by a dynamic, emergent and embodied notion of context. The findings of this study demonstrate how the CHNs’ collective and distributed knowledge production work shapes experiences with acquiring health literacy, and the material consequences of such efforts and practices.

Drawing on ethnographic research methods and critical-incident methodologies that involved the CHNs in the inquiry process, this study provides a nuanced analysis of the different kinds of work they do, the constraints they encounter, and how they creatively respond to such constraints in real time. The findings demonstrate that a collaborative engagement with critical incidents as a method of intercultural inquiry facilitates a more robust and dynamic understanding of the distributed nature of decision-making practices and ways of knowing. Embodying sensitivity to situated ways of knowing and dynamic practices in institutional settings, this study demonstrates the value of combining social science methodologies with rhetorical inquiry methods to conduct interdisciplinary and cross-institutional research to address pressing social problems in ways that benefit historically marginalized groups.