Table 3.

Example quotes for thematic domains 3 and 4.

Theme 3: Navigating and facilitating access to care
Thematic domain	Example quotes
Navigating and facilitating access to care	It’s important to focus on health before anything but we always target whatever is needed immediately to have—to find a doctor that speaks your language or maybe doesn’t speak your language but is receiving new patients is one challenge, that is close to your area is another. Then you finally find a doctor and we go from family doctor, pediatrician, if there is something going on with a family trying to find a specialist
Sensemaking of primary care and the importance of continuity of care	They’re not used to going for check-up. So going to doctor is kind of in some area a taboo, like you must be very sick. So having that mentality like you know, if I go to doctor that means I’m really sick, I’m not very well. So they kind of very closed to accept some medication or to accept like a service. They will be very much doubting and they’re not like openly even discussing their problem cause if they tell them and then they probably give them this chemical medicine and what are we going to do. And yeah, it’s going to doctors not as positive for a lot of people and it’s kind of stressed them. But then what I find is sometimes clients do not understand how important is—these follow up appointments are. They came from a culture they only see the doctor when the baby is about to come out. They see this is not necessary. But us brokers, we play a role in educating them, talking to them, and addressing these issues, yeah.’ Again, it might be a(n issue with) time and resource and also the relationship… does the client understand why am I booking this appointment again. You know? How important it’s—for the many times I will hear from a mom my health is unimportant, I am not going, I don't think it’s necessary. Do the, you know, that understanding and I think that the bottom line will be the relationship is. They need, you know, understanding that this is very important for them to assess, this will be the benefits. I think that really, that piece need to be addressed.

Theme 4: Facilitating communication and provider–patient relationships through cultural interpretation
Thematic domain	Example quotes
Overcoming challenges to communication	Here the issue is being targeted and the information is provided but not in a way that the family feels comfortable and sometimes it’s only in one language only and even if you try to interpret the information when it’s delivered is not coming from the doctor. It’s coming from the interpreter.(…)Whereas if a physician knows a little bit more of a family they would understand that this family are either refugee or just new immigrants that are trying to, you know, live day by day and get by and survive, right? There is no such a thing as salads on the table because that doesn’t fill me or my child
Nurturing relationships and facilitating meaningful conversations	Sometimes I just go to the dietitian or the nurse or whomever have seen the family and I just try to deliver the message in a more cultural way, right? Like I try to say it in words that the client can actually understand that this is not a statement for you to feel bad or nobody here is judging you. You know, my role also sometimes will start with also engaging with the doctor asking—when I see my client does not understand what’s going on, I will ask the doctor to—would you mind taking the time and explain that to her. Sometimes what I say is not heard, but what you said will be heard. So, yeah, talking, you know, starting with the doctor.
Brokers as partners in healthcare team	I would like to see actually—many times I see the physicians or the doctors will not directly communicate with us. I would like to see—establish that relationship between—close relationship between the healthcare team and the brokers so that we can together address the family’s issues and help them, yeah.
Bidirectional cultural interpretation	For me to be in this process, when somebody has diabetes or obesity, we have to prepare before going to the doctor. Or not to be offended by what the doctor said, or to know what they answer or what to ask the doctor. They can prepare then before. To do the information.
Culturally safe communication and health education	So the word obese, I can’t mention. I can’t even say it to her even though I see that she needs a lot help. But I try as much as I can to say. I went with her to the Leisure Access and I said, ‘You know, while he is doing swimming lessons, let’s walk. That’s healthy. She accepted that which was really good because I didn’t want to say to her that’. But I said, ‘While they are teaching him, why are you sitting there? You don’t need to sit. You can walk the stairs and if you don’t want to do exercise, people they are walking. Do you see those people?’ She said, ‘Yeah, you are right. I have to walk’. That she started doing which is really great. She didn’t feel that I am going into her privacy but she felt it. She said, ‘You are right. I need to do that’. We go back to why is my child obese. Is there a reason why my child because if you hear your child is obese, well you’re judging me, right? You don’t know where I come from, what I do and what I don’t, you know.(…)but I would say that like every mother in the world and I have seen it where there is African, Asian or American, mothers are always looking after the best interest of the children. So, I think if the conversation starts first by acknowledging that they want the best for their children and everything is done with love and you know, dedication and so much compassion. I think if a physician says, you know, I know you love your child so much and this and this and that so I would strongly recommend you that, it comes—the delivery of that information comes out much easier to hear than if someone says your child is overweight because it’s more like attachment than kind of a family matter and we go back why. Obesity is there but if I translate in my language, it would be too much. They would feel like, ‘Oh, what are you talking about’? Sometimes a visual picture is good because they can see, even though we didn’t say anything. They will understand. Some of them they worry about their kids who are obese. Because I see a lot in my community their kids, they are obese. The parent who understands, they worry. The woman who doesn’t understand, they think that it’s healthy.