Primary Health Care Research & Development


Competence trust among providers as fundamental to a culturally competent primary healthcare system for immigrant families

Sandra Isaacsa1a2 c1, Ruta Valaitisa3, K. Bruce Newbolda4, Margaret Blacka5 and Jan Sargeanta6

a1 Assistant Clinical Professor, School of Nursing, McMaster University, Hamilton, Canada

a2 Senior Epidemiologist, The Public Health Agency of Canada, Ontario, Canada

a3 Associate Professor, Dorothy C. Hair Chair in Primary Health Care Nursing, School of Nursing, McMaster University, Hamilton, Canada

a4 Director, McMaster Institute of Environment and Health, Professor, School of Geography and Earth Sciences, McMaster University, Hamilton, Canada

a5 Associate Professor, Assistant Dean (retired), School of Nursing, McMaster University, Hamilton, Canada

a6 Director, Centre for Public Health and Zoonoses, Professor, Population Medicine, Ontario Veterinary College, University of Guelph, Ontario, Canada


Aim To explore how an organization's trust in the cultural competency of other service providers (competence trust) can influence the effectiveness of a services network in meeting the needs of recent immigrant families.

Background Primary health care for recent immigrants arriving in Canada is delivered through a network of community-based services. To ensure the functioning of the network and its ability to facilitate access to needed services for new arrivals, network members need to be able to work together collaboratively. A case study involving services for an urban community in Atlantic Canada was undertaken in 2009 to explore how service organizations worked together to address the needs of recent immigrant families with young children. This paper focuses on provider perceptions of cultural competency among local service organizations and how this influenced trust and desire to work together for the benefit of families.

Methods The case study utilized both social network analysis and qualitative inquiry methodology. Twenty-one of 27 selected organizations responded to the online social network survey, and 14 key informant interviews were conducted. Social network measures and network mapping were used to demonstrate trusting relationships and associated interactions, while interview data were used to explain the relationships observed.

Findings Perceived cultural competency affected the degree of trust and collaboration within the services network when addressing the needs of recent immigrant families. Competence trust toward other providers increased the desire and commitment to work together, while lack of competence trust created avoidance. Non-government organizations were identified among the most culturally competent. The perceived positive and negative experiences of families with different providers influenced the level of trust among network members. The development of systemic cultural competences within a services network is needed in order to improve collaborations and access to services for immigrant families.

(Received January 24 2012)

(Revised April 11 2012)

(Accepted April 18 2012)

(Online publication July 13 2012)


  • cultural competence;
  • primary healthcare system;
  • recent immigrants;
  • social network analysis;
  • trust


c1 Correspondence to: Dr Sandra Isaacs, Public Health Agency of Canada, 255 Woodlawn Rd. W. Unit 120, Guelph, Ontario, N1H 851 Canada. Email:

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