Cultural Competence and Dietetics: What We Need to Know

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Cultural competence is the ability and willingness to treat patients effectively and appropriately, without bias, prejudice, or stereotypes.

It affects everything that you do—the way you talk, the food you eat, and what you think is right and wrong. It also influences your religious and spiritual practices and your view of health, healing, and wellness. Culture is a fluid and complex concept, with many ethnocultural communities and identities. It also includes cross-cultural practices.

This diversity poses a challenge for the healthcare industry and its providers. They must be trained and skilled enough to incorporate the subtleties of culture into their consultations and suggestions. Dietetics is a field that requires culturally appropriate nutrition guidelines and nutrition therapy. Dietitians who lack cultural competency may perpetuate disparities and health inequalities for marginalized and diverse groups. This article will explain what cultural competence in dietetics is, why it's important, and how practitioners can become more culturally proficient.

What does cultural competence mean?

Cultural competence is the ability and willingness to treat patients effectively and appropriately, without bias, prejudice, or stereotypes.

Respecting the attitudes, values, and beliefs of others while evaluating and assessing your own is essential.

Race, ethnicity, and religion are all areas where there can be differences.

Cultural competence is a framework that was developed in the 1980s. It aims to make healthcare more accessible, relatable, and effective for people of diverse backgrounds.

It's a set of strategies in nutrition that are meant to tackle cultural diversity and challenge the cookie-cutter approach to nutrition education among ethnic communities.

The book includes a nutrition guide and illustrations of diverse food cultures, as well as a definition of "healthy" eating.

Nutritionists and dietitians who are skilled and knowledgeable in cultural counseling techniques, including the inclusion of culture in discussions and recommendations

Nutritionists provide unbiased services that don't undermine the influence of culture on food, lifestyle, and eating habits.

Cultural competence is a combination of cultural sensitivity, cultural awareness, and cultural security. It includes more than race, ethnicity, and religion.

Cultural competence is a major goal of healthcare professionals who are trained to provide culturally appropriate expertise.

Why is cultural competence in dietetics important?

The social determinants of health should be understood and interpreted in relation to systemic racism and its impact on different cultures and ethnicities. These determinants, including socioeconomic status (SES), education, food security, housing, employment, and food access, lead to health inequities and social gradients. The health inequalities and health disparities that result are amplified for marginalized, red-lined, and underserved groups who may not have access to healthy foods or food security.

The client's culture also affects their perspective on health, healing, and the use of alternative therapies versus medication, as well as their food choices and eating habits. Dietitians can improve their skills in addressing ethnic diversity by using models of cultural competency.

Often, however, the context of clinical practice guidelines, healthy eating, and medical nutrition therapy is not included. Dietitian-patient encounters are shaped by differences in cultures, biases, and stereotypes. A dietitian who fails to effectively manage these differences may lead to a breakdown of trust, communication, and compliance with nutrition plans.

Dietitians and nutritionists need to acknowledge these influences in order to create an atmosphere of trust with their patients and build affinity. This will allow them to effectively communicate a nutrition plan, which leads to greater compliance and better health outcomes. In addition, the definition of healthy eating varies across ethnic groups and geographic locations, depending on factors such as food availability, sustainability, and food culture.

Dietitians who fail to provide culturally appropriate nutrition interventions may create health disparities. While cultural competence is not the panacea to health disparities in all cultures, better communication with clients can promote better health outcomes.

The nutrition advice provided to clients should be appropriate, responsive, and tailored to their lifestyle, food culture, eating habits, and living conditions. Cultural competence is therefore a vital skill for both dietitians and healthcare professionals. Fresh Food Fast: Turkey Pumpkin Chilli Registered dietitian Vanessa Rissetto shares how to make this delicious turkey pumpkin chili.

What happens if cultural competence is absent?

Here are some examples of how cultural barriers and a lack of cultural competency can lead to a breakdown in communication. You can think of solutions to improve future similar events by reviewing these scenarios.

Indian patient versus Dhal

A patient from India with prediabetes and high-risk pregnancies struggles to manage her blood sugar. Her mother's dhal (pureed pea split soup) is her comfort food.

The visibly angry dietitian concludes the consultation after her third visit by telling the patient to stop eating carbohydrate-rich food.

The calorie count of the Islamic patient

The patient was recovering from a stroke and could not speak directly to the team. The patient's relative cooked cultural food for him.

Dietitians could not find similar ingredients in institutional nutrition analysis software. The calorie count was therefore omitted, instead using Ensure Supplement Intake as a guide to estimate total intake.

Nigerian cornmeal and client

The dietitian was unfamiliar with ground maize and did not know how to make culturally appropriate suggestions.

Clients also had difficulty describing their dishes, which contained starches that are not common in American diets.

The challenges of cultural competency, communication, and trust at the interpersonal and institutional levels are reflected in this and previous scenarios.

Steps to improve cultural competency

There is evidence that reducing health disparities requires change at the institutional and individual levels.

Individual level

To become culturally competent, you must first assess your own values, beliefs, prejudices, and stereotypes.

Be aware of your own biases, both positive and negative. You should also be able to accept the differences between yourself and someone with a different ethnic background. Respectable people do not have to be identical.

This list will help you start:

     Reflect on your own beliefs and biases to identify your personal biases.

     Do not judge your clients, but rather acknowledge their differences.

     Instead of lecturing, ask for permission. By asking, "Does it bother you if we talked about [insert culture topic/behavior]", you show respect to the patient and are more likely to engage them.

     Develop culturally appropriate interventions that are specific for the patient and not based on a stereotypical view of their ethnicity.

The institutional level

The types of assistance that a healthcare system offers reflect its value for cultural practices and knowledge.

Inequality and disparity in health are caused by the inability to obtain culturally appropriate nutrition and dietary services. Institutions should improve their engagement with marginalized groups and empower them.

Here are some suggestions to improve cultural competency at the institution level:

     Hire a staff that is representative of the ethnic diversity of your patient population.

     The patient will feel more comfortable and understood if the dietitian matches their ethnicity.

     Create standards of practice to encourage dietitians to develop culturally adapted interventions or offer patients culturally adapted interventions as part of their care plan.

     Refer to other healing methods that are both safe and in line with the patient's culture.

     Include nutrition guidelines that consider food cultures. This includes one-pot meals, as they are part of many immigrant or ethnocultural diet patterns.

Does cultural competency go far enough?

There is some literature that suggests that cultural competency is not sufficient—that making dietitians and nutritionists aware of cultural differences will not be enough to end stereotyping or affect change. Some cultural competency movements can be superficial or purely cosmetic.

As a more systematic and inclusive approach to dismantling institutional discrimination, the concepts of cultural security and cultural humility were proposed.

Cultural safety goes beyond the skills of a dietitian to create an environment where patients feel safe and respected, with a workplace that is sensitive to their beliefs.

Cultural humility, on the other hand, is seen as a reflexive approach that goes beyond acquiring knowledge. It involves continuous self-exploration, self-critique, and the willingness to learn from others. Demeaning or disempowering a patient's culture is considered to be a culturally dangerous practice.

Some patients may feel comfortable and understandable in terms of the institutional cultural competency and ethnic match between the dietitian or patient and other patients, but others may feel isolated and subject to racial bias. Consultation times may be extended if you implement cultural competency in your clinical practice. This is because it involves more dialogue with patients.

It is interesting to note that not all non-Western practices are the best interventions. The notion that any style of eating, such as Western food, is harmful must be abandoned. Instead, we should focus on eating habits that are potentially harmful, no matter where they come from.

Organizations advocating cultural competence in dietetics

Several member interest groups within the Academy of Nutrition and Dietetics and other independent organizations advocate for diversifying nutrition in order to make it more inclusive. They include:

     National Organisation of Blacks in Dietetics Provides a professional forum for the development of dietetics and optimal nutrition for the public. Especially for those of African descent.

     Latinos and Hispanics: Dietetics and Nutrition The mission of the organization is to empower its members to become food and nutrition leaders for Latinos and Hispanics.

     Asian Americans, Pacific Islanders, and Indians Nutrition and Dietetics They are primarily concerned with cultural issues and cultural approaches to nutrition and dietetics.

     Diversify dietetics. They strive to increase racial diversity and ethnicity in nutrition through the empowerment of nutrition leaders of color and by providing financial aid for aspiring dietitians.

     Dietitians for Food Justice This Canadian network of dietetic interns and students, as well as dietitians, addresses food injustices. Members are working to develop a health equity and anti-racist approach to food accessibility in Toronto and beyond.

     Growing Resilience in the South A nonprofit that bridges the gap between culture and nutrition by offering free nutrition counseling and programmes to students and dietitians to better understand African American cultural food

The bottom line

Cultural competence is the ability and willingness to provide nutrition services that are unbiased and judgment-free to clients and people of different cultural backgrounds.

The intersection of cultural competence and safety and the institutional change required to improve services to marginalized and minority communities.

Culture is fluid, so nutritionists and dieticians should not assume that all members of an ethnic group will identify with and adhere to the cultural practices that are common in that group. It is possible that they have adopted their own values and behaviors.

Dietitians must remain objective and engage their clients in meaningful discussions that provide them with the necessary information to give culturally appropriate and respectful advice.

Credit: The Web Health & Drugs Discussion

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