Why is cultural competence important in nutrition education and counseling?

Among the significant challenges dietitians and nutritionists face today and in the immediate future are: the increasingly diverse population of this country and increased emphasis on patient/client behavioral changes as evidence of effectiveness. Sensitivity to cultural differences in ourselves and in those of different ethnic backgrounds is an important aspect of competence in reaching a diverse population. Nutrition counselors are now and will be evaluated on their ability to produce desirable behavioral changes in patients/clients (1).

"In nutrition counseling, where many therapeutic interventions are on a personal level, sensitivity to the strong influence of culture on an individual's food intake, attitudes, and behaviors is especially imperative." Nutrition counselors should not view multicultural competence as a luxury or as a specialty but as a requirement (1).

What competencies are important for multicultural nutrition counseling?

Multicultural nutrition counseling occurs when a nutrition professional and client are from different cultures. Ethnicity, religion, group affiliation, socioeconomic status, and world-view may all influence clients' needs (1). Gaining insight into what competencies are important for multicultural nutrition counseling can help ensure cultural proficiency in counseling.

Harris-Davis and Haughton developed and tested a model for multicultural nutrition counseling competencies for registered dietitians (2). From their model, 28 competencies emerged in 3 groups as listed below:

Multicultural nutrition counseling skills

• Have ability to differentiate between individual and universal similarities.
• Be experienced in application of medical nutrition therapy and nutrition-related health promotion/disease prevention strategies that are culturally appropriate.
• Have ability to use cultural knowledge and sensitivity for appropriate nutrition intervention and materials.
• Take responsibility of collectively working with community leaders or members about unique knowledge or abilities for benefit of the culturally different client.
• Be able to evaluate new techniques, research, and knowledge as to validity and applicability in working with culturally different populations.

Multicultural awareness

• Be aware of how own cultural background and experiences and attitudes, values, and biases influence nutrition counseling.
• Be able to recognize limits of own cultural competencies and abilities.
• Have moved from being culturally aware to being aware and sensitive to own cultural heritage and to valuing and respecting differences.

Multicultural food and nutrition counseling knowledge

• Understand food selection, preparation, and storage with a cultural context.
• Have knowledge of cultural eating patterns and family traditions such as core foods, traditional celebrations, and fasting.
• Familiarize self with relevant research and latest findings regarding food practices and nutrition-related health problems of various ethnic and racial groups.
  

Careful attention should also be paid to nutrition education materials. "Ideally, written materials in other languages should reflect the dialectic and cultural nuances of the target population (3)." Nutrition education resources that reflect an awareness of these details and the educational and literacy level of the target audience require a more sensitive approach than mere text translation. The best process involves developing materials from scratch in the target language based on discussions with focus groups representing the target population. The material should reflect an appreciation of the cultural norms of that population. When materials are to be used to motivate behavior change, this process is especially important (3).

Where can I find information and resources regarding cultural diversity?

The Administration on Aging

• Achieving Cultural Competence: A Guidebook for Providers of Services to Older Americans and Their Families - This guidebook is designed for use by providers of services to racially and ethnically diverse older populations. Each chapter will help enable you to evaluate current programs with a critical eye toward your staff achieving cultural competence.
• The Many Faces of Aging: Resources to Effectively Serve Minority Older Persons - This site was designed to provide information that can help to increase access to and improve programs for older minority Americans. Information on laws and Executive Orders aimed at increasing access by older minority Americans to government programs; demographic snapshots of minority elder populations in America; descriptions of several programs that are successfully serving minority elders are a few of the subjects addressed on this website.

The American Dietetic Association

• Ethnic and Regional Food Practices: A Series - Increase your clients'
  adherence to new diets by including their favorite traditional foods and
  recipes. The Exchange Lists have been expanded to 11 ethnic and regional
  groups. They contain information about important cultural and dietary
  customs for helping clients develop meal plans.

Georgia State University, Nutrition Education for New Americans Project

• Handouts - Language sets contain black line masters (for ease in reproduction) of Food Pyramids plus four handouts for healthy adults, mothers and babies, mature adults, and children, which may be used individually or as a package. All are bilingual and copyright free. You are encouraged to make copies and distribute these materials freely.
• CD-ROM of Nutrition Materials - Contains all 37 language handouts, plus Partnering for Cultural Competency: A Resource Guide of Culturally Relevant Nutrition Education Materials and Counseling Strategies in Microsoft Word and Adobe PDF format.

Oregon State University, Extension Family and Community Development

• Program Planning to Reach Culturally Diverse Audiences
  Addresses such questions as: Are your materials relevant to your audience?; In what other ways can you make your materials more relevant?; In what other ways can you recognize other cultures?; In what other ways can you respect other cultures?
• Additional Resources
  

National Policy and Resource Center on Nutrition and Aging

• Bibliographies: Special Populations section lists current research articles on
  cultural competency.
• Resources: Special Populations section lists many nutrition education and counseling resources in International/Multicultural, African American, Alaska Natives & American Indian, Asian American & Pacific Islander, Hispanic American, and Rural Populations
  • Cross-Cultural Counseling: A Guide for Nutrition and Health Counselors: This guide contains tips on how counseling different cultural groups and how to approach a diet change; applies to all cross-cultural counseling situations.
  • Asian Food Guide Pyramid: Handout from California Milk Advisory Board in consultation with Asian-American dietitians working in California. Comes in 5 languages: Chinese, Japanese, Korean, Talalog, and Vietnamese; gives the number and size of servings recommended for each food groups for optimum daily health.
  • FoodShapes Hispanic Foods CD-ROM: This CD-ROM includes illustrations of a wide range of Mexican foods, as well as popular Latin and Caribbean foods, many of which have regional variations in Cuba, Puerto Rico, the Dominican Republic, Guatemala, El Salvador, and other Latin countries. While many of the foods depicted are healthy ones, the CD-ROM also includes images in a special "low-fat, healthy" category for use by nutritionists.
• Hotlinks: Nutrition Services/Aging Advocacy Organizations section links to various ethnic organizations.

www.Eatethnic.com

This website is maintained by Four Winds Food Specialists, a partnership between Pamela Goyan Kittler, MS and Kathryn P. Sucher, ScD, RD. "Cultural foods and nutrition is our profession... and our passion!" It has received an Arbor Nutrition Guide Site Award. Resources include Food Videos, Newsletter, Books, Traditional and Holiday Foods, Links, and Food Quiz.

References

1. Curry K. Multicultural competence in dietetics and nutrition. J Am Diet Assoc. 2000;100:1142-1143.
2. Harris-Davis E, Haughton B. Model for multicultural nutrition counseling competencies. J Am Diet Assoc. 2000;100:1178-1185.
3. Multicultural Health Best Practices Overview. Diversity Rx, www.diversityrx.org. 1999.

Compiled by Amy J. Sindler RD, LD/N, Masters Candidate and Graduate Research Assistant, and staff of the National Policy and Resource Center on Nutrition and Aging, Florida International University, Miami, FL. Contact: nutritionandaging@fiu.edu

This project is supported, in part, by a grant from the Administration on Aging,
Department of Health and Human Services (DHHS). Grantees undertaking projects under government
sponsorship are encouraged to express freely their findings and conclusions.
Points of view or opinions do not, therefore, reflect official DHHS policy.