Culturally-Sensitive Practices

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Author: Christian Maino Vieytes, Doctoral Student, Division of Nutritional Sciences, University of Illinois at Urbana-Champaign

Cultural sensitivity in the health care setting is essential for enhancing the quality of care a patient receives (1). Effective and thoughtful communication in a multicultural society, such as the one we share here in the United States, is of vital importance. As our society embraces and welcomes more diversity, the need for culturally competent providers is magnified (2). This idea is especially important in the health care setting, where a provider regularly encounters individuals from an eclectic set of backgrounds, both demographically and socioeconomically. Group membership in our society is highly valuable and influences the way individuals from different groups perceive themselves as well as others (3). Consequently, modifying one’s conversation to reflect an understanding of the lived experience that a patient brings to an encounter can increase the provider’s alliance with the patient and can maximize the patient’s satisfaction and experience (4). With cultural understanding, the emphasis is to maintain a sense of humility, openness, and enthusiasm to learn from the client (5).

In the arena of nutrition and dietetics, concerns over being sensitive to culture become magnified. Can you think of any other component that describes culture as well as diet does? Thinking about different cultures immediately conjures images of rich and elaborate cuisines coming from different corners of the world. Tandoori dishes from India, Chiles Rellenos from Guatemala, Baltic Herring from Sweden, and sushi from Japan are just a few that quickly come to mind. Attitudes about food as well as the actual intake of food are intricately linked to culture (6). In the same way that different cultures celebrate by consuming different foods, individuals from different cultures also experience disparities in health outcomes and may have differing beliefs on what constitutes “good” health. Additionally, individuals from some cultures are often predisposed to higher risks of certain chronic illnesses and the nutrition counselor needs to be aware of those prior to counseling their patient (7). In summary, a provider must be sensitive to three aspects of a client’s culture (8):

  • Health-related beliefs associated with the client’s culture
  • The prevalence and incidence of disease within that culture
  • The effectiveness of treatments within that culture

Increasing Cultural Awareness

Fortunately, there has been a lot of focus on identifying ways that dietitians and other health professionals can promote greater cultural understanding in their lives and practice. One way that was found to be effective, was to take a class on cultural foods (9). By gaining a greater sense of the cuisine a culture identifies with, the nutrition practitioner can prescribe more personalized plans that are likely to result in better health outcomes for the patient as well as a greater sense of satisfaction. Another important approach is to recognize the client as a teacher. You learn from them just as they learn from you. When it comes to the actual encounters with the client, a provider can work on embracing the following five pillars of culturally sensitive care (10):

  1. Cultural Awareness This begins with the question “who am I and where is my place in the fabric of our society?” It also means analyzing one’s level of understanding of other cultures.
  2. Cultural Knowledge This pillar reflects obtaining knowledge of other cultures. This can be achieved through courses, the internet, books, or other methods.
  3. Cultural Skill When interacting with a client, this involves gathering cultural data on them. What is their origin? What are their beliefs?
  4. Cultural Encounter The more encounters a nutrition provider has with individuals from diverse backgrounds, the more prepared they will become to provide culturally sensitive care. Practice makes perfect.
  5. Cultural Desire Providing culturally sensitive care cannot be achieved without a desire, on the part of the practitioner, to want to learn and expand their understanding of different cultures. You need to be motivated and willing to learn from others.

References

  1.  Betancourt JR, Green AR, Carrillo JE, Park ER. Cultural Competence And Health Care Disparities: Key Perspectives And Trends. Health Aff (Millwood). 2005 Mar;24(2):499–505.
  2. Harris-Davis E, Haughton B. Model for Multicultural Nutrition Counseling Competencies. J Am Diet Assoc. 2000 Oct;100(10):1178–85.
  3. Atkinson DR, Thompson CE, Grant SK. A Three-Dimensional Model for Counseling Racial/Ethnic Minorities. Couns Psychol. 1993 Apr;21(2):257–77.
  4. Meyer EG, Wynn GH. The Importance of US Military Cultural Competence. In: Roberts LW, Warner CH, editors. Military and Veteran Mental Health [Internet]. New York, NY: Springer New York; 2018 [cited 2020 Jun 9]. p. 15–33. Available from: http://link.springer.com/10.1007/978-1-4939-7438-2_2
  5. Dyche L, Zayas LH. The Value of Curiosity and Naivete for the Cross-Cultural Psychotherapist. Fam Process. 1995 Dec;34(4):389–99.
  6. Curry KR. Multicultural Competence in Dietetics and Nutrition. J Am Diet Assoc. 2000 Oct;100(10):1142–3.
  7. Giger J, Davidhizar RE, Purnell L, Harden JT, Phillips J, Strickland O. American Academy of Nursing Expert Panel Report: Developing Cultural Competence to Eliminate Health Disparities in Ethnic Minorities and Other Vulnerable Populations. J Transcult Nurs. 2007 Apr;18(2):95–102.
  8. Purnell LD, editor. Transcultural health care: a culturally competent approach. 4th ed. Philadelphia: F.A. Davis; 2013. 505 p.
  9. Hack R, Hekmat S, Ahmadi L. Examining the Cultural Competence of Third- and Fourth-Year Nutrition Students: A Pilot Study. Can J Diet Pract Res. 2015 Dec;76(4):178–84.
  10. Brathwaite AEC. Evaluation of a Cultural Competence Course. J Transcult Nurs. 2005 Oct;16(4):361–9.

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