The beliefs, habits, and behaviors of a group of people or a community are referred to as culture (1).
It impacts almost everything you do, including how you talk, what you eat, what you perceive to be good or bad, your religious and spiritual practices, and even your outlook on wellness, healing, and healthcare (2).
On the other hand, culture is a complex and flexible notion with multiple ethnocultural groupings, identities, and cross-cultural activities (1, 3).
This variety poses a challenge to the healthcare business and clinicians, who must be sufficiently trained and qualified to include cultural subtleties in consultations and recommendations.
Culturally appropriate nutrition guidelines and nutrition treatment suggestions are critical in dietetics.
Dietitians’ lack of cultural competency may exacerbate health inequalities and disparities among marginalized and varied groups.
This article covers all you need to know about cultural competency in dietetics, why it matters, and what practitioners can do to improve their cultural competence.
What is cultural competence?
The willingness and capacity to treat a patient effectively and correctly without the impact of bias, prejudice, or preconceptions are referred to as cultural competency (3).
Respecting others’ attitudes, ideas, and values while examining your own and getting comfortable with any differences is required.
Differences in race, ethnicity, religion and dietary habits are common.
As a concept created in the 1980s, cultural competency in the health business aims to make healthcare services more acceptable, accessible, relevant, and successful for people from varied backgrounds (1, 2).
It is a set of techniques in nutrition that aim to recognize cultural variation and challenge the cookie-cutter approach to nutrition education and dietary interventions in ethnocultural settings.
This contains dietary standards, pictures of various cuisine cultures, and an enlarged definition of “good eating.”
It entails nutritionists and dietitians who are informed and proficient in cultural counseling approaches, as well as the inclusion of culture in talks and recommendations.
They offer unbiased nutrition services that do not diminish the importance of culture on lifestyle, food choices, and eating patterns.
Cultural competency intersects with cultural sensitivity, awareness, and cultural safety, and it encompasses more than race/ethnicity and religion, and it is cautious not to label based on prejudices (1, 3).
One of the primary goals of cultural competency is to establish a network of educated healthcare professionals capable of offering customized, culturally relevant expertise (1).
Why is cultural competence in dietetics necessary?
The social determinants of health must be read and comprehended in the context of systematic racism and how it impacts various cultures and races (3, 4).
These factors, including socioeconomic position, education, food insecurity, housing, employment, and availability, contribute to social gradients and health disparities (1, 4).
These health imbalances, and the resulting health disparities, are exacerbated in disadvantaged, red-lined, and underserved groups, who may lack access to nutritious diets and food security.
Culture also impacts the client’s view of health and recovery, their use of pharmaceutical vs. alternative therapies, and their dietary preferences and eating habits.
Cultural competency models exist and are advocated in nutrition textbooks, practicums, and internships to help dietitians enhance their abilities in dealing with ethnocultural diversity (5).
Clinical practice recommendations, meal planning, healthy eating, and medical nutrition treatment, on the other hand, are frequently provided in a decontextualized manner (1).
The contact between dietician and patient is impacted by cultural differences, biases, prejudices, and preconceptions (1).
If a dietitian does not handle these differences successfully, a breakdown in trust, communication, and adherence to the nutrition plan may exacerbate poor health outcomes.
Dietitians and nutritionists must recognize these many effects to establish a trusting environment and develop an affinity with patients, allowing them to convey an effective nutrition plan and achieve higher compliance and better health results.
Furthermore, depending on food accessibility, sustainability, and food cultures, healthy eating appears to vary across ethnocultural populations and geographical locales.
Health inequities may arise if dietitians do not provide culturally competent dietary treatments.
While cultural competence is not a cure-all for health inequities, improved client communication supports better health outcomes (3).
Nutrition counseling must be sensitive, suitable, and successful about the client’s lifestyle, living environment, dietary requirements, and food culture.
As a result, cultural competency is an essential ability for dietitians and healthcare professionals.
What happens in the absence of cultural competence?
The following are some real-life examples of communication breakdowns caused by cultural barriers due to insufficient or improper cultural competency.
While reviewing these examples, explore possible methods to enhance the result of similar future events.
Indian patient versus dhal
An Indian patient with a high-risk pregnancy and prediabetes struggle to make the necessary dietary modifications to help her regulate her blood sugar levels.
Her go-to comfort dish is her mother’s dhal (puréed split pea soup).
On her third visit, the very frustrated nutritionist reiterated that the patient must quit eating too many carbohydrate-rich items and concluded the appointment.
Islamic patient and calorie count
The patient, who is recovering from a stroke, could not speak with the healthcare staff directly.
The patient was unfamiliar with the hospital’s cuisine, so his relative prepared traditional dishes for him to eat.
The nutritionist couldn’t discover comparable items in the institutional nutritional analysis program. Thus the calorie count was skipped to estimate overall consumption using Ensure supplement intake.
Nigerian client and cornmeal
The dietician did not comprehend the content of the client’s meals and how to offer culturally acceptable suggestions since she was unfamiliar with cornmeal (ground maize).
The customer also had difficulty describing her foods, including starches not usually found in the American diet.
This and earlier instances reflect difficulties with cultural competency, communication, and trust at the interpersonal and institutional levels.
Steps for improving cultural competence
Change is needed at the institutional and individual levels, and there is evidence that doing so lowers health inequalities (1).
At the individual level
The first step in becoming culturally competent is to analyze your views, values, biases, prejudices, and stereotypes (3).
Be aware of your prejudices, both excellent and negative, and grow comfortable with the disparities that may occur between you and someone from a different ethnocultural background.
People do not have to be the same to be appreciated.
Here is a list to get you started:
- Reflect on your belief system to address your personal biases and prejudices.
- Recognize your clients’ differences, but do not pass judgment; instead, stay impartial.
- Instead of lecturing the sufferer, ask for permission. “Do you mind if we talked about [insert cultural topic/behavior]?” expresses respect for the patient and increases their likelihood of engagement.
- Create culturally appropriate therapies tailored to the patient rather than a generalization about their ethnicity.
At the institutional level
The types of assistance accessible in a healthcare system reflect the institution’s importance on cultural knowledge and traditions (1, 2).
Access to culturally appropriate nutrition and dietary services is a type of social injustice and health disparities.
Institutions can strive to enhance their interactions with and empower people of disadvantaged populations (1).
Here are some recommendations for increasing institutional and cultural competence:
- Employ a broad workforce that reflects the patient population’s ethnocultural variety.
- Dietitian-patient ethnic matching may help the patient feel comfortable and understood.
- Create professional guidelines that encourage dietitians to design culturally adapted therapies or provide patients with interventions taken from their cultural heritage as part of their care plan.
- Refer the patient to additional sources of healing that are safe and consistent with their cultural customs.
- Include nutrition standards that consider food cultures, such as one-pot meals, which are common in immigrant and ethnocultural diets.
Does cultural competence go far enough?
Some research shows that merely educating nutritionists and dietitians aware of cultural variations is insufficient to prevent stereotyping and effect change (1).
In addition, specific cultural competency initiatives may be just cosmetic or superficial.
As more inclusive and organized means of eliminating institutional inequality, the notions of cultural safety and cultural humility have been presented (1).
Cultural safety extends beyond an individual dietitian’s abilities to establish a professional atmosphere that provides a safe cultural space for patients that is sensitive to and receptive to their diverse belief systems (1).
Meanwhile, cultural humility is considered a more reactive approach that incorporates a continuous self-exploration and self-critique process, as well as a readiness to learn from others (6).
It is considered a culturally dangerous approach to degrade or undermine a patient’s cultural identity (7).
However, although some patients may feel secure and understood regarding institutional, cultural competency, and dietitian-patient ethnic matching, others may feel singled out and subjected to racial discrimination (1).
Cultural competency implementation in clinical practice may lengthen consultation durations since it necessitates more interaction with the patient.
Surprisingly, not every non-Western method will be the most effective solution.
It’s critical to shift away from the idea that anyone eating style is undesirable — as Western food has been vilified — and instead address eating behaviors that may be unhealthy regardless of origin.
Organizations advocating for cultural competence in dietetics
Several Member Interest Groups within the Academy of Nutrition and Dietetics (AND) and independent organizations push for nutrition diversification to make it more inclusive. These are some examples:
- Dietetics National Organization of Blacks (NOBIDAN). This professional organization provides a venue for professional growth and support of dietetics, optimal nutrition, and general well-being for the general population, particularly those of African heritage.
- Hispanics and Latinos in Dietetics and Nutrition (LAHIDAN). Their purpose is to encourage members to be Latino and Hispanic food and nutrition leaders.
- Indians and Asian Americans and Pacific Islanders (AAPI) in Nutrition and Dietetics (IND). Their key ideas include advocacy for cultural subjects and approaches to nutrition and dietetics.
- Dietetics should be expanded (DD). By empowering nutrition leaders of color and aiding aspiring dietitians of color with financial assistance and internship applications, they hope to improve racial and ethnic diversity in nutrition.
- Dietitians working for food justice This Canadian network of dietitians, dietetic interns, and students works to eliminate food inequities. Members aim to develop an anti-racist, health-equitable approach to food availability in Toronto and beyond.
- Southern Resilience is Growing (GRITS). A non-profit that bridges the nutrition-culture divide by offering free nutrition advice to disadvantaged individuals and programs for dietitians and students to better their awareness of African American traditional cuisine.
The bottom line
The willingness and capacity to deliver unbiased, judgment-free nutrition services to persons and clients from varied cultural backgrounds are referred to as cultural competency.
Cultural competency and cultural safety interact and necessitate institutional reforms to improve the types of assistance offered to minority and underprivileged populations.
However, culture is a flexible notion. Nutritionists and dietitians should not assume that every member of a particular ethnic group identifies with and adheres to that group’s widely accepted cultural customs. They could have modified their values and habits.
Dietitians should maintain objectivity and engage clients in meaningful interactions that give them the knowledge they need to deliver culturally appropriate, respectful counsel.
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