Page 77 - Nutrition Counseling and Education Skills: A Guide for Professionals

Introduction

The area of cultural communication, counseling, and quality healthcare is receiving increased attention. Our
global society with changing demographics makes it common for food and nutrition professionals to be
interacting with other healthcare professionals, employees, and clients with cultural backgrounds different
from their own. Knowledge of food and food habits, the cultural influences of food, and the factors
influencing lifestyle behaviors are fundamental for effective communication and education skills. The
Academy of Nutrition and Dietetics prepares their members for the challenges of a multicultural society by
integrating diversity and cultural competence into the Scope of Practice for both the Registered Dietitian
Nutritionist (RDN) and Nutrition and Dietetic Technician, Registered (NDTR).1,2 In the United States, the
Joint Commission requires evidence of cultural and linguistic appropriate healthcare when accrediting
healthcare facilities.3

The issue of culture and diversity is not new to America. The United States is continually evolving into an
increasingly heterogeneous population.4 Other countries are also experiencing new challenges in diversity due
to global migration and mobility. The objectives of Healthy People 2020 reflect the health needs of a diverse
population.5 Because nutrition and dietetics professionals encounter diverse clients every day, they must make
every effort to learn about customs and cultures different from their own. In this way, they can develop
effective methods and strategies for serving all of their clients. Being alert to cultural diversity differences and
similarities will enable the professional to better adapt and function in a multicultural environment.

Cultural competence is a broader term that attempts to encompass the multiple dimensions of an individual
or group “core requirement for working effectively with culturally diverse people”.6 Competence infers a
process, rather than an end point.7 The challenge for health professionals is to be culturally competent in
helping clients change their food choices without disturbing the sociocultural functions of food. For dietary
changes to succeed, a combination of approaches—including behavioral and cognitive interventions, self-
efficacy, relapse prevention, self-monitoring, stages of change, social support, and educational strategies—may
be necessary to assist people to make changes in food choices.8,9

Food has been a cultural influence for centuries. Culture is the sum total of a group’s learned and shared
behavior. It is acquired by people living their everyday lives and provides a sense of identity, order, and
security. As a group phenomenon, culture is learned from others and transmitted formally and informally to
the next generation. These learned traditions are not static; they are dynamic with some changes accepted over
time. All cultural and ethnic groups sustain their identities, in part, through their food practices, values, and
beliefs. Family and culture determine what foods are appropriate and inappropriate.8,9

This chapter explores the effective strategies for use by nutrition and dietetics professionals in
communicating with culturally diverse clients, employees, and other healthcare team members.

Cultural Diversity

What is cultural diversity? Cultural diversity and cultural identity have many components and definitions
beyond ethnicity, nationality, and language. Cultural identity also includes race, age, gender, religion,
disability, socioeconomic status, occupation, educational level, politics, physical ability, sexual orientation, and
immigration status.6 Diversity consists of the many ways in which individuals are unique or different while at

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