Page 94 - Nutrition Counseling and Education Skills: A Guide for Professionals

4. Talk in slow, clear words. Look for understanding. Repeat as necessary.

5. Encourage questions. Strive for interaction within cultural parameters.

6. Utilize the “teach-back” method. After each key concept is discussed, ask client to restate what was just
presented in their own language.

Table 4-2 ■ Common Effective Strategies to Use When Delivering Culturally Diverse Nutrition Counseling

Source: Adapted from Academy of Nutrition and Dietetics. Practice tips: Cultural competence resources. http://www.eatrightpro.org/10877.pdf. Accessed
January 10, 2016; Goody CM, Drago L, eds. Cultural Food Practices. Chicago, IL: American Dietetic Association; 2010; Duggan A, Street L.
Interpersonal communication in health and illness. In: Glamz K, Rimer BK, Viswanath R, eds. Health Behavior: Theory, Research, and Practice.
5th ed. San Francisco, Jossey-Bass, 2015; and Kittler PG, Sucher KP, Nelms J. Food and Culture. 6th ed. Belmont, CA: Wadsworth, 2011.

Effective counseling skills require one to be aware of and knowledgeable about various cultures. Cultural
healthcare beliefs must be acknowledged and respected. For example, some believe that a heavier body weight
is preferable and favored.10 Reason for this belief varies from culture to culture. The client’s beliefs must be
acknowledged and respected. The approach should be one of understanding. Instead of putting the emphasis
of the counseling session on the weight numbers, using more of an “eating healthier” approach may be the
technique to use in this situation.

Trust is an important counseling skill that all dietetics professionals must develop. One must be credible in
the eyes of the client. Although the counselor may find that trust is difficult to develop, it is a necessary key to
success.8–10 The gap between the professional and the client must be bridged, whether the client comes
voluntarily or by referral. One way to achieve this is to develop rapport through conversation on neutral
subjects that are unrelated to health or nutrition. For example, you may want to develop a personal
relationship with your clients first by asking questions such as “Where did you grow up?” In providing
counseling, you may want to first inform clients of what you will be doing by saying “You are probably
wondering what we are going to do. Let me explain.” Then, you can explain the purpose, process, and the
client’s role as your guide. The client should take an active role in the session and decision-making process.

Finally, a counselor may want to call upon the services of a translator to assist with transmitting nutrition
information. The translator may help rewriting written handouts or transmitting oral information into the
client’s language. An experienced translator should always be the first option. Although translating skills of
the client’s son or daughter are sufficient for these purposes, nutrition and dietetics professionals must be
cautious about using a family member in this role. In many cultures, having a child act as the interpreter
presents the problem of role reversal, which can lead to resentment and can change the family dynamics at
home.10 Regardless of the type of translator, remember to address questions directly to the client, not the
interpreter, and focus on the client as answers are provided.

Limited Literacy

About 40 to 44 million people, or approximately 25% of the US adult population, cannot understand
materials written at a basic proficiency level. Although individuals with limited literacy skills vary, most are of
lower socioeconomic status, have dropped out of school, are learning disabled, or are older. They may be
immigrants who do not yet know much English and may not read even in their native language.4 It is
important to identify these individuals, because poor reading skills are associated with poor health.

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