© 2006 thomson-wadsworth chapter 16 gaining cultural competence in community nutrition

Chapter 16

Gaining Cultural Competence in Community Nutrition

Learning Objectives

• Define cultural competence as exhibited by community nutrition professionals.

• Identify and explain two cultural competence models.

• Describe the influence of culture on beliefs, values, and behaviors.

• Explain the importance of recognizing one’s own cultural values and biases.

Learning Objectives

• Describe the basics of developing cross-cultural communication skills.

• Explain strategies for providing culturally competent nutrition interventions.

Introduction

• Differences between cultures occur on many levels including: – Communication– Sense of time– Family practices– Beliefs about the cause of illness– Healing beliefs– Food practices

• Community health professionals need to have strategies to bridge cultural gaps.

Gaining Cultural Competence

• Gaining cultural competence in community nutrition means developing attitudes, skills, and levels of awareness to provide culturally appropriate interventions.

• The foundation of cultural competency is development of an awareness of one’s own cultural matrix.

Terms Related to Cultural Competence

• Culture - shared history defined as the thoughts, communication, actions, customs, beliefs, values, and institutions of racial, ethnic, religious or societal groups.

• Cultural values - principles or standards that members of a cultural group share in common.

• Diversity - in a cultural context, the differences among groups of people. – Physical differences, abilities and

disabilities, and language differences are visible forms of diversity.

– Forms of diversity that may not be visible are sexual orientation, gender identification, socioeconomic status, and age.

• Cross-cultural - denotes interaction between or among individuals who represent different cultures.

• Ethnocentric - one’s own cultural view is considered best.

Need for Cultural Competence

• There are many reasons why community health professionals need to develop cultural competence...

• Demographics—population trends– The United States has been moving

toward a cultural plurality since the 1970s due in part to changes in immigration laws, corporate expansions into the global market, and the tendency for minorities and immigrants to have higher birth rates.

• Increased utilization of traditional therapies– There has been an increase in the use of

traditional therapies.– Developing an understanding of the health

practices of various cultures can help health practitioners develop and implement meaningful interventions.

– There has been a substantial increase in utilization of practices such as acupuncture, meditation, and ayurveda.

• Health disparities - exist because of:– Socioeconomic status

• Many minorities have lower socioeconomic status, and many are uninsured.

– Lack of insurance• Minorities are more likely than whites to be

uninsured.

– Culture• Some cultural beliefs and health practices of

minorities may contribute to health risks.

• Health disparities - exist because of:– Access to and utilization of quality health

care services• Many minorities do not have access to and

utilization of quality health care services.

– Discrimination/racism/stereotyping• Some minorities may experience discrimination or

racism and experience psychological distress, substance use, and health problems as a result.

– Environment• Minorities are more likely to live in polluted

environments and work in hazardous occupations.

• Under-representation of health care providers from culturally and linguistically diverse groups– Community nutrition professionals are

frequently challenged to provide services for cultural groups they have never encountered.

– Ideally, the health care workforce should be as diverse as the population it serves.

• Legislative, regulatory, and accreditation mandates– Many organizations and agencies

have set educational standards and core curriculum guidelines for developing cultural competence and providing culturally competent services.

Cultural Competence Models

• Cultural Competence Continuum Model– Structures the act of gaining cultural

competence through a succession of stages.

• The Campinha-Bacote Cultural Competence Model– Views cultural competence as a

process rather than an end result.

Cultural Competence Models – Campinha-Bacote Model

• Five interdependent constructs of this model include: – Cultural awareness– Cultural knowledge– Cultural skills– Cultural encounters– Cultural desire

• Cultural Awareness– Awareness of your own beliefs, values, and

attitudes and an understanding that these are biased provides the foundation of cultural competence.

– Our worldviews, or how we believe the world should function, have been reinforced over our lifetimes and may lead to culture shock.

• Cultural Knowledge– Valuing diversity and having the ability to

view the world through multiple cultural lenses are the heart of cultural competence.

– There are many advantages of gaining knowledge and understanding of cultural groups, but you should always remember that characteristics of a group are simply generalities and you should try to avoid stereotyping.

• Cultural Knowledge (continued)– An understanding of generalities

allows community nutritionists to develop relevant programming that builds on strengths and respects cultural differences.

• Cultural Encounters– Areas to explore about cultural groups you

encounter in your work include:• Socioeconomic and environmental factors• Language and communication styles• Cultural food practices• Common health problems• Health care values, beliefs, and practices• Attitudes toward seeking help from health care

providers• Religious behaviors and beliefs

• Cultural Encounters (continued)– There are many different strategies

for learning about different cultural practices:• Exploring the media• Arranging cultural encounters• Walking or driving through communities

Cross-Cultural Communication

• Barriers to Cross-Cultural Communication– Nutritionist and client not speaking

the same language– Individuals using the same word but

with different meanings– Not interpreting nonverbal behavior

correctly

Cross-Cultural Communication

• Practical Guidelines for Cross-Cultural Communication– Create a comfortable cross-cultural

interaction by being friendly, attempting to learn and use key words, articulating clearly, and asking clients to identify their ethnicity.

Cross-Cultural Communication – Practical Guidelines

• Suggestions for Communicating Information: – Use a less direct approach for

communicating information– Use visual aids– Ask the same question a different way– Consider alternatives to written

communications– Write numbers down

• Ways in Which Discussions about Food Can Open Dialogue– Ask about favorite foods– Foods used for celebrations– Tell food stories

• Working with Interpreters– Community nutritionists should use

professional interpreters or translators, as needed, rather than relying on friends or relatives of clients.

Culturally Appropriate Intervention Strategies

• The fundamental requirements for utilizing intervention strategies effectively:– To have an inherent caring,

appreciation, and respect for clients.– To be able to display warmth,

empathy, and genuineness.

• Explanatory Models– Anthropologists have developed explanatory

models as a culturally sensitive way to investigate a client’s perception of illness.

– Explore 5 major concerns about an illness episode:

• Etiology• Time and mode of onset of symptoms• Pathophysiology• Course of sickness• Treatment

• Explanatory Models (continued)– Open-ended questions can be used in

a respondent-driven interview approach to aid in understanding illness and food issues from a client’s perspective.

• LEARN Intervention Guidelines– LEARN guidelines provide a

framework for negotiating a culturally sensitive treatment plan to address a given illness episode:• Listen• Explain• Acknowledge• Recommend• Negotiate

• Practical Considerations for Interventions– Use practical considerations for

planning interventions.– Take into consideration the physical

environment and resources, community participation, and special considerations for new immigrants.

Encouraging Breastfeeding among African-American Women

• Northside Breastfeeding Media Campaign – A grassroots, community-based

breastfeeding promotion project.

• Goals and Objectives– Raise awareness and increase

knowledge of breastfeeding in an African-American population

– Create a supportive environment for breastfeeding through culturally specific images, messages, and materials

• Target Audience– African-American women in the Near North

Community of Minneapolis

• Rationale for the Intervention– In November 2000, the U.S. DHHS released

the “Blueprint for Action on Breastfeeding”– This comprehensive plan outlined the

critical need to promote breastfeeding in minority communities as a way to reduce health disparities

• Methodology– Developed culturally specific materials and

tested them prior to publication and distribution– Media strategies:

• Bus stop posters• Newspaper articles• Public service announcements• Radio and television newsrooms• Pamphlets to distribute to media audiences• Target audience reached directly through pamphlets

and promotional gifts that displayed the campaign themes

• Results– 31% of females and 15% of males who were

surveyed reported that they saw or heard the campaign messages

– Bus stop posters, newspaper articles, and posters in health clinics were most effective

– Acceptance of breastfeeding increased with age in both males and females, with females being more accepting

• Lessons Learned– The Northside Breastfeeding

Campaign demonstrated the positive impact of involving community members and organizations in the development of nutrition materials and messages.

Organizational Cultural Competence

• Health care agencies must scrutinize all aspects of their organizational structure to infuse cultural competency at every level:– Mission statements– Structures to assure consumer and

community participation– Policies and procedures for recruitment,

hiring, retention, and training– Fiscal resources for translation and

interpretation services

• Five essential elements necessary for an organization to provide culturally competent programming:– Valuing diversity.– Having the capacity for cultural self-

assessment.– Being conscious of the dynamics inherent

when cultures interact.– Having institutionalized cultural knowledge.– Adapting service delivery based on

understanding of cultural diversity.

• Three levels of organizational intervention:– Macro level - health care providers can

develop culturally sensitive laws, policies, and regulations.

– Mezzo level - addresses the design and delivery of culturally appropriate and effective community programs.

– Micro level - providing resources and training programs to help professionals develop and utilize cultural competence skills.

Cross-Cultural Nutrition Counseling

• Relationship-Building Skills– Attending– Reflection– Legitimation– Show respect– Personal support– Partnership

• The Involving Phase– Begin interactions in a formal manner– Small talk can aid in the development of a

comfortable atmosphere– Ask an open-ended question, such as “What

brings you here today?”– Explain something about your program

and/or the counseling process– Set a short agenda for the session

• The Exploration–Education Phase– Counselor provides educational

interventions – Uses respondent-driven interview

questions to understand nutritional concerns

– Identifies skills and resources that can be used to find solutions

• Exploration–Education Phase (cont.)– First 4 components of the LEARN guidelines

• Listen• Explain your perceptions of workable strategies

and your client’s beliefs about treatment • Acknowledge and discuss differences and

similarities• Recommend options and strategies

– Counselor needs to assess the client’s motivational level for implementing any of the strategies

• The Resolving Phase– Client not ready to make changes - your

major goal will be to raise doubt about his or her present dietary behavior

– Client is unsure of their readiness to take action - your goal will be to build confidence by exploring their ambivalence

– Clients ready to make dietary changes - set goals and develop action plans for implementing the goals

• The Closing Phase– Review what occurred during the session– Summarize issues– Identify strengths– Support self-efficacy– Restate goals– Plan for the next counseling encounter

© 2006 thomson-wadsworth chapter 16 gaining cultural competence in community nutrition

cultural competence

thomsonwadsworth slide

cultural competence

cultural context

cultural view

cultural matrix

cultural plurality

cultural gaps

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