Dietitian RoleCommunication Styles

! A passionate and animated communication style is regarded as the most authentic in the

African American population. African American men and women are direct communicators and often

have high emotional intensity. It is common to communicate face-to-face with direct eye contact.

African Americans communicate in an expressive style, and larger gestures indicate interest in a

conversation. Communicating in a neutral, dispassionate way is viewed as less credible. If someone has

a strong opinion, it is expected that they will stand by it. Slang is commonly used, especially among the

youth; but may be offensive if used by someone outside of their culture. Responses are often quick after

the speaker, but it is not viewed as rude or an interruption. (1,2)

Food Preparation Techniques and Preferences

! Popular foods among the African American population include grits, watermelon, okra, rice,

peanuts, and yams. The creative use of these foods gave rise to “soul food”. Soul food is flavor-rich

cuisine made from inexpensive products and is associated with African Americans in the South.

Popular dishes include fried chicken, fish, macaroni and cheese, cornbread, and collard greens. (3)

! Soul food is often high in fat, sodium, and carbohydrates; and contributes to obesity, heart

disease, and diabetes as the African American culture became more urban and sedentary. Adapting

healthy food substitutes for traditional meals is becoming popular as health-consciousness increases

among African Americans. (3, 4)

! There is low fruit and vegetable consumption among African Americans, but it only slightly

lower than among whites. This may reflect the typical American diet pattern more than ethnic

variation, except among some lower-income groups with limited access to fresh produce. (3)

! African Americans have higher rates of nutrition related disease states; iron-deficiency anemia

and calcium deficiency are the most frequent. Rates of iron-deficiency anemia among African

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Americans are higher than for whites at every age, regardless of sex or income level. Lactose

intolerance is also prevalent among the African American population. (3)

Health Beliefs

African Americans may be apprehensive to trust the health care system. African Americans may

have a fear and fatalism related to cancer, and mistrust of the medical establishment. For example, a

common fear is being unintentional subjects to medical experimentation, and historically African

Americans have been mistreated by the medical system in such abhorrent studies like the Tuskegee

experiment. (3, 5)

Traditionally, African American families viewed illness as two categories, natural and

unnatural, rooted in the belief of witchcraft. Natural illness comes from sources such as air, food, or

water, or done under God’s will. Unnatural illness the result of evil influences looking to alter God’s

intended plan. (3)

Christianity and Islam are the most common religious belief systems among modern day

African Americans. Prayer and religion may be used for coping, and the church establishment provides

spiritual, psychological, and social support. There is a strong belief in fate and God’s power to change

events. Spiritual healing may be kept private from health care providers to avoid stigma and judgment.

(3)

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References

1. Elliot, C.E. Communication Patterns and Assumptions of Differing Cultural Group in the United States. http://www.lpi.usra.edu/education/lpsc_wksp_2007/resources/elliott.pdf. Published 1999. Accessed February 19, 2016.

2. Senegal:Language, Culture, Customs and Etiquette. http://www.kwintessential.co.uk/resources/global-etiquette/usa.html. Revised 2016. Accessed February 19, 2016.

3. Welch M. Care of Blacks and Africans Americans. American College of Physicians. https:/store.acponline.org/ebizatpro/images/productimages/books/sample%20chapters/cultural_ch02.pdf. Accessed February 19, 2016.

4. Bramble J, Cornelius LJ, Simpson GM. Eating as a cultural expression of caring among Afro-Caribbean and African American Women: Understanding the cultural dimensions of obesity. Journal of health care for the poor and underserved. 2009;20(20):53-68.

5. Smith C. African Americans and the medical establishment. Mt Sinai J Med. 1999;66: 280-1.

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Counseling Questions

1. How are you feeling today?

2. Were you able to complete the three day food record?

3. Are these three days typical of what you eat most of the time?

4. How you rate your stress level on a scale of 1-5 (1 being low, 5 being high)?

5. Do you drink coffee? How many cups of coffee do you have each day?

6. Do you have any allergies / aversions to foods / special diet?

7. Is there anything specific you would like to discuss during our consultation?

8. How much time do you have to prepare / eat meals?

9. Where do you typically eat? Home, office, etc.

10. Do you eat out at restaurants / how often (days per week)?

11. Do you eat fast food?

12. Do you exercise? What activities do you enjoy? How often? Activity levels (sedentary-very active)

13. Have you had any prior health conditions?

14. Are you taking any medications? (and supplements if noted on food record)

15. Do you add salt to your foods?

16. Would you like to discuss your cholesterol and triglyceride levels?

17. Do you smoke cigarettes?

18. Do you drink alcohol?

19. Are there any food or nutrition related goals you would like to discuss with me?

20. If you could change three things about health and nutritional habits, what would they be?

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Client Role

! In San Diego, there are an estimated 20,000 Native Americans, and 19 indian reservations; 13 of

which are inhabited by Kumeyaay descendants. The Kumeyaay are descendants of Native American

Indian tribes who have resided on the west coast of the United States for over 10,000 years, and

continue to live in San Diego County, Imperial County and Baja California, Mexico (1).

Interpersonal communication

! Traditionally, the Kumeyaay are peaceful and hospitable. The extended family is the primary

social unit, and lineage is inherited through the matriarchy. The elderly are treated with upmost respect

in Native American culture. (2)

! Indirect communication is common to avoid personal and confrontational situations. Native

Americans take pride in not expressing emotions in public, emotions such as anger and stress are

taught to be repressed. Native Americans chose to speak only when they have something meaningful

to say, and small talk is reserved for close friends and family. Prolonged eye contact is viewed as

invasive and a violation of personal space; direct eye contact with an elder or respected individual is

especially rude. Gestures within a typical conversation are restrained, but more frequent amongst

elders. Interruptions in conversations are rare, and no one speaks until the previous speaker is clearly

done with speaking. It is disrespectful to talk too soon after the previous speaker has spoken, and is

viewed as rash and inconsiderate. Conversations should be short and brief and not be too personal. It is

recommended to not ask questions in a direct manner or expect an immediate response. (2)

Food preparation techniques and food preferences

! Native Americans have a diverse culture, which is reflected in their cuisine. Native Americans

lived off the land, and were very interconnected and dependent on nature. Innovative techniques and

tools used by Native Americans allowed them to thrive for centuries. (1)

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! Common staple foods for Native Americans are beans, corn, and squash. A few indigenous

foods of the Americas include berries, cactus, bell pepper, tomatoes, arrowroot, sweet potatoes,

amaranth, and walnuts. Traditionally, Native Americans relied on hunting game meat, but the

introduction of European foods and livestock reduced their dependency on hunting. Most Native

Americans are lactose intolerant due to their genetic make up. (5)

! Common food sources for traditional Kumeyaay tribes included grunion, mollusk, small game,

picked fruit and nuts, birds, insects, and ocean and freshwater fish. The acorn was a staple amongst the

Kumeyaay, eaten almost daily. Acorns were ground down to make into moist dough to eat or use in

cooking. Although Native Americans incorporate some of their traditional food items in their modern-

day diets, there has been an increase in fast foods, processed foods, soda and other sugary drinks. (3, 5)

Health beliefs

! The Kumeyaay people live a religious and spiritual lifestyle. Traditionally, Native Americans

live in harmony with nature and only take what is necessary to sustain life from the natural

environment. To the Kumeyaay, their health reflects their relationships to nature, family, community,

and the environment. They believe illness is due to an imbalance with supernatural, spiritual, or social

implications. Native American people believe in restoring wholeness to a person’s life to cure them

from illness and disease. They focus on a holistic approach to illness through traditional healers such as

shaman to cure such imbalances. (4, 6)

! Overconsumption and obesity are common in Native Americans, with rates 20% above the

national average. This is in part due to their low SES status, and heavier body weight being preferred

by their culture. They also have higher rates of TB, alcoholism, MVA, diabetes, homicide and suicide.

The overall poverty rate for American Indians is more than double of the general population (203

Notes). (6)

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Client Interaction

! I am Nadia Whitehorse, a 62-year-old Kumeyaay female. I weigh 165lbs and am 5’2’’ tall.

Around 15 years ago I was diagnosed with hypertension from the family nurse at the medical clinic. I

was prescribed medication to help with the hypertension but often times I forget to take it. I can’t

understand why I should be taking medication when I am currently feeling ok and have no symptoms.

I don’t exactly know what hypertension is and no one has ever taken the time to explain the diagnosis

in a way that makes sense to me. I do know that it has something to do with high blood pressure, but

that just made me more confused. I am unsure if I want to begin taking medication, and the nurse at

my clinic recommended I see a RD to review my eating habits. I was told that if I lose weight and watch

what I eat I might not have to take my medication anymore. I don’t understand what my weight has to

do with my condition, though. I might be apprehensive to the advice of the RD, and unwilling to open

up to them. I would consider working with my healthcare providers to get healthy so I have more

energy to cook and spend with my family. My favorite thing to do is cook for my extended family and

spend time with my children, grandchildren and great grandchildren. I can’t imagine not being around

to watch them grow up and teach them about our culture.

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References

1. Hoffman, G. M., & Gamble, L. H. 2006. A Teacher’s Guide to Historical and Contemporary Kumeyaay Culture. Institute for Regional Studies of the Californias.

2. Elliot C, Adams RJ, Sockalingam S. Communication Patterns and Assumptions. http://www.lpi.usra.edu/education/lpsc_wksp_2007/resources/elliott.pdf. Revised January 2016. Accessed February 20, 2016.

3. Research Summary: The Communication Styles of Indian Peoples. http://www.lpi.usra.edu/education/lpsc_wksp_2007/resources/heit_report.pdf. AWASIS Journal, March 1987. Accessed February 20, 2016.

4. Hendrix. L. Health and Health Care of American Indian and Alaska Native Elders. http://web.stanford.edu/group/ethnoger/americanindian.html. Accessed February 20, 2016.

5. Native American Food. Indians.org. http://www.indians.org/articles/native-american-food.html. Updated 2016. Accessed February 23, 2016.

6. Shipek, F. Kumeyaay. http://www.encyclopedia.com/doc/1G2-3458000123.html. Published 1996. Revised 2016. Accessed February 19, 2016.

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Three-Day Food Record for Nadia WhitehorseDay 1 of 3

Day of the week Thursday

Date 2/18/16

Time Food Item Description & Preparation Quantity

7:00 AM Coffee Black 16 ozCorned Beef Hash Canned, fried in lard 6 ozTortilla Corn, toasted 2, 8” diameter

1:30 PM Catfish Coated in cornmeal and fried in lard 6 ozZucchini squash Sauteed, with butter; from garden 1 cupButter 3 Tb

4:00 PM Chips Lays, BBQ 3 ozSoda Coca Cola 8 oz

7:00 PM Hamburger patty Homemade ground beef patty, grilled 2 patties, 6 ozBun White, sesame seed 2 bunsMayonnaise 2 TbKetchup 1 TbMustard 1/2 TbLettuce Romaine, from garden 1/2 cupTomato From garden 1/4 cupBaked Beans Canned, with bacon 3 oz

Did you take any supplements? No If yes, please specify: ___________________________

______________________________________________________________________________

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Three-Day Food Record for Nadia WhitehorseDay 2 of 3

Day of the week Friday

Date 2/19/16

Time Food Item Description & Preparation Quantity

7:30 AM Coffee Black 16 ozEggs Scrambled, with pepper and butter 2 large eggsButter 2 TbHot sauce Great value brand 2 TbTortilla Corn, toasted 2, 8” diameterSalt 1/2 tsp

12:00 PM Tuna Canned 6 ozMayonnaise 3 TbOnion 1/4 cupLettuce Romaine, from garden 1/4 cupBread White, great value brand 2 slices

5:00 PM Rabbit Game meat, stewed in water 6 ozTomato From garden 1/3 cupsOnion Diced 1/3 medium

onionCorn Grilled 1 large Butter 1 Tb

7:00 PM Blue corn muffins Homemade 2 muffins

Did you take any supplements? No If yes, please specify: ___________________________

______________________________________________________________________________

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Three-Day Food Record for Nadia WhitehorseDay 3 of 3

Day of the week Saturday

Date 2/20/16

Time Food Item Description & Preparation Quantity

8:00 AM Coffee Black 16 ozEgg McMuffins McDonald’s 2Hash brown McDonald’s 1

11:00 AM Pasta Spaghetti 1 cupGround beef Cooked in pan with salt and pepper 3 ozSpaghetti sauce Great value brand 1/2 cup

3:30 PM Tortilla Chips Blue corn, homemade, fried in lard 2 cups

6:00 PM Zucchini squash From garden 1/3 cupBlack beans Canned, with salt, added spices 1/4 cupSalt 1/2 tspCorn Canned, kernels 1/4 cupRice White, cooked in water 1 cup

8:00 PM Birthday cake Made from box cake mix, yellow cake with frosting

1/8 serving

Did you take any supplements? No If yes, please specify: ___________________________

______________________________________________________________________________

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