© 2006 Thomson-Wadsworth Chapter 16 Gaining Cultural Competence in Community Nutrition.
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Transcript of © 2006 Thomson-Wadsworth Chapter 16 Gaining Cultural Competence in Community Nutrition.
© 2006 Thomson-Wadsworth
Chapter 16
Gaining Cultural Competence in Community Nutrition
© 2006 Thomson-Wadsworth
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.
© 2006 Thomson-Wadsworth
Learning Objectives
• Describe the basics of developing cross-cultural communication skills.
• Explain strategies for providing culturally competent nutrition interventions.
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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.
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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.
© 2006 Thomson-Wadsworth
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.
© 2006 Thomson-Wadsworth
© 2006 Thomson-Wadsworth
Terms Related to Cultural Competence
• 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.
© 2006 Thomson-Wadsworth
Terms Related to Cultural Competence
• Cross-cultural - denotes interaction between or among individuals who represent different cultures.
• Ethnocentric - one’s own cultural view is considered best.
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Need for Cultural Competence
• There are many reasons why community health professionals need to develop cultural competence...
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Need for 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.
© 2006 Thomson-Wadsworth
Need for Cultural Competence
• 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.
© 2006 Thomson-Wadsworth
© 2006 Thomson-Wadsworth
Need for Cultural Competence
• 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.
© 2006 Thomson-Wadsworth
Need for Cultural Competence
• 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.
© 2006 Thomson-Wadsworth
Need for Cultural Competence
• 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.
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Need for Cultural Competence
• 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.
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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.
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© 2006 Thomson-Wadsworth
Cultural Competence Models – Campinha-Bacote Model
• Five interdependent constructs of this model include: – Cultural awareness– Cultural knowledge– Cultural skills– Cultural encounters– Cultural desire
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© 2006 Thomson-Wadsworth
Cultural Competence Models – Campinha-Bacote Model
• 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.
© 2006 Thomson-Wadsworth
© 2006 Thomson-Wadsworth
© 2006 Thomson-Wadsworth
Cultural Competence Models – Campinha-Bacote Model
• 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.
© 2006 Thomson-Wadsworth
© 2006 Thomson-Wadsworth
Cultural Competence Models – Campinha-Bacote Model
• Cultural Knowledge (continued)– An understanding of generalities
allows community nutritionists to develop relevant programming that builds on strengths and respects cultural differences.
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© 2006 Thomson-Wadsworth
Cultural Competence Models – Campinha-Bacote Model
• 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
© 2006 Thomson-Wadsworth
© 2006 Thomson-Wadsworth
© 2006 Thomson-Wadsworth
© 2006 Thomson-Wadsworth
© 2006 Thomson-Wadsworth
© 2006 Thomson-Wadsworth
Cultural Competence Models – Campinha-Bacote Model
• 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
© 2006 Thomson-Wadsworth
© 2006 Thomson-Wadsworth
© 2006 Thomson-Wadsworth
© 2006 Thomson-Wadsworth
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
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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.
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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
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Cross-Cultural Communication – Practical Guidelines
• Ways in Which Discussions about Food Can Open Dialogue– Ask about favorite foods– Foods used for celebrations– Tell food stories
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Cross-Cultural Communication – Practical Guidelines
• Working with Interpreters– Community nutritionists should use
professional interpreters or translators, as needed, rather than relying on friends or relatives of clients.
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© 2006 Thomson-Wadsworth
© 2006 Thomson-Wadsworth
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.
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Culturally Appropriate Intervention Strategies
• 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
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Culturally Appropriate Intervention Strategies
• 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.
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© 2006 Thomson-Wadsworth
Culturally Appropriate Intervention Strategies
• 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
© 2006 Thomson-Wadsworth
© 2006 Thomson-Wadsworth
Culturally Appropriate Intervention Strategies
• 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.
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Encouraging Breastfeeding among African-American Women
• Northside Breastfeeding Media Campaign – A grassroots, community-based
breastfeeding promotion project.
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Encouraging Breastfeeding among African-American Women
• 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
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Encouraging Breastfeeding among African-American Women
• 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
© 2006 Thomson-Wadsworth
Encouraging Breastfeeding among African-American Women
• 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
© 2006 Thomson-Wadsworth
Encouraging Breastfeeding among African-American Women
• 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
© 2006 Thomson-Wadsworth
Encouraging Breastfeeding among African-American Women
• Lessons Learned– The Northside Breastfeeding
Campaign demonstrated the positive impact of involving community members and organizations in the development of nutrition materials and messages.
© 2006 Thomson-Wadsworth
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
© 2006 Thomson-Wadsworth
Organizational Cultural Competence
• 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.
© 2006 Thomson-Wadsworth
Organizational Cultural Competence
• 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.
© 2006 Thomson-Wadsworth
© 2006 Thomson-Wadsworth
© 2006 Thomson-Wadsworth
Cross-Cultural Nutrition Counseling
• Relationship-Building Skills– Attending– Reflection– Legitimation– Show respect– Personal support– Partnership
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© 2006 Thomson-Wadsworth
© 2006 Thomson-Wadsworth
© 2006 Thomson-Wadsworth
Cross-Cultural Nutrition Counseling
• 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
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Cross-Cultural Nutrition Counseling
• 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
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Cross-Cultural Nutrition Counseling
• 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
© 2006 Thomson-Wadsworth
Cross-Cultural Nutrition Counseling
• 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
© 2006 Thomson-Wadsworth
Cross-Cultural Nutrition Counseling
• The Closing Phase– Review what occurred during the session– Summarize issues– Identify strengths– Support self-efficacy– Restate goals– Plan for the next counseling encounter