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.
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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:
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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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Cultural Competence Models
– Campinha-Bacote Model
• Five interdependent constructs of
this model include:
– Cultural
– Cultural
– Cultural
– Cultural
– Cultural
awareness
knowledge
skills
encounters
desire
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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.
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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.
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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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Cultural Competence Models
– Campinha-Bacote Model
• Cultural Encounters
– Areas to explore about cultural groups you
encounter in your work include:
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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
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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
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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 CrossCultural 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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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:
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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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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
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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
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Encouraging Breastfeeding among
African-American Women
• Methodology
– Developed culturally specific materials and
tested them prior to publication and
distribution
– Media strategies:
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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
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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
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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.
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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
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Organizational Cultural
Competence
• Five essential elements necessary for
an organization to provide culturally
competent programming:
– Valuing diversity.
– Having the capacity for cultural selfassessment.
– Being conscious of the dynamics inherent
when cultures interact.
– Having institutionalized cultural knowledge.
– Adapting service delivery based on
understanding of cultural diversity.
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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.
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Cross-Cultural Nutrition
Counseling
• Relationship-Building Skills
– Attending
– Reflection
– Legitimation
– Show respect
– Personal support
– Partnership
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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
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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
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Cross-Cultural Nutrition
Counseling
• The Closing Phase
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Review what occurred during the session
Summarize issues
Identify strengths
Support self-efficacy
Restate goals
Plan for the next counseling encounter
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