The Role of Cultural Competence in Dietetics

By Brandy Leno

It’s no secret that the field of dietetics is lacking in diversity. And while the goal is to ideally have more diverse practitioners that look more like the populations they serve, we should also aim to encourage dietitians to be culturally competent when communicating with their patients or clients. So, what does it mean to be culturally competent? According to the American Psychological Association, it can be described as “the ability to understand, appreciate, and interact with people from cultures or belief systems different from one’s own.” Becoming more culturally competent is seen as a journey, not a destination, so there is always room for growth in personal awareness of biases that may be subconsciously present.

Cultural competence is especially important in the field of dietetics because food is one of the most important aspects of someone’s culture. Personal identity, religious beliefs, and family traditions are just a few things that are tied in with food. It’s easy to give food and nutrition advice based on our own experiences, but we must be aware of our audience and their cultural background to increase the level of adherence to nutrition advice. Because it’s so common to give nutrition advice based on our own experiences, clients who never hear their cultural foods represented when seeing a professional feel like their foods aren’t considered “healthy.” I’ve even had to tell someone that, yes, collard greens are very good for you! Keeping the patient or client’s cultural foods in mind when giving nutrition advice is crucial for establishing trust and creating healthy lifestyle changes.

One thing I really appreciate from the University of Maryland College Park dietetic internship program is the dedication to training their interns to become culturally competent professionals. Even before the program began, we were practicing counseling and motivational interviewing skills while keeping the diversity of our clients in mind. We routinely practice motivational interviewing skills during class days using different scenarios and have even received bias training with plenty of open discussion. Since it’s currently Hispanic Heritage Month, our group of interns made different hispanic meals to share with each other. Our dishes included plantain empanadas, arroz con leche, pupusas with curtido, and more. We were able to discuss how the dishes were made and try new recipes. Understanding the different foods and their typical cooking practices was a great way to apply what nutrition information I’ve learned so far to counseling patients of various backgrounds. By continuing this fun experience with different cultures moving forward, I will be able to explain to others what makes these foods healthy and how they fit within MyPlate guidelines.

Here are some of the things that I’ve learned so far about becoming more culturally competent:

1. Research is invaluable! As a health practitioner, I strive to become aware of the common cultural backgrounds I see amongst my patients or clients. I want to become familiar with their foods and norms to avoid doing or saying something offensive during interactions and so I can more successfully counsel them. When our group of interns were tasked with making a Hispanic dish and sharing it with everyone, I immediately thought of pupusas. The recipe I wanted to make featured a video that showcased a Salvadoran man and his grandma making the pupusas together. I was able to see the cooking process and listen to what this dish meant to them and their family. Seeing stories like that remind me that food is more than just a meal, so I look forward to hearing them whenever I get the chance. I will also strive to provide educational handouts in different languages to make current research and nutrition guidelines more accessible. At the same time, I will try my best to not make assumptions or stereotype any individual. No one person from any country is the same as someone else, which is why an individualized approach is always best.
2. Be aware of biases. Everyone has some sort of bias, be it conscious or subconscious, so it’s important to be aware of them. Being able to recognize a personal bias is just the first step in preventing differences in care or treatment between one individual or another solely based on their culture or ethnicity. No one culture or worldview is “right,” so recognizing that can help to increase the quality of patient-focused care.
3. Listen. Actively listening to individuals during all interactions can help me understand more about them. No person is the same, so listening can help me determine what makes them unique and give advice or guidance that is tailored to their lifestyle.
4. When in doubt, I can just ask! Asking questions during a session or any interaction is the best way to gather new information. If a client mentions a specific food they make often, if it is unfamiliar to me I can ask how it’s prepared. Making the attempt to engage in conversation and learn something new about the other person will generally be seen positively. Asking questions and clarifying anything I may be confused about is one of the best ways to avoid making assumptions as well.

These tips are only the beginning. As mentioned earlier, becoming culturally competent isn’t a goal, but a process. So far, I am enjoying the journey! I’ve only just begun my experience with UMD’s dietetic internship, but I’m looking forward to interacting with as many communities as I can and learning from those experiences.