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Cultural competency key to counseling patients with diabetes
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AADE Annual Meeting and Exhibition
LAS VEGAS — Eliminating health care disparities for black patients with diabetes begins with gaining cultural insight and tailoring educational efforts to individual patients, a speaker said here.
“Often, people will say, ‘I treat everyone the same.’ But, that’s the problem — that is not cultural competence,” Constance Brown-Riggs, MSEd, RD, CDE, CDN, president and owner of CBR Nutrition Enterprises, Massapequa, N.Y., said during a presentation.
According to Brown-Riggs, a major focus of developing cultural competence to improve communication with patients is awareness. Providers need to examine their own cultural backgrounds, specific health beliefs and practices, diets and more before counseling patients.
“Even when a patient comes from the same ethnic background, you can’t assume that they eat the way you do,” she said. “Part of overcoming this problem is developing the skill and comfort level to ask those questions, [as well as] having a culturally competent interchange.”
There are several ways to overcome barriers to effective care, according to Brown-Riggs. Regardless of race or ethnicity, it is often difficult for diabetes educators to encourage behavioral changes in patients. Being prepared to “roll with resistance” may be a better way to tackle this issue, she said. Diabetes educators should collaborate with patients to set realistic goals. For example, if patients’ circumstances, culture or tastes impede them from completely overhauling their diet, then diabetes educators should help them figure out how to work those foods into a nutrition plan while still considering fat grams or carbohydrates. In addition, rather than telling patients what is best, diabetes educators should propose a plan, let the patients decide what works best and boost their confidence that they can follow the plan.
Specific issues other than food selection may complicate this process when educating black patients with diabetes, Brown-Riggs said. Many patients who live in dangerous neighborhoods or who have low socioeconomic status may be most concerned about day-to-day living. They may also be unable to afford health care, and in some cases, a lack of education may lead to a mistrust of the health care system and medical treatment. In addition, black patients, especially those who have emigrated from other countries, may have more faith in complementary and alternative medicine or prayer. Therefore, diabetes educators should increase culturally sensitive educational efforts and can even refer patients to health clinics supported by faith-based organizations. It is also essential that providers have materials depicting black patients.
“Using basic counseling tips, building on cultural practices, encouraging positive changes and showing genuine concern … will improve outcomes, reduce health care disparities and shorten the cultural distance between health care providers and people with diabetes,” Brown-Riggs said. – by Melissa Foster
For more information:
- Brown-Riggs C. F01. Presented at: the American Association of Diabetes Educators Annual Meeting & Exhibition; Aug. 3-6, 2011; Las Vegas.
Disclosure: Brown-Riggs is a consultant for Eli Lilly and dLife.com.
The cultural disparity presentation was a very important look at the African American population. We know that these patients are at higher risk for diabetes and there is a greater prevalence of diabetes. As a diabetes educator, it is very important that I learn about the culture of the patients that I’m working with. I cannot just assume that the way that they eat or what their goals or priorities are in life are the same as my own. It is important if we are going to improve health in different cultures that we learn more about them.
I care very much about cultural disparities, particularly in the African American population. I work with an African American population in inner-city Atlanta, which is part of the “diabetes belt.” I know the importance when we are communicating with our patients to create that acceptance of what their lives are like is OK and what they’re doing is OK. When we ask about what medications they are using to manage their diabetes or other health issues, we need to bring up the topic of complementary medicine, herbs and over-the-counter types of treatment because this is very common in the African American population, particularly in the South. Another unique feature is cultural tastes for foods and what they eat. It’s very different in the diabetes belt. Many of the African Americans were only able to access lower-quality foods, and there has been a tradition of high-fat diets and also fast food because of costs.
– Kathy Berkowitz, APRN, BC, FNP, CDE
Chair, AADE
Annual Meeting Planning Committee
Disclosure: Berkowitz reports no relevant financial disclosures.
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