Recognition, respect crucial for delivering culturally appropriate care in diabetes
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BALTIMORE — Providers must recognize and respect the culture of their patients with diabetes to deliver a strong level of care, according to a speaker at the Association of Diabetes Care & Education Specialists Annual Conference.
Melinda Boyd, DCN, MPH, MHR, RD, FAND, assistant professor at Cedar Crest College in Allentown, Pennsylvania, discussed the importance of culturally appropriate care, which is defined in the Academy of Nutrition and Dietetics Definition of Term List as care that responds to the needs of diverse individuals, families and caregivers. Boyd said culturally appropriate care can help pave the way to cultural humility between providers and patients.
“This is about respect and building a trusting relationship between the patient and the provider,” Boyd told Healio. “Care should be patient-centered, which means in order to achieve a health outcome or expect a certain behavior change, the recommendations need to be tailored to the patient. As a dietitian, when I make a recommendation to a patient about a diet change, if it doesn’t incorporate their traditional way of eating, the recommendation likely won’t be followed. This is important so we can connect better and help the patient be successful.”
Implementing culturally appropriate care
Culturally appropriate care weaves into many aspects of diabetes management, including discussions about food, beliefs in health outcomes, medication and alternative treatments and the understanding of checking glucose, participation in physical activity and fasting practices.
Culturally appropriate care requires several actions. Providers should go out of their way to recognize the differences between themselves and their patients. A two-way learning process is required in which providers are learning about patients just as patients are learning about their diabetes self-care. Providers need to respect the culture of others and make sure any intervention honors that patient’s culture. Understanding a patient’s motivations can allow providers to properly motivate them. Providers should also try to understand body image from each person’s perspective.
Boyd said there are several ways to provide more culturally appropriate care in practice.
“Learn some of the basics of the cultures you will come across most often,” Boyd told Healio. “Knowing your patient population is helpful in making sure you have the knowledge and tools to best help them. We can’t be experts in everything about every culture, but there is always going to be a place to get started. Avoid stereotypes; in other words, don’t make assumptions. Ask questions, but remember to be respectful. Remember that it’s all about the patient, not the provider. Your beliefs and food preferences don’t matter when it comes to the patient’s care. This means you need to ask instead of assuming they do things the same as you or feel the same way about something.”
Providers can improve care within their community by identifying the most common cultures in their patient population and learning a little about a lot cultures. Keeping a journal after seeing a patient from a different culture can help a provider identify any biases they have. Visiting local grocery stores that cater to different cultures can improve a provider’s knowledge of ethnic foods and help them avoid harmful stereotypes. Communication can be improved if a provider knows a few basic words in various native languages. Materials such as the U.S. Department of Agriculture’s MyPlate model can also be adapted to accommodate a patient’s culture.
Incorporating culture into evidence-based practice
Providers should be aware of a few diabetes-specific cultural considerations, according to Boyd. Different fasting or religious holidays could have an impact on food intake. Meal timing and size may differ between cultures. Weight inclusiveness is important to practice based on different cultural beliefs. A family member may have an active role in participating in care or in cooking for the families. Herbal remedies may also play a different role depending on the culture.
Boyd said there are a few principles to keep in mind when incorporating culturally appropriate care into evidence-based practice.
“Patient care should always be individualized, but we do want to make sure we’re at least looking at current evidence, whether it be from the Diabetes Standards of Practice or the Evidence Analysis Library from the Academy of Nutrition and Dietetics,” Boyd said during the presentation. “Consider the sample population from your studies and think if this evidence that I’m using, does it apply to the patient population that I’m working with? We may have to make some tweaks and we might know just from our own experience with the patient population what we read may not apply to them. Always use professional judgment.”
Boyd said evidence should be adapted to each individual’s beliefs and encouraged providers to approach guidelines in a way that makes sense to the patient.
“You have the power to make a difference in the health outcomes of your patients,” Boyd said during the presentation. “It starts with delivering care that honors and respects the culture of your patient.”
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Boyd M. F07. Presented at: ADCES22; Aug. 12-15, 2022; Baltimore.
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