Cultural Competence in Dietetics Education: Where Are We Now and Where Do We Need to Go?

Nosotros mismos nos estamos matando/We are the ones killing ourselves: Unraveling individual and network characteristics associated with negative dietary acculturation among Mexican Americans in New York City

BACKGROUND

Research on negative dietary acculturation among Mexican-Americans has mostly focused on individual-level processes and has largely ignored the role of social networks.

METHODS

This mixed-method study used an egocentric network approach and derived 1620 personal ties of self-identified Mexican adults in New York. 24-hour dietary recalls were used to derive a total Healthy Eating Index (HEI) and subscores. The qualitative portion generated narratives around who helps or hinders their efforts to eat healthfully.

RESULTS

At the individual level, age at which participants migrated to the U.S. was negatively associated with total HEI (β = -0.39, p < .01). An annual income below $30,000 was positively associated with total HEI (β = 0.25, p < .05) and with HEI fruit subscores (β = 0.25, p < .05). Acculturative stress was negatively associated with HEI fruit (β = -0.29, p < .05) and refined grain subscores (β = -0.34, p < .01). At the network level, the proportion of network members who consumed traditional Latino diets was negatively associated with total HEI and HEI refined grains subscores (β = -0.39, p < .001; and β = -0.23, p < .05; respectively). In contrast, the proportion of alters who lived in another country was positively associated with HEI dairy subscores (β = 0.25, p < .05). Juxtaposing qualitative participants' visual representation of their total HEI scores with their lay interpretations of healthy and unhealthy eating matched public health messages of reducing sugar, red meat intake, and processed foods. However, participants felt that this could only be achieved through restriction rather than balance. Qualitative narratives also elucidated how dietary acculturation and income could help shape dietary quality in unexpected ways.

CONCLUSIONS

This study found evidence of negative dietary acculturation and showcases the complex ways in which both individual- and network-level processes help shape dietary choices for Mexican-Americans.

Degree-Granting Nutrition Programs in the Republic of Yemen: A Status Report on Postsecondary Education

Yemen is noted as one of the most food-insecure countries in the Arab world coupled with high rates of malnutrition. To address the public health outcomes related to nutrition, trained nutrition professionals are needed. This report provides a snapshot of current nutrition-affiliated programs offered in postsecondary institutions in Yemen. Partnering with or creating independent organizations responsible for defining the scope of practice is warranted. Additionally, ensuring educational quality, program accreditation, and competence of graduating students and readiness to practice will be central to progressively moving Yemen's dietetics profession forward.

Developing Dietetic Students' Confidence in Multicultural Communication through Flipped Learning

Problem: In a Master of Dietetics program, cultural competence was originally taught with lectures of cultural food practices. Course evaluations reflected that students wanted more opportunities to practice multicultural communication skills whereas lecturers felt that students' personal inquiry of cultural competence could be strengthened. This study explores whether the combination of self-directed pre-class learning and in-class activities through flipped learning could address these instructional issues. Three research questions were examined: (1) How did dietetic students' perceived confidence in multicultural communication change before and after undergoing flipped learning? (2) Which aspects of cultural competence influenced students' confidence in multicultural communication before and after flipped learning? (3) Which aspects of cultural competence were students' cultural learning goals based upon after flipped learning? Intervention: The intervention began with an introductory lesson in which students attended a lecture on New Zealand's cultural landscape, self-assessed their cultural influences, and completed self-directed learning of cultural competence concepts. After this, students participated in two flipped learning lessons; the first lesson focused on cultural knowledge and the second on multicultural communication skills. For both lessons, students completed preparatory activities before engaging in small-group activities during the class sessions. Before and after the flipped learning lessons, students wrote online reflections about the reasons underlying their confidence in multicultural communication. Context: The intervention was carried out with 32 early dietetic students who were in their first semester of postgraduate studies and 31 students consented to study participation. The majority of study participants were female (n = 30, 97%), European or Asian (n = 28, 91%), and between 21-30 years old (n = 27, 87%). Impact: Pre and post module surveys submitted by 31 students showed that more of them reported being confident or very confident in multicultural communication after flipped learning. Reflections submitted by 31 students before flipped learning showed that their confidence in multicultural communication was based upon their cultural knowledge and cultural interaction experiences. Reflections submitted by 19 students after flipped learning indicated that they developed cultural skill which helped them become confident in multicultural communication. These students set goals to continue developing their cultural knowledge, engaging in cultural interaction, and optimizing opportunities for applying cultural skill during clinical practice. Lessons learned: The study results showed that flipped learning can be used for cultural learning. As compared to lectures, flipped learning can provide students with more authentic contexts to practice multicultural communication. These learning experiences model how students might continue to self-direct their cultural competence development throughout their professional practice.

Aboriginal Cultural Competency in Dietetics: A National Survey of Canadian Registered Dietitians

Little has been published on cultural competency curriculum and dietetics considering the impact of food-related beliefs and behaviours on health. A 14-item online survey was administered in January 2016 to 145 participants (125 members of Dietitians of Canada Aboriginal Nutrition Network and 20 dietitians with an interest in Aboriginal nutrition). Questions included multiple choice and ranking responses and were pretested by 4 preceptors with the Northern Ontario Dietetic Internship Program (NODIP). Quantitative data analysis included frequencies, pivot tables, and averaging/grouping of ranking scores. A total of 42 individuals (29%) completed the survey. The majority rated the 5 health and cultural competencies and 6 food and nutrition competencies as "important" (90%-98% and 86%-100%, respectively). Overall, the competency related to identifying health status was ranked highest (78%), whereas developing culturally appropriate recipes was ranked lowest (83%). Most participants (95%) believed that all dietitians and graduating dietetic interns should be minimally competent in Aboriginal health and culture. The initial 11 draft competencies for dietetic interns were condensed to 6 minimum and 2 advanced competencies. Results will inform dietitians working with Aboriginal peoples and refinement of NODIP intern and preceptor tools, with the potential to integrate across Canadian dietetic internship programs.

Beyond the Melting Pot and Salad Bowl Views of Cultural Diversity: Advancing Cultural Diversity Education of Nutrition Educators

This article outlines how the melting pot and salad bowl views of cultural diversity have influenced the cultural training of nutrition educators and other health professionals. It explores how these views are changing in reaction to the changing demographics and health disparities seen in the US today and how the cultural training of nutrition educators has not kept up with these changing views. Suggestions for how this cultural education could be modified include placing a greater emphasis on both the cultural self-awareness of nutrition educators and the sociopolitical historical factors that influence the cultural orientation of nutrition educators and their clients.

Examining the Cultural Competence of Third- and Fourth-Year Nutrition Students: A Pilot Study

The purpose of this study was to provide preliminary Canadian research assessing nutrition students’ cultural competence and to identify areas for future education initiatives in dietetic education that could ultimately improve dietitians’ cultural competence. A mixed-methods study was conducted using a 24-item questionnaire that was administered to students enrolled in third- and fourth-year undergraduate nutrition classes (n = 133). In total, 115 questionnaires were analyzed for quantitative data, and 109 were analyzed for qualitative data. The students scored an overall medium–high level of cultural competence. Out of the 5 areas examined (skills, attitudes, awareness, desires, knowledge), students’ multicultural knowledge scores were the lowest. It was found that a lower number of barriers to learning about other cultures were significantly associated with a higher overall cultural competence score, and taking a course in cultural foods significantly increased the students’ knowledge and overall cultural competence (P ≤ 0.05). The qualitative data found that students felt the cultural competence curriculum had gaps and identified several ideas for improvement. In conclusion, this research data provides novel insights into the cultural competence of Canadian dietetic students and additionally supports future research and curriculum development to enhance cultural competence.