E3 Integrating Cultural Practices Nutrition Intervention Strategies for Diabetes and CV Health

1. E3 Integrating Cultural PracticesNutrition Intervention Strategies for Diabetes and CV Health Katherine Brieger, RD,CDE Hudson River HealthCare May 2005

2. Foods and Culture Culture can be defined as a learned set of values, beliefs, norms and patterns of behavior. The foods people eat reflects their culture, and the degree to which they are acculturated and assimilated to a specific community.

3. Edible verses inedible foods • All people use food in a culturally defined way. A plant classified as food by one group may be considered inedible by another. • What foods are considered health promoting verses harmful are determined by culture.

4. What are the factors that impact Diet? • Diet depends on many factors including religious, economic, family, psychological, and personal factors.

5. Food and Religion • Religion is a key aspect of culture that often prescribes food patterns. • Fasting is related to many of these religious beliefs. • When foods can be eaten and how they may be eaten are all related to some religious practices.

6. Acculturation • Higher degrees of acculturation are tied to poorer nutritional intakes. • As communities become more “Americanized” a loss of the healthier food choices occurs. • Infant feeding practices may be determined as individuals become acculturated. • Activity levels may also be impacted.

7. Culture and Food • What type of foods eaten • When foods are eaten • How foods are eaten • Where foods are eaten • Acceptable body size

8. Body Image In many cultures, a larger physique is indicative of good health. Don’t assume that your patient automatically agrees with you for the need to lose weight.

9. Learn more about the foods your patients are eating by….. • Ask them about the foods they eat • Go to ethnic restaurants • Visit grocery stores • Take a look at ethnic cook books

10. How to Start…… • Determine the CORE foods of the patient’s diet • Determine how these CORE foods are prepared • Get an idea of what the patient is currently eating (the routine) • Determine the knowledge and beliefs of the patient-what does he or she believe about the foods eaten

11. Evaluating Individual Needs: • Do you have a working stove or oven? • Do you have a refrigerator? Do you share it with others? • Do you have difficulty using any of the kitchen equipment? • Are you able to buy the foods you need throughout the month? • How often have you had to use the food pantry/Hot meal program this month? How about last month?

12. Ask questions Taste foods from different cultures Ask how foods are prepared Ask how the food may impact health Ask if there are any special foods/teas which help to improve health Assume that all people of a specific culture eat the same foods Assume that all people of a specific culture eat the same foods or foods which are prepared in the same way Assume that foods are prepared in the same way you are familiar with Assume that people are not willing to change the way they eat Do’s and Don’ts

13. Working with Communities • Build Coalitions which can work together on programs • Use culturally sensitive intervention models • Use a variety of teaching techniques • Consider recruiting patients and their families for bringing about change • Approach communities with culturally appropriate methods/learning styles • Make use of culturally appropriate community resources (often the people themselves)

14. Cardiovascular: • Heart Health Workers-Community Health Workers/AMERICORPS/VISTA • Food demonstrations • Mexican Aerobics (Walking Clubs) • Head Start Program: make permanent environmental changes, ie. Use of 1 % low fat milk, using revised recipes which increase fruit and vegetables and decrease fried/high fat foods • Workshops for cooks-camp cooks, school cooks

15. Some ideas for Diabetes Programs: • Use of Community Health Workers • Food demonstrations • Workshops in Head Start and other community organizations • Community Education Day • Outreach

16. Use of Peers to teach nutrition • Curriculums for Lay Health Promoters • Techniques for sharing information

17. Resources of the Human Kind • Use successful lay health outreach models targeted to MSFWs in heart health and diabetes

18. Self-Management Support • Integrating culturally diverse recipes and food preparation techniques in programs • Use of elders in assisting others.