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Cultural Competency Is Key to Counseling Patients with Diabetes

Eliminating health care disparities for black patients with diabetes begins with gaining cultural insight and tailoring educational efforts to individual patients….

Constance Brown-Riggs, MSEd, RD, CDE, CDN, said during a presentation at the AADE (American Association of Diabetes Educators), “Often, people will say, ‘I treat everyone the same.’ But, that’s the problem — that is not cultural competence.”

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.”

According to Brown-Riggs, there are several ways to overcome barriers to effective care. 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 and 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 so that they can follow the plan.

Specific issues other than food selection may complicate this process when educating black patients with diabetes. 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, including 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.”

Presented at: the American Association of Diabetes Educators Annual Meeting & Exhibition; Aug. 3-6, 2011; Las Vegas. Brown-Riggs C. F01.