Transcript Cultural Competence in Treating A Chronic Disease: DIABETES

Cultural Competence in
Treating A Chronic Disease:
DIABETES
Lorena Drago MS RD CDN CDE
www.hispanicfoodways.com
Scenario:
A supermarket chain with a large Hispanic customer base
is promoting a diabetes program titled “Shop for your Heart”
The events will be held in Hempstead, L.I. and the Bronx.
Diabetes
The event coordinator has asked you to provide:
•Heart healthy shopping tips
•Food demonstration suggestions
•Physical activity tips
ASPECTS OF HISPANIC CULTURE
Decennial
Counts
of MajorOrigin
Hispanic
U.S Census
Population
Hispanic
by Subgroups
New York
City
and Boroughs, 2000
Type,
2006
8
6
Mexican
8
Puerto Rican
Cuban
3
COUNTRY OF ORIGIN
Dominican
3
Central American
9
64
South American
Other Hispanic
Preferred Foods Based on
Country/Area of Origin
Mexico
Corn, beans,
chiles, hearty stews,
moles, chocolate
Central America
Rice, beans, corn,
chiles, chocolate
Caribbean
Rice, beans, starchy root
Vegetables, coconut, adobo
sofrito
South America
Potato, corn, rice,
Annato, coriander, onions,
Beef in Brazil/Argentina
Latin American Breakfasts
Eggs (with
EggsColombia
with
Mangú (mashed
green, red,
tomatoMexico
sauce
boiled green
pasilla sauce) Dominican
plantains)
Fried green Republic
Green salsa
plantain
El Salvador Fried cheese
Refried beans Casamiento
Eggs
(fried beans and Salami
Chilaquiles
rice) with
EL
DOMINICAN
Orange
juice/milk
MEXICO
SALVADOR
REPUBLIC
cheese/cream
shake
Tortillas
Coffee
The Language of Food
Mexico
Central America
Beans: Frijoles
Squash: Calabaza
South America
Beans: Frijoles
Habas
Squash: Ahuyama, Zapallo
Caribbean
Beans: Habichuelas
Judias
Squash: Calabaza, Ahuyama
Low health literacy affects patient safety
Less knowledge about disease and self-care
In a 1995 JAMA study, what percentage of
individuals could not understand the
instruction
"take medication on an empty stomach?"
29%
39%
49%
HEALTH LITERACY
If you ate the entire bag of chips, how many
total grams of carbohydrate would you eat?
In a recent study,
25% of patients could not determine what glucose
meter readings were within normal range
of 80-120mg/dl
56% could not calculate the total carbohydrate
content in a container of snack chips
59% could not accurately calculate an insulin dose
Conveying Health Messages
Successfully
• ½ cup of potatoes count as 1 CHO choice.
How many choices does 2 cups of potato
count as?
• Your target blood glucose level is 60120mg/dl. Circle the values that are in the
target range
–
–
–
–
55
88
116
145
CONCEPT WORDS
“Balanced” “Healthy” Diet “Normal Range”
CATEGORY WORDS
“Fats and Oils” “Whole Grains”
VALUE/JUDGEMENT WORDS
“Excessive” bleeding, drink in “moderation”
Exercise “regularly”
FAMILY
FRIEND
S
FOUR CULTURAL VALUES
FAITH
FATALISM
Appeal to the
well-being of the
familyUse Risk Communication
1. Explain what is “at risk”
2. How high is the risk
(compare high to normal)
ADDRESSING
FATALISM
3. Show patient his/her risk
factor
4. Provide treatment strategies
5. Include testimonials (group
specific)
How to Develop Cultural
Competency Interventions
• Country of Origin
– Language
– Food Tastes and Predilections
• Health Literacy
• Health Beliefs and Attitudes
–
–
–
–
Family
Friends
Faith
Fatalism
• Culture is fluid – Culture guides but does not
define the individual
Questions
• How does acculturation impact dietary
behavior among Hispanics?
• How can we ensure that patient education
materials are suitable for different Hispanic
subgroups?
• What education tools have proven
successful when working with Hispanics?
• What is the best way to determine and
address health beliefs among different
cultural groups?
Lorena Drago, MS, RD, CND, CDE
Lorena Drago, MS, RD, CDN, CDE, is a registered dietitian, consultant and certified diabetes educator. She is
Senior Associate Director of Ambulatory Care Nutrition Programs at Lincoln Hospital including: Director of the
Diabetes Education Program and the Women, Infants and Children Supplemental Nutrition Program and maintains
her own private practice.
Lorena specializes in the multicultural aspects of diabetes self-management education and is an expert in
developing culturally and ethnically-oriented nutrition and diabetes education materials. She founded, Hispanic
Foodways, and most recently she developed teaching tools and patient education materials such as the
Nutriportion™ Measuring Cups that has the calorie and carbohydrate amounts of common foods embossed on
each cup and the Nutriportion™ Hispanic Food Cards that have pictures and nutrition composition of common
Hispanic foods.
Lorena serves on the American Association of Diabetes Educators board of directors; Nominating Committee Chair
of the Member Interest Group Latinos and Hispanics in Dietetics and Nutrition; and is the Chair-elect of the
American Diabetes Association Latino Committee. She also served as Past President of the Metropolitan New York
Association of Diabetes Educators in 2004.
She is the author of Beyond Rice and Beans: The Caribbean Guide to Eating Well with Diabetes, published by the
American Diabetes Association in October of 2006 and a contributing editor of Newsflash, a publication of the
Diabetes Care and Education Specialty Practice Group of the American Dietetic Association. She is a contributing
author and co-editor of the book Cultural Food Practices and Diabetes, soon to be published by the American
Dietetic Association. Lorena has appeared on several national TV shows speaking about diabetes management,
including The Early Show and CNBC's dLife TV. She has also appeared on New York’s “Diálogo con Glenis” a live
Spanish community cable show, where she discusses nutrition and diabetes, topics especially relevant to the Latin
community of the Bronx, which has the highest diabetes rate in New York City.
Lorena speaks on nutrition education, cultural competent diabetes care and health literacy. She has been an invited
guest speaker and/or faculty member at the following annual meetings: Mexican Association of Diabetes Educators,
Colombian Diabetes Association, American Diabetes Association and American Association of Diabetes Educators.
Lorena graduated cum laude from Hunter College of the City University of New York with a Masters of Science
degree in Food and Nutrition, and received her BA in Home Economics, Food and Nutrition from Queens College.