Nutrition Counseling

Effective Counseling in Low-Socioeconomic Communities

Health disparities in low-socioeconomic communities continue to be a pervasive problem. Low-socioeconomic communities often lack access to healthful, nutrient-dense foods and culturally relevant, high-quality nutrition education, leading to disproportionate chronic disease rates and low self-efficacy to make healthful choices. When high-quality, healthful foods are sold in these communities, they’re often far more expensive than in areas where these foods are widely available.

These inequities are associated with higher rates of preventable chronic diseases such as type 2 diabetes and CVD in these communities, many of which have high numbers African Americans and other people of color, than are seen in predominantly white, higher-income areas.

RDs have a significant role to play in helping to stem the tide of these health disparities, but education strategies must go beyond traditional nutrition counseling. It’s essential for RDs to reflect on their own biases toward low socioeconomic populations, as well as learn how to practice cultural sensitivity and humility when working with them. In doing so, dietitians can more effectively help these clients overcome environmental hurdles so they can live more healthful lifestyles.

Here are some steps RDs can take to improve their cultural sensitivity and humility and improve outcomes for low-socioeconomic communities, particularly those of color.

1. Learn about the community you intend to serve. To make customized and appropriate recommendations, it’s important to gather information while speaking directly with the community of people you’re serving. This includes asking questions about their culture, food preferences, doing research on their health disparities and identifying the hurdles to effective dietary and lifestyle interventions.

To that end, don’t assume a community, ethnic group, or population has certain eating habits. For example, some may assume that all African Americans eat soul food, but this isn’t a foundational eating pattern for all. There’s enormous diversity within the African American culture, including Caribbean American culture and Afro Cuban American culture. When RDs make assumptions and don’t listen to patients, they begin to shut down and the rapport is lost.

Don’t be afraid to ask what dishes and traditions are part of a client’s food pattern and culture. This helps to build rapport and understanding, enabling RDs as the educators to continuously learn. Bárbara Escudero, MA, a culturally relevant pedagogy expert and leader for Teach for America, argues for the necessity of educators of any kind to provide “an education that recognizes and celebrates their identities, lived experiences, and culture” for communities with which they don’t have firsthand experience.

2. Consider hosting health education classes targeting separate groups in different communities, such as a church congregation–only weight loss class and exercise group or a weight loss group for ethnic minority women. Structuring your classes this way creates a sense of community support, and attendance tends to improve. This also enables RDs to ensure cultural sensitivity and customize the nutrition content based on the population’s needs.

3. Keep it simple when educating, asking clients how they learn best and considering visual aids to make messages more digestible. Nutrition knowledge is strongly related to education level and often plays a role in adopting healthful dietary habits; however, RDs also must understand that improving overall nutrition may be a lower priority for economically disadvantaged groups, who have many other seemingly more pressing needs. Evidence shows that customizing interventions and goals to a population’s or individual’s needs is highly effective for making sustainable lifestyle changes.

4. Acknowledge environmental factors such as cost, access, and availability of food and daily activities or behaviors. Lifestyle interventions and goal setting must be take into account cost of healthful foods, culture, as well as language and literacy barriers in these populations.

— Jasmine Westbrooks, MS, RD/LDN, is a registered dietitian at a diabetes outpatient center who resides in Sebring, Florida. She’s been featured as a guest speaker and media dietitian on WWTK 730 AM radio, KISS 107.5, and Tampa Bay’s WFLA BLOOM TV show and has written several articles for the newspaper Highlands News-Sun. Jasmine is a program director of EatWell Exchange Inc., a nonprofit organization that provides nutrition education to low-socioeconomic populations with a focus on culture. She’s also the co-owner of a virtual private practice, Wilkins and Westbrooks Nutrition Counseling, LLC. Jasmine’s specialties include diabetes education, healthful cooking, meal planning and guidance, childhood obesity, community nutrition, and heart disease. She serves in the Academy of Nutrition and Dietetics as the former membership chair of the National Organization of Blacks in Dietetics and Nutrition and the current diversity liaison. She’s also a part of the Diversity Leadership Program.

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