Transcending
cultural competence
in dietetic practice
Brooke Dekofsky
MPH, RDN, CDCES
“When healthcare providers do
not examine their biases and
demonstrate cultural humility,
patient care is compromised.”
“Dietetic Training: Understanding Racial
Inequity in Power and Privilege” (2020)
Journal of the Academy of Nutrition and
Dietetics
Learning Objectives
Define, understand and identify differences between cultural
competence, cultural humility and cultural competemility
 Be able to define ethno-centrism and ethno-relativism
 Define and recognize the use of cultural appropriation
 List tips for success in using cultural competemility in practice
 If provided a case study, be able to list the patients’ views,
perceptions, symptoms, culture, and experiences as valid and
important to help formulate an appropriate nutrition intervention

Constructs of cultural competence
Awareness
Recognition
Ability and willingness
Kilter, P.G., Food and Culture. (2016)
Cultural Competence
Cultural
knowledge
• Avoidance of
ethnocentricity
Cultural
awareness
• Knowledge of
the culture,
focusing on
health-related
beliefs and
practices,
cultural values
• Ability to
gather
relevant
data
Cultural skill
Cultural
encounters
• Being open to
correction about
perceptions vs.
reality
Cultural
desire
Emphasis on becoming competent rather than being culturally competent.
“Culturally Competent Model of Care”
(Campinha-Bacote, 1991)
http://www.transculturalcare.net/
Ethno-centrism
Denial: Ignores other
cultures/deny cultural
differences
Places one’s own
cultural group at the
center of their
observations of the
world
Perception that one’s
culture is better or
more “natural” than
others
Rigidity that all other
cultural groups must
behave in a certain
way without thinking
about context
Kilter, P.G., Food and Culture. (2016)
Ethno-relativism
Knowing one’s own
cultural identify
Makes attempts at
understanding others
Curious and
accepting of others’
cultural identities
Consider cultural
practice as relative to
context vs. judging
based on own
personal experience
Kilter, P.G., Food and Culture. (2016)
Cultural Humility
Emphasis on attention to avoid cultural appropriation and understand the impact of colonization in foodways
• constant selfreflection, selfcritique, and
become aware
of your own
values, culture,
beliefs, biases,
and position in
the world.
lifelong
process
open to
learn
• emphasizes
that you have
something to
learn from your
clients or
patients.
• respecting your
client as an
individual, not a
representative
collective of a
culture
prioritizes
respect
historical
awareness
• educating
yourself on
historical
realities and
injustices that
shape today.
“The concepts of cultural humility in the
healthcare setting “(Tervalon & MurrayGarcia, 1998)
Apposition vs Opposition
Our ability to
understand as
well as
communicate
and interact with
people across
cultures
cultural competence
cultural
humility
cultural
competence
cultural humility
A life-long process
of self-reflection and
self-critique in which
we evaluate our
core beliefs, values,
assumptions,
biases, and cultural
identities.
cultural
competemility
A learning
experience
A lifelong
process
SYNERGY
cultural
competency
cultural
humility
“Culturally Competent Model of Care”
(Campinha-Bacote, 2018)
http://www.transculturalcare.net/
“The Process of Cultural Competemility
in the Delivery of Healthcare Services
model views cultural humility, cultural
awareness, cultural knowledge, cultural
skill, cultural encounters and cultural
desire as the essential components of
cultural competemility with cultural
encounters being the pivotal construct
of this model.”
“Culturally Competent Model of Care”
(Campinha-Bacote, 2018)
http://www.transculturalcare.net/
Have you ASKED the right questions?
Uses the mnemonic
ASKED
Awareness
Desire
Skill
Encounters
Knowledge
“Culturally Competent Model of Care”
(Campinha-Bacote, 2018)
http://www.transculturalcare.net/
Identify the need and work together
Be aware that certain communities might have different needs
Be open to different protocols
When working with BIPOC [Black, Indigenous, and People of Color]
patients, it is important to acknowledge that the patients’ views,
perceptions, symptoms, culture, and experiences are valid
“Cultural Humility in Food and Nutrition”
(Palmer, 2021) Today’s Dietitian
Avoid cultural appropriation
Recognize and avoid cultural appropriation
From recipe writing to culinary education to cooking videos, there are many opportunities
for dietitians avoid these errors.
Ask yourself these questions to avoid cultural appropriation:
•
•
•
•
•
•
•
•
•
Is a recipe or food from a culture that isn’t my own?
Have I done research to understand its origins?
Am I giving credit to those origins?
Am I being respectful in how we describe or deliver information?
Have I engaged with someone who’s more familiar with this culture?
Am I the right person to bring this information or create this recipe, or is there an
opportunity to amplify someone else’s voice?
Am I influenced by another culture?
Have I given recognition to those influences?
Am I claiming others’ work as our own?
Instead - celebrate culture!

Dietitians can show cultural appreciation
Traditionally used for
flour, oil and drinks
Chia means strength in Mayan
”Chia Seeds: Tiny Seeds with a Rich History.”
(Kerry Neville, 2013) Food and Nutrition.
Tips for success
Begin analyzing personal biases and assumptions about patients
with different values than yourself. Accept your own mistakes,
shortcomings, and biases
Focus on historical perspectives related to food and health
 Learn about BIPOC food traditions, recipes, cooking,
ingredients, and food preferences
 Actively listen to center your client’s voice and in discussions
with patients by asking about and identifying their cultural
heritage, family values, and beliefs

Tips for success
Make learning from BIPOC professionals an essential part of
your nutrition philosophy
 Celebrate BIPOC food traditions by sharing diverse foodways
 Develop culturally humble nutrition education materials, making
sure the food recommendations are respectful and relevant to
BIPOC clients and patients.
 Create a simple survey to get feedback from the community to
continue to learn

Let’s practice: Case Study
A new patient, Mr. J, walks into
your office for an initial
counseling appointment with a
primary diagnosis of T2DM and
obesity. He shares with you…
Additional information you gather
Assessment
CC: newly diagnosed T2DM
Height: 68” Weight: 210# BMI: 31.9
•
59-year-old male living in Santa Maria
•
Medications/ Supplements: Metformin 500 mg orally BID, MVI for men
•
Altered labs from chart: A1c: 7.5%, FBG: 174 mg/dL, LDL: 131 mg/dL
•
Diet hx: Mr. J states he regularly skips a breakfast meal and instead sips on champurrado his roommate makes
who is from Mexico. His first meal of the day is lunch which he purchases from a local restaurant that prepares
foods from his country of origin, El Salvador (today was 3 cheese pupusas with curtido (1/4 cup) and a regular 12
oz soda) and enjoys a smaller snack for dinner such as pan dulce with coffee (prepared with 2 Tbsp whole milk, 4
packs of regular sugar).
•
•
Mr. J states that he doesn’t understand why his “weight and sugars are so high since ‘he’ only eats 1 meal a day.”
He also mentions to you that he is on a fixed income on workers comp with a work-related back injury and cannot
exercise.
Can you use cultural competemility to help Mr. J reach his nutrition goals?