Why Dietitians Should Practice Cultural Humility and How to Make a Habit of it

 By Sarah Bostic, SLU Dietetic Intern

In the clinical realm, I have heard the ambiguous term “cultural competency” tossed around (might I say) haphazardly, with little regard for the confusion it causes. As far as we, the health sciences students, know, cultural competency is a standard. The American academic system requires most of us healthcare professionals to complete a workshop, take a class, or ace a test to ensure future practitioners meet a standard for understanding of diversity. But does anyone actually know what it means to achieve cultural competency? Can we actually become fully competent in culture?

Spoiler alert: We can’t.

Disheartening? Perhaps. As dietetics professionals, we aspire to be worldly. We want to soak up every ounce of cultural and culinary knowledge to best relate to patients. But frankly, as humans, we are naturally limited in our knowledge of the world. We will never be fully “competent” in culture, no matter the number of hours we study, years we practice, or multitude of crash courses we take in history or culture. No length of education is sufficient enough to lead healthcare professionals to full understanding of the needs and desires of unique individuals in this diverse world. Therefore, instead of striving for competence, I propose we should encounter the backgrounds of patients and clients with cultural humility. 

Practicing Cultural Humility: Explained

Cultural humility is a relatively new tool in healthcare; it was developed in 1998 to teach US doctors how to treat populations with diverse cultures, races, and ethnicities. It has since taken hold in various settings around the world, one of them being dietetics.

Cultural humility allows healthcare workers to obtain a comprehensive understanding of a client’s personal beliefs and values without relying on preconceived ideas about their culture.

Rather than “achieving” cultural humility, the practice is regarded as a lifestyle. We are asked to continually educate ourselves, engage in conversation, reflect, recognize and overcome biases, and work toward compassion and understanding in every interaction. Practicing cultural humility allows workers to enter relationships with patients openly, seeing that their patients are uniquely wonderful individuals. The interaction is doubly fruitful-- the client can aid in providing the most culturally appropriate (and likely most effective) intervention, AND the client will feel deeply heard, valued, and safe. Who doesn’t love that? 

Practicing Cultural Humility: Clinical Implications

Dietitians, among all healthcare professionals, have a great opportunity and responsibility to be the experts that practice cultural humility and lean in when we encounter unfamiliar cultural practices. Food is intimately tied to an individual’s culture, tradition, and upbringing. Meals are a communal experience, so in using cultural humility, we can capitalize on our curiosity about food to gain a beautiful insight into the client’s practices and values.

Practicing Cultural Humility: Personal Growth and Development

As dietitians and dietetics students, we must use our greatest tool-- the commonality of food-- as a ground for understanding, learning, and offering improved patient-centered care. In little increments, we can use our knowledge to inform future interactions and grow as professionals and people.

 In addition to learning from patients, we can intentionally choose to grow daily in our knowledge of history, culture, and food habits. With greater exposure to new thoughts and ideas through engagement with the world, we can uncover and break free from our ethno-centric American biases and encounter clients and patients from a more compassionate and informed standpoint.

Cultural humility is a tool for facilitating personal growth and development; it is grounded in the understanding that there is always something valuable to learn. 

How to Make Cultural Humility a Regular Habit

Though there are no concrete steps to follow, the following practices that will help you grow in your approach to cultural humility:

●     Develop Awareness-- Recognize diversity and how your unique identity and experiences shape the world around you.

●     Evaluate Perspective-- Welcome discomfort when your personal views are challenged. Work to understand why you feel the way you do. Address bias. Work toward respecting others and the beauty their unique perspective brings.

●     Practice-- Listening, reflecting, analyzing, and empathizing with other perspectives.

●     Gain Exposure-- Inform yourself through conversation, non-fiction reading, films, documentaries, podcasts, trying new restaurants, traveling, and regularly following trusted media outlets.

●     Include and Engage-- Make a habit of inclusion by promoting diversity in every decision you make. Ask if there is more you can do to ensure your actions have equitable and sustainable outcomes.

●     Act-- Utilize your position to actively work against inequity. Encounter individuals with love and openness.

Adapted from Baylor University's “Developing Cultural Humility” https://www.baylor.edu/diversity/index.php?id=948078

For more information on Cultural Humility:

With a limited budget, I, personally, have taken up reading as a hobby to expand my knowledge of the world and create a foundation for patient interaction. Reading books on populations I do not interact with regularly has opened my eyes to the diversity of needs that exist. The following resources may be a great start!

●     Cultural Competence v Cultural Humility, Public Health Culture Podcast

●     “What is Cultural Humility?” https://www.youtube.com/watch?v=c_wOnJJEfxE

●     Recommended reading:

○     Ask Me Why I Hurt by Randy Christensen, MD

○     Tattoos on the Heart by Fr. Gregory Boyle

Final Thoughts:

As a dietetics student, I am lucky that “autopilot” has not yet set in. I am always looking for new things to learn and often feel a strong sense of humility any time I speak with a patient. More often than not, I know, when I walk into my patient’s room with sweaty palms and a handful of questions, that I will be learning much more from the interaction than the patient will be learning from me. That has been my greatest take-away-- I sincerely hope that all Dietitians, no matter their tenure, will encounter patients with this same vulnerability as they carry out their important work. Dietitians should always approach patients with fresh eyes and anticipate there is something to learn from their patients.

Image taken from https://a-thousand-words.tumblr.com/page/3