Diabetes is largely a self-managed disease.1 Education tailored to the individual patient is therefore vital to ensure optimal patient health and wellbeing. In our current multicultural society, the influence of different cultures and backgrounds on nutrition must be considered when individualising diabetes care and management. Professor Winnie Chee from International Medical University, Malaysia, presented on diabetes management in Malaysia’s multicultural landscape.
The impact of culture on food and nutrition
Culture heavily influences many factors of a patient’s life, including their behaviours and attitudes around food and nutrition (Figure 1).
In addition to diet, culture may also influence a patient’s approach to healthcare, how they communicate with their healthcare professionals and process information, as well as how they perceive ill health and weight loss. Ultimately, patients cultural preferences need to be addressed in order to optimise diabetes management.2,3
Challenges of multi-cultural diabetes management
Malaysia’s multicultural population has a high prevalence of diabetes.4 Prof. Chee noted that this disproportionately affects some ethnic groups, including people of Chinese, Indian and Malaysian background. Additionally, in Malaysia, there is a disparity between the many patients of different cultures and the smaller number of dietitians from these cultures. If healthcare professionals lack lived experience and knowledge about the cultures of their multiethnic patient population, this introduces further challenges to diabetes management. These challenges include facilitating shared decision making, bidirectional communication information during consultations, and development of a trusting relationship between the patient and clinician.5 These challenges may allow missed opportunities for appropriate diabetes care.
The importance of cultural competency
Prof. Chee emphasised that healthcare professionals must develop cultural competency to effectively care for patients from different cultural or ethnic backgrounds. Cultural competency in dietetics is the ability to effectively deliver healthcare services that meet the social, cultural and linguistic needs of patients, and provide unbiased nutrition services that do not undermine culture’s influence on lifestyle, food choices, and eating patterns.6 Cultural competency may require clinicians to educate themselves and interact more with different cultures, as well as reflect on and challenge the biases and stereotypes that they hold.
“It is important for dietitians to have cultural competency. Understanding different cultures help us to connect and communicate effectively with patients and improve patient outcomes.”
– Prof. Winnie Chee
Strategies for optimal diabetes management in culturally and linguistic diverse patients
Diabetes care should be tailored to each patient’s personal beliefs and perceptions. Prof. Chee suggested that patients from different cultures should not be instructed to remove certain food groups, as these different ingredients may have cultural significance. “Instead,” Prof Chee said, “Suggest a change in cooking method or portion size, or an increase in other healthier ingredients”. Healthcare professionals can also try different methods to facilitate effective communication with patients from a different culture. This might include using open-ended questions, offering group consultations, using visual aids, or an interpreter, to overcome language barriers. Prof. Chee noted the value of learning common names for foods in different cultures to connect better with patients. It’s also important to learn to recognise non-verbal ques from culturally diverse patients.
