By: Sandra Arevalo, MPH, RDN, CDN, CLC, CDE, FADA
Originally posted in the September | October issue of AADE's eFYI Member Newsletter.
As diabetes educators, our main goal is to help people with diabetes better manage the disease. We spend hours trying to help people with diabetes understand what diabetes is, how it works, the why’s, when’s, and how’s of treatments and recommendations. However, when it comes to Hispanic people with diabetes, many of us can find it particularly difficult to help them achieve their goals. We might even start to feel frustrated because no matter how we explain things or how frequently, or closely we follow up with them, we seem to be getting nowhere. We start asking ourselves: is it a cultural thing?
What is culture?
When looking at different definitions of the word “culture”, my favorite is one from Tylor (1974), "that complex whole which includes knowledge, belief, art, morals, law, custom and any other capabilities and habits acquired by man as a member of society." But wait a minute, not only does that sound complex, we need to add more factors to the mix. The U.S. Hispanic population is beautifully diverse and dynamic. Processes of acculturation can change many of our typical customs and behaviors, so not being aware of cultural differences between different Hispanic groups can interfere with effective counseling and positive results.
Here are five common misconceptions I have seen that can damage the relationship between Hispanic people with diabetes and diabetes educators.
1. All Latinos eat tortillas
Really? Tortillas are popular in Central America and Mexico, not in South America. When you tell your patients to cut down on their intake of tortillas, because we know that when eating tortillas you can eat eight or more per meal, you first need to make sure that tortillas are food staples. Take your time to find out what carbs your patient most often eats, and you might be surprised to hear many different answers.
Patients who don’t eat tortillas and are asked about their intake might feel offended or believe that you have no idea what you are talking about. All rapport and trust that was built prior could be broken at this point.
2. All Latinos are born overseas
When you get patients with an accent you might assume they are born overseas and their first language is Spanish. As a matter of fact, only one-third of Hispanics in the U.S. are foreign born, as per the 2015 American Community Survey of the U.S. Census Bureau.
Why the accent then? Because many Hispanics grow up speaking Spanish in their households, communities, and neighborhoods, they develop their own accent over time. Do not forget that Hispanic families keep very close. Neighbors and longtime friends are often called compadres, tios y parientes, which are terms for family members. So don’t let the accent confuse you.
3. All Latinos are Mexicans
If you think this way, you are not necessarily to blame. Take into consideration that over 60% of Hispanics in the U.S. are have Mexican origins, so it’s easy to be confused about nationalities, mainly if you are living in the southern states. However, in the northeast, there a large percent of the Hispanic population are from Puerto Rico (9.5%), El Salvador (3.8%), Cuba (3.7%), Dominican Republic (3.3%) or Guatemala (2.4%). For more information see results from the 2016 Census.
Join cultural groups, ethnic book clubs, enjoy food at ethnic restaurants and food festivals, and share time with people from different Hispanic nationalities.
4. All Latinos play sports
Many Latinos are not huge fans of playing sports, and American football is not really followed at all. Instead, many Hispanics from Central America and the Caribbean prefer to watch and play baseball and feel very proud of some elite baseball players that come from their countries.
On the other side, Hispanics from South America and Mexico might prefer soccer. They are very passionate about this sport, and often play on weekends with family and friends. And it’s not just men. More and more women are joining soccer practice as well. But if you want your Hispanic patient to move, invite them to dance! With the variety of rhythms from Latin America, from salsa, merengue, bachata, cumbia, reggaeton and vallenato to son, bolero y balada, you will always find a rhythm to which your patients want to dance. Music is in our blood!
5. All Latinos eat vegetables
When you are doing a 24-hour recall you might often hear that a Hispanic person eats vegetables daily, with soups, as side dishes and even at breakfast. You might be pulling your hair trying to find out why they might be eating so healthy and still not losing weight or improving his or her A1C. The truth is that many Hispanics call tubers and plantains vegetables, and they eat them in a variety of ways, at all times of day, even as snacks.
So when you ask “Do you eat vegetables?” and “How often?” they might say a few times per day. So be sure to always ask which vegetables they eat. Help them differentiate between tubers or starchy vegetables, and green vegetables. They might be surprised to find out that tubers may raise their blood sugars, while green vegetables have a beneficial effect on their diabetes management.
In order to avoid these and other common misconceptions, take the time to visit ethnic stores, look for healthier Hispanic food choices to suggest to your clients, join cultural groups, ethnic book clubs, enjoy food at ethnic restaurants and food festivals, and share time with people from different Hispanic nationalities. Ask them about their country of origin, food, music, sports, climate, family values, favorite markets and stores, holidays and celebrations, ingredients and recipes. Learn about their favorite activities, health fears, home remedies, health beliefs and ask what they think are culturally sensitive food exchanges and preferred physical activities.
Once you have expanded your knowledge of Hispanic culture, you will be better prepared to build rapport with your patients, specifically, meeting them in their space at a cultural level where they feel comfortable and appreciated. This will help you work through any language barriers and knock down any cultural walls that might exist.
About the Author
Sandra Arevalo, MPH, RDN, CDN, CLC, CDE, FADA
Sandra works as Director of Nutrition Services and Community Outreach at South Bronx Health Center, a program of Montefiore and The Children’s Health Fund. Her work in nutrition, obesity and diabetes for the underserved has received numerous awards and presented at national conferences, published in peer reviewed journals, and featured in national and international television. Sandra is a recognized speaker and expert in food and culture.
She has dedicated her time to train people working with food understand the cultural factors that lead to food choices. She is the author of Microwave Chef, a book inspired by people living in shelters in New York City. Currently, she is a spokesperson for the Academy of Nutrition and Dietetics, and the American Association of Diabetes Educators.