Communicating About Food in Today's Diverse World
-Have you ever needed to communicate ideas about food and nutrition to a family with a culture very different from your own?
-Do you find yourself teaching people from an assortment of backgrounds --people who have important, lasting ties to their own cultures?
-Are you called upon to provide guidance to people who have recently joined the community, for whom everything -- language, living accommodations, and economic status -- is new and different?
Nutrition educators face challenges like these more and more every day. In a multicultural world, opportunities abound for knowledge to be shared among educators, families, and communities. This begins with understanding the many ways in which seemingly different cultures are alike, including foods eaten, occasions celebrated, and traditions followed. It also involves fostering respect for the great variety in cultures and developing an appreciation for what makes people different. Above all, it means celebrating diversity -- in nutrition, as in so many other aspects of life.
Our Nation's Changing Culture
There's no doubt about it -- the face of our nation is changing. The population of the United States is diverse, and this racial and ethnic diversity is growing rapidly. In fact, according to the 1990 census, almost one in four Americans has African, Asian, Hispanic, or American Indian ancestry. That figure is projected to rise to almost one in three by the year 2020 and almost one in two by the year 2050.
Within each of these broad ethnic groups, there are people of many different backgrounds and cultures. For example, there are 530 federally recognized American Indian and Alaska Native nations, and that doesn't include the scores of other American Indian nations that are not recognized. The 1990 census lists over 60 European, Asian, African, North American, Caribbean, Central American, and South American countries of origin for immigrants. The number continues to grow.
The growth of culturally distinct groups in the United States has two main origins: a higher birth rate for many ethnic groups and an increase in immigration, including the entry of refugees as well as undocumented persons.
Working With a Culturally Diverse Population
As a part of living in the United States, most of us interact with people from a variety of cultures every day. When new people move into our community or we move to another part of the country, we inevitably meet people of different cultural backgrounds. Differences in language or dialect are an obvious barrier to effective communication. We may also encounter differences in family structure, values, and interaction style. To be successful educators, we must learn to work within other value systems.
Understanding Relationships Between Culture and Food
Specific foods mean different things in different cultures, but most cultural groups use food for similar purposes. People from virtually (practically) all cultures use food during celebrations. Many cultural groups use food as medicine or to promote health. Nutrition educators must recognize the strong preferences that people have for the foods they eat and their special uses of food.
Managing Time in Nutrition Education
Time presents a challenge for both educator and student. When people are of different cultures, it takes time for trust to develop between them. The nutrition educator may need to spend extra time becoming familiar with the student's culture. A newly arrived immigrant family needs time to learn new ways. Language barriers slow communication and different views of time occasionally cause misunderstandings between educator and client. The challenge for nutrition educators is to make the best and most effective use of time for all involved.
Approach to Nutrition Education
Communication works best when nutrition educators focus on each family's background and present situation -- without making assumptions. To do this, nutrition educators should first learn about their client as an individual and about the client's family and culture as a whole. Second, educators should place the food habits of the individual or the family within a cultural context. Third, educators should consider how the family's eating patterns are likely to change in a new environment.
Lists can promote stereotypes, too. For example, a food list masks the wide variety of foods that people eat and does not show differences in methods of preparation. Food lists may give the impression that nutrition educators learn everything they need to know about a person's food habits from looking at a chart. (However, if you can use a food list as a starting point or to fill in some gaps.)
Today there are many creative ways for nutrition educators to consider cultural diversity in their nutrition education activities. Traditional foods of all cultural groups in the United States are becoming more widely available and accessible to much of the population.

Chapter 2: Opening the Dialogue - Using Food to Create Common Ground
Communication works best with familiar topics. For nutrition educators, food provides a terrific opportunity to open up a dialogue with a client. After all, everybody eats!
Even when educators and clients have very different eating habits, sharing food experiences can help create common ground. Telling stories about a favourite food or how food is used opens the dialogue between provider and client. Most people enjoy letting an interested listener know about their background and culture. And you can go one step further. Preparing food together -- and sharing the results -- goes a long way in bridging the gaps and developing good relationships.
Ask About Food Experiences
Everyone has memories related to food. For many people, these memories are connected with family, celebration, and caring.
Using Food to Create Common Ground
Ask about food experiences, including foods used for celebrations and other special occasions. Can you imagine a family celebration that doesn't involve food? Asking clients about special occasions helps you learn how foods are used in their culture and also how their religious beliefs may affect their eating habits. Other memories of food may not be pleasant, but they still provide an opening to talk about food.
Ask questions with an open mind. Keep your sense of humor. Always remember to ask questions with an open mind -- and keep your sense of humor! Listen carefully to answers, and don't be judgmental. You might learn about foods you personally find distasteful (e.g., snakes, lizards, or turtle eggs) or foods you have never even heard of (e.g., pitaya juice). It's all part of the mutual learning process. You may even discover some unfamiliar combinations of familiar foods.
Tell your own food stories. Food is very personal. Who likes to be told that what they eat isn't good for them? So when you ask about food, clients may tell you only what they think you want to hear. Those who are more shy may hesitate to open up. If you share with them that you yourself do not always make "perfect" choices, they may be more candid. This sharing helps establish trust, and your clients will realize that you understand their struggles and experiences.
Find out what foods are used as medicine or to promote health. Members of some cultural groups eat special foods or diets during menstruation, pregnancy, or lactation, and during illnesses such as colds or fevers. Ask about what your clients eat during these times in their lives. You may also discover health concerns about specific ingredients or preparation methods.
Ask about favourite foods, meals, or recipes. You and your client can communicate through food even if you don't have a common food experience or like the same foods. Nutrition educators will probably encounter this situation with anyone outside their own family. Try beginning an instructional session by asking about the student's favourite foods. And remember, not everyone uses written recipes, so ask about ingredients and preparation techniques, too.
This give and take sets the stage for a mutual exchange of information and shows interest in and respect for what is important to your student. This approach involves your client in the education process instead of dictating to her. If you tell a mother that her child can no longer eat his favourite foods because they are "bad" for him, you risk making her angry, especially if she feels that you are criticizing the foods she offers to her child or her methods of food preparation. In this case, she might not hear anything else you have to say. Favourite foods can be included in any meal pattern, but suggest moderation if needed. Try to work with your client while educating.
The value of using food to create common ground cannot be overemphasized(Exaggerate). This technique was recommended repeatedly by experienced nutrition educators around the country when they were asked about ways to communicate effectively about food. Effective communication also requires an appreciation (approval) of changing food patterns.

Chapter 3: Changing Food Patterns
Defining "Acculturation"
"Acculturation" is the process of adopting the beliefs, values, attitudes, and behaviours of a dominant, or mainstream, culture. Part of this process includes changing some traditional dietary patterns to be more like those of a dominant culture. Many factors influence acculturation.
Acculturation does not involve only immigrants; it is an ongoing process that affects anyone who moves from one community to another. As nutrition communicators, we must understand how acculturation affects the families we work with and how, in turn, nutritionists are affected by the process.
Changes Are Different for Everyone
Acculturation occurs differently for everyone. This means more than different rates among different families from the same cultural background; it means different rates among members of the same family as well.
Everyone has a different reason for coming to the United States or moving from one community to another. These reasons affect the process and rate of acculturation. For example, those seeking a higher education usually have more exposure to the mainstream culture. They tend to acculturate at a faster rate than those coming to do migrant farm work, who remain more closely tied to their native cultural groups.
Variations in age and exposure to new ideas affect the extent to which people adopt new practices or beliefs. The older generation may keep traditional cultural ways and maintain the traditional diet.
Parents may make some changes (often with pressure from their children). Children may adopt new ways quickly as they learn from other children at school, despite family pressure to retain cultural traditions related to food.
Acculturation is often viewed as the extent to which a person has "mainstreamed" into the U.S. population. But don't make assumptions! Those who dress and speak like the "mainstream" may still follow traditional ways at home out of respect for their elders or because of their own ethnic pride. For example, they might continue to use foods in traditional combinations or as medicines.
Factors That Influence Acculturation • History of cultural groups in the community • Length of time the individual or group has been in the community • Involvement of the individual with his ethnic group in the community • Ties with family • Family structure • Language • Employment • Education
Changing Dietary Patterns
Changes in dietary patterns -- or "repatterning" -- occur as a part of the larger acculturation process. People constantly reevaluate the foods in their diet and make changes by adding, substituting or rejecting foods. Together, these changes result in repatte rning of the diet, sometimes causing major changes in nutrient intake.
Addition of New Foods
New foods are added to the diet for several reasons: status, health, economics, information, taste, or exposure. Eating "American" food (foods such as hamburgers, hot dogs, and pizza) may represent status and make people feel that they are a part of their new culture and the American way of life. Or people may add foods because they believe that they are healthy, based on new information that they've learned. Children may bring new foods home after they hear about them in school or from their friends. New foods are often added for economic reasons -- they may be inexpensive and readily available.
Substitution of Foods
Sometimes traditional foods are replaced by new foods in a family's diet. This happens for a variety of reasons. Perhaps it's hard to find a traditional food in local food stores, and new foods or ingredients must be substituted. New foods may be more convenient, less expensive, or better liked. For example, after Mexicans come to the United States, many use flour tortillas or white bread instead of corn tortillas. One reason given is that flour tortillas and sandwiches are easier to pack in a lunch to take to work -- cold corn tortillas can crack and leak. Substitutions such as these can lead to changes in nutrient intake (in this case, a lower calcium intake). In addition, a medium-sized flour tortilla made with white flour and added fat may contain up to four grams of fat, while a corn tortilla typically contains only about half a gram of fat. The use of luncheon meats and mayonnaise in sandwiches may increase fat intake as well.
Rejection of Foods
Some people -- especially children and adolescents -- will give up traditional foods because eating these foods makes them feel different from their peers, and out of place. They want to become "Americans" and may resent parents or grandparents who are trying to force them to continue traditional ways of eating.
Changes are Interrelated
Keep in mind that dietary changes -- additions, substitutions, and rejections -- do not happen independently of each other, and they are not always easy to predict. As people settle in a new community, they may increase or decrease the use of traditional foods. For example, meat may be eaten more frequently than it was in another country where it was very expensive. Families who one ate rice at every meal may eat it only once a day as they experiment with new staple foods.
Change is almost always a two-way street. Whenever people from two or more cultures interact, they will influence each other. For example, when new members of the community adopt typical "American" foods, they also contribute some of their favorites to the American diet. Just consider the variety of ethnic restaurants that might be found on a single city block -- and the growing ethnic sections of traditional American supermarkets.
Changes such as these also occur when people move between regions of this country, where distinct patterns of eating can be found. For example, many people in the Midwest and the Northeast may insist on having meat and potatoes daily, and some families in the South think that breakfast is not complete without grits. As we move around within the country, we take some food patterns with us, adopt some new ones, and continually alter the cultural food mix.
So you see, acculturation affects us all, and it affects our food habits. Even so, the dietary changes that occur when a family moves to a new community depend ultimately on the family's background and current circumstances.
Chapter 4: Food Choices & How We Make Them
Now that we have explored the changing food patterns of everyday life, let's take a closer look at specific factors that affect the food choices we make everyday. These factors apply no matter what our cultural background. Note that for new arrivals to a community, an even greater number of factors play a part in determining food choices.
Food Availability -- Where to Find It
Today, the "marketplace" includes supermarkets, convenience stores, farmers' markets, sidewalk vendors, ethnic food markets, restaurants, fast food businesses, delis, commodity supplemental foods program warehouses, and more. Many of these sources offer more ethnic foods than ever before. We are also exposed to food in other settings: at work, through vending machines, snack bars, or cafeterias; at out-of-home child care; at school, through the school breakfast and lunch programs; and even at home, through television and print advertisements, and videotapes. Food choices are everywhere. And the more available a food is, the easier it is to add it to our diets.
Cultural Eating Patterns and Family Traditions
Tradition plays a major part in the choices we make. Culture influences the role of certain foods in our diets, methods of food preparation, the use of foods (including celebration and comfort), and health benefits related to food. Let's take a closer look at these factors as we examine the importance of cultural and family traditions in the food choices we make.
Factors That Affect Food Choices
For All Availability Cultural eating patterns and family traditions Exposure to new foods and new methods of food preparation Economics Ability to get to the market Living arrangements (including the presence of specific food preparation equipment) Convenience of preparing food, and skill at preparation For New Arrivals to a Community Access to traditional and nontraditional foods and beverages Length of time in the community Time and skill required to prepare new dishes rather than traditional ones Availability of low-cost ethnic restaurants or diners Level of comfort shopping (ability to ask for items, drive to stores, etc.) Ties with family or ethnic group in the new community Staple Foods
All cultures have "staple" or "core" foods that form the foundation of their diet. A staple food is typically bland, relatively inexpensive, easy to prepare, and an important source of calories. As you work with different cultures, you'll find such staples as cereal grains (rice, wheat, millet, and corn); starchy tubers (potatoes, yams, taro, and cassava); or starchy vegetables (plantain or green bananas).
Staples are considered to be an indispensable part of the meal. For Southeast Asians, for example, rice is the staple food -- the major part of each meal. In fact, a meal served without rice is considered a snack. For natives of East India and Pakistan, roti (Indian bread) is served at every meal. In the United States, boiled potatoes are a staple for many New Englanders.
Nonstaple Foods
Foods that are eaten less frequently are "peripheral" to the core, meaning that they are not a central focus of the diet. Foods that fall into this category have a weaker cultural meaning; they are based on individual preferences. Nonstaple foods are often grouped into protective foods and status foods.
Protective Foods
Foods considered to be protective are generally rich in nutrients. They are used in various combinations, along with traditional spices, to prepare seasoned dishes that give flavor and ethnic identity to a meal or cuisine. Protective foods include a variety of vegetables, legumes, nuts, fish, eggs, meat, and certain grains.
Status Foods
Status foods are those that are generally rare and expensive in a cultural group's place of origin. They are not a part of the typical daily diet. And just as cultures vary, status foods vary widely from group to group. Usually consumed on special occasions, they often require much time and many ingredients to prepare.
Traditional Preparation
Methods of food preparation -- which may vary greatly or only a little, both within and between cultures -- play a big role in influencing food choices. Consider dried beans, for example. Central Americans often prepare beans as a paste and eat them with tortillas. People from the Caribbean frequently fix beans as a stew or with rice and sofrita (onions, bell pepper, garlic, cilantro, oregano, and salt fried in oil). People of Chinese origin use beans extensively in desserts and cold drinks. And people from many cultures use beans in soups.
The use of seasonings often distinguishes one culture's traditional food habits from another's. Seasonings vary from country to country and according to the weather and the time of year. In the tropics, fresh hot peppers are plentiful, and foods are highly spiced. In more moderate climates, fresh, flavorful herbs like cilantro are easily grown and commonly used.
Traditional Seasonings
The use of seasonings often distinguishes one culture's traditional food habits from another's. Seasonings vary from country to country and according to the weather and the time of year. In the tropics, fresh hot peppers are plentiful, and foods are highly spices. In more moderate climates, fresh, flavorful herbs like cilantro are easily grown and commonly used.
Frequency of Consumption
Even when people eat the same foods, the frequency of consumption can vary based on culture. For example, many Central and South Americans eat beans at every meal. But in Caribbean countries, rice and beans may be served as a special meal on Sundays -- only rice is served during the week. And in the Midwest or the Northeast in the United States, people may eat baked beans mainly on Saturday night.
The frequency of consumption may change over time, too. For example, while yogurt is a traditional food in the Middle East, only recently has it become widely accepted in this country. Americans of many ethnic backgrounds now eat it often. Some consider it a health food.
Lactose Intolerance
In this country, it has been estimated that from 60-95% of adult African Americans, American Indians, Jews, Mexican Americans, and Asian Americans are lactose intolerant. For these people, eating lactose-containing foods such as milk products may cause cramps and diarrhea. Milk drinking by adults tends to be uncommon among these groups -- even those who do not have the condition. Most infants can tolerate lactose. Most children, adolescents, and adults can avoid symptoms by taking small servings and spacing them out throughout the day. Cheese and yogurt are often better tolerated than milk, but for severe cases of lactose intolerance, all milk products may be omitted from the diet.
Food and Health Beliefs
Food is often believed to promote health, cure disease, or have other medicinal qualities. Health beliefs can have a great impact on food choices. For example, Asian and Southeast Asian cultures, among others, feel that maintaining a balance is very important to health. among traditional Chinese people, health and disease are believed to relate to the balance between yin and yang forces in the body. Diseases that are caused by yang forces may be treated with yin foods to restore balance.
In many Asian cultures, pregnancy is classified as a yang or "hot" condition, so a woman following traditional practices during this period will eat yin foods. These are typically low-calorie, low-protein foods. Following the birth of the baby, the mother enters again into the "cold" state with the loss of heat and blood at delivery. She may be given steamed rice (a neutral food) with heavily seasoned pork (yang), but not allowed to consume fresh fruits, most of which are yin foods. Hot tea may be allowed because it is thought to increase blood volume and heat and decrease diarrhea.
Other cultures have similar theories. The hot/cold theory in Puerto Rico follows the same principles as yin and yang, but the food groupings differ somewhat. Culture, Food and Beliefs About Medicinal Uses Hispanic Lemon Juice (added to water or hot tea) Garlic Raw Onions (chopped with honey Thought to cure a cold. Used fresh as an antibiotic and topically on insect bites. Thought to lower blood pressure.
Believed to be good for a cold or other respiratory infection. Vietnamese Oregano Tea (served hot, with salt instead of sugar) Rice Porridge Given for an upset stomach. Considered standard food for sick people.
Taiwanese "Tonic Herbs" Believed to increase blood circulation.
Caribbean, Filipino
Chayote, Papaya Soup (prepared with cow's feet and viandas) Porridge (prepared with grated green plantain (peel included) Beet Juice Used as a treatment for hypertension. Believed to restore strength. Believed to give strength. Believed to cure anemia.
Iranian
Liver, Beets, Pomegranate Believed to increase blood. United States
Chicken Soup
Believed to cure anything. Culturally-Based Attitudes
Culturally-based attitudes about food, the proper use of food, and other aspects of life can also affect the food choices people make.
Based on previous experience, people from different cultures may view weight very differently. If they have had experience with extreme poverty and insufficient food, the dangers of underweight in children may be all too familiar. They may view overweight as a sign of wealth and excess weight as healthy. Mentioning underweight, especially if talking about a child, may be seen as offensive. Be sure to find out the background of the person you are speaking with before you address weight issues.
Attitudes about food can vary from region to region.
Traditional Celebrations
Culturally-based attitudes about food, the proper use of food, and other aspects of life can also affect the food choices people make.
Based on previous experience, people from different cultures may view weight very differently. If they have had experience with extreme poverty and insufficient food, the dangers of underweight in children may be all too familiar. They may view overweight as a sign of wealth and excess weight as healthy. Mentioning underweight, especially if talking about a child, may be seen as offensive. Be sure to find out the background of the person you are speaking with before you address weight issues.
Attitudes about food can vary from region to region.
Traditional Celebrations
All cultures celebrate with food, and they make their food choices accordingly. There may be special foods for any number of occasions, including religious holidays, national holidays, family get-togethers, or gatherings in honor of individuals' accomplishments.
Consider the following examples. People from the Caribbean Islands often eat roasted pork for celebrations, while Central Americans often choose turkey. Among Filipinos, noodles are served at birthday parties and other functions to symbolize long life. and in the Southern United States, eating black-eyed peas on New Year's Day is said to bring good luck for the year.
Within cultures, individual families may have their own traditions at times of celebration.
Foods That Nurture
Many cultures associate food with nurturing children and families. Sharing available food with the extended family is a common way to show caring by putting the family first. In the United States, milk and cookies might be used to offer comfort. Traditional foods can be reassuring in a variety of circumstances.
Economics
Economic considerations often have a major impact on food choices. In the United States, economic status may vary according to level of education, ability to speak English, job skills, and employment opportunities in the community.
To better understand how economics affects your students' food choices, consider each family's background and present situation. For example, immigrants may have different resources than they did in their homeland. Their situation depends partly on whether they are joining a family or group that is already established. People who were doing well in their homeland may suddenly find themselves in need of assistance (e.g., food stamps). Or they may find that foods that were rare and expensive in their homeland are easier to get in the United States.
Affordability and availability are interdependent. Those who are new to the area may find an amazing number of foods available., but the cost of some of the foods can greatly reduce the actual number of choices. For your clients, there is often a sharp contrast between what they see on television or in the supermarket and what they can afford to buy. Some community groups have formed buying clubs. Some have even evolved into co-ops. One church group arranged to bus people to a grocery discount chain to enable families to get more food for their money. To pass the time and make the 40-minute bus ride more enjoyable, nutrition education was provided to the families along the way.
NOTE: Here is the first of the ideas from nutrition educators that you'll find throughout this publication. |1 |Extend purchasing power: To make food purchases more economical, some community groups have formed buying clubs. Some have even |
| |evolved into co-ops. One church group arranged to bus people to a grocery discount chain to enable families to get more food for |
| |their money. To pass the time and make the 40-minute bus ride more enjoyable, nutrition education was provided to the families |
| |along the way. |

Food Preparation -- Convenience and Capability
Besides being able to purchase food, a family must be able to prepare it. The time needed for preparation plays a big role in food choices. With so many adults working away from home for most of the day, having the time to prepare foods becomes key. Choices are sometimes based on whether a family has the space and equipment needed to store and prepare the foods they are used to eating. For example, many households on American Indian and Alaska Native reservations do not have electricity or adequate storage capabilities (e.g., refrigeration). You may need to provide families with information about affordable, nutritious foods that are compatible with their food preferences and storage capabilities, and that are easy to prepare.
Cultural eating patterns, economics, and practical issues related to obtaining and preparing food each affect the food choices people make every day. That's why it is important to communicate with your students and learn the reasons for their food choices. Developing good communication skills helps you gather the information and resources you need to be a better educator.
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Chapter 5: Communicating with Clients and Families
Communication provides an opportunity for persons of different cultures to learn from each other. It is the key to your role as an educator. To keep the lines of communication open, you must build skills that enhance communication between cultures. These skills will help you overcome any real or perceived differences with your client or your client's family. Be open, honest, respectful, nonjudgmental, and -- most of all -- willing to listen and learn. Offer assistance in a way that maintains your client's dignity.
Keys to Good Communication • Respect personal space. When you first sit down to speak with students, ask them to sit where they feel the most comfortable or let them tell you where to sit. This will allow people to choose the distance that feels right to them. For example, Hispanics tend to feel comfortable at a closer distance than do American Indians or Asian Americans. • Learn the cultural rules about touching. Find out the cultural rules regarding touch for the ethnic group with whom you will work -- including differences based on gender. In some Asian cultures, the head should not be touched because it is the seat of wisdom. In many Hispanic cultures, the head of a child should be touched when you admire the child. A vigorous handshake may be considered a sign of aggression by American Indians. • Establish rapport. Take time to establish common ground through sharing experiences and exchanging information. • Ask questions. Do not be afraid to ask someone about something with which you are unfamiliar or uncomfortable. Nutrition educators suggest open-ended, honest questions that show an interest in the person, a respect for his culture, and a willingness to learn. • Appreciate and use silence. Observe your student to get a feel for how he or she uses silence. Do not feel that silence has to be filled in with small talk. Give people a chance to formulate their thoughts, especially if they are trying to speak in a language that is not their native tongue. Cultures that value silence learn to distinguish varying qualities of silence, which may be hard for others to discern. "Pause time" is different for different cultures. • Notice eye contact. Notice the kind of eye contact your student is making with others. Many cultures consider it impolite to look directly at the person speaking. Lowered eyes or side glances may be seen as respectful, especially if the speaker is older or in a position of authority. • Pay attention to body movements. Movements such as upturned palms of the hand, waving one's hand, and pointing with fingers or feet convey varying messages. Observe your clients for clues. Ask them to tell you what gestures should be avoided. • Note student responses. Note that a "yes" response does not necessarily indicate that a student has understood or is willing to do what is being discussed. It may simply be an offering of respect for your status. American Indians, among others, may not ask questions because this would indicate a lack of clear communication by the provider. In some cultures, smiling and laughing may mask other emotions or prevent conflict.
Listen and Observe
Listening and observation skills are essential. You'll find that you can break down barriers by listening to people and letting them know that you are interested in what they have to say. This is the single most important way to make people feel that their interactions with health professionals have been successful. |2 |Rely on cultural experts: For cultural groups you will interact with frequently, have someone knowledgeable about the culture help |
| |you interpret people's actions. Sometimes when we rely on our own point of view, we misinterpret. |

When you are faced with a family whose culture is initially unfamiliar to you, you can learn a lot just by being a good observer. Nonverbal communications is just as important as the spoken word. Facial expressions, gestures, body movements, and silence can all be perceived through the eyes of an observer, and they have meanings that differ among cultures. Watch how each family member interacts with others in the family and cultural group. This may give you clues to appropriate behavior.
Know Your Audience
Do you have their attention? Do you know what they are interested in learning? Are they comfortable? Are they likely to be preoccupied with thoughts of other things going on in their lives? Sometimes silence is a form of respect to you, the communicator. Don't judge your audience based on your own notions of attentiveness. For example, many groups don't make eye contact, out of respect. Don't assume that you do not have their attention.
At the same time, you should also watch for signs that you need to change your approach.
|3 |Be sensitive to feedback: Look for cues that communication has shut down. Avoid over-explaining, and encourage a give-and-take |
| |discussion. |

Think About Your Client's Comfort
Nutrition educators throughout the country emphasize the importance of helping clients feel comfortable, and they shared a wealth of ideas for doing so.
Express interest in people. • Smile. • Be friendly, and show warmth and caring. • Show respect for each individual's culture. • Tell the family a bit about yourself. • Present yourself as an open-minded learner and potential partner. • Pay attention to children -- this appeals to mothers of all cultures. • Learn what people of different cultures think are polite greetings and responses. Practice using them correctly. • Be genuinely interested or be businesslike. Otherwise, the artificiality shows through and establishes the barrier.
Ask the right questions. • Ask the family to describe their culture, homeland, or customs. • Show concern by asking about the family, the living environment, the children. • Ask the family about themselves -- their experience, the expertise. • Ask the family how they are adjusting to their life in the new community -- the problems and benefits. • Ask them to let you know if you do or say anything offensive -- let them know you respect them.
Create a comfortable physical environment for adults. • Have enough chairs that are comfortable and fit the client. • Turn chairs away from the windows so clients do not have to look into the sun. • Try to provide adequate ventilation in the room. • Offer nutritious snacks, using food from different cultures.
Attend to the needs of children. • Have small tables and chairs for children. • Try to have toys, games, or coloring books to keep children occupied -- parents become embarrassed if their children get restless or rowdy. • Have an adult caregiver to attend to children in another area if possible.
Set the stage for effective communication. • Decorate bulletin boards and other common spaces to reflect different cultures or the culture of your client group. • Try to provide materials in the client's own language. • Include pictures. • Provide information about community resources. • If possible, set the stage for nutrition education in a place where people already feel comfortable. • Coordinate appointments to avoid unnecessary trips. • Don't try to educate clients after they have been through many hours of clinic services and waiting. • For individual counseling, provide privacy. In some cultures, talking about food can be very personal and private.
Identify the "Teachable Moment"
Start where the person or family is. Let group members tell you what they need to know. If you get to know the individual or family, you can relate to them on their level, with something that's of interest to them. Avoid having a set agenda. Be prepared to take advantage of every situation that offers you an opportunity to teach someone about nutrition. You will get farther if you address what your clients want or need to learn.
|4 |Allow flexible agendas: While we were trying to get everything together for an on-site celebration, I realized the conversation |
| |among the mothers was centered on health issues, especially those concerning women -- breast cancer, PMS (premenstrual syndrome), |
| |nutrition. I capitalized on the moment and during dessert had a group discussion centered around their expectations of the WIC |
| |program (Special Supplemental Food Program for Women, Infants and Children) and what topics they were interested in. I was also |
| |able to show a 15-minute video about women and nutrition, which led to a lively discussion. |

|5 |Use refreshment breaks: For parenting classes, nutrition topics are a natural link for young families. Any meeting that requires a |
| |refreshment break has offered fantastic nutrition teaching moments by providing culinary treats that are healthy and tasty. |

Create Opportunities to Combine Nutrition With Social Events
Plan social occasions that allow people from different cultures to interact and share food experiences while providing you with an opportunity for nutrition education. |6 |Arrange for snack tasting: Have tasting parties at the WIC, Head Start, or other site to give people a chance to try new or |
| |unfamiliar foods. Participants may be particularly receptive to new foods used as snacks, since using them in the daily food fare |
| |does not alter the main meals. |

|7 |Help plan wellness parties: Have a wellness party based on the Tupperware model. Focus on healthful eating, and involve a nutrition|
| |educator. Involve the men in the community if possible. Community members might be paid for giving the party. |

Make Good Use of Limited Time
When time with a client is limited, don't expect to make drastic changes. It's better to find out what the person needs to know and address these issues. Confront barriers head on. This way, your client will walk away with positive feelings about the encounter with you, and will be more likely to listen to other suggestions you make in the future. |8 |Establish rapport: In many cultures, it is important to establish rapport with the person and then discuss business. The few extra |
| |minutes taken to do this may save many hours of work in the long run. |

|9 |Focus and reinforce: Use simple, direct, and repeated messages. Teach one idea at a time for greatest impact, and reinforce it |
| |later. |

Family Interaction
You can use family interaction to strengthen nutrition education. Each family member tends to influence the foods and dishes eaten by others in the family. Look for ways to educate family members in addition to the student.
Reach the Right Family Members
Many times, students want to check with their family before making decisions or agreeing to try something new. |10 |Identify the decision-maker: Find out how your client makes decisions. It may be important to ask her, "Do you need to discuss |
| |important decisions with other members of your family? |

|11 |Establish the chain of authority: If two or more family members are present, find out to whom questions should be directed. |

Many cultures, including Asians and Hispanics, see the oldest male as the head of the family. In African American families and in American Indian families, an elderly male or female may be the most respected. In such cases, you should try to include this person in any family nutrition discussions. Even though they might not be responsible for making food purchases or preparing food, their influence is important. In fact, encourage all interested family members to take part in education.
The roles of the husband, wife, and children in buying, preparing, and eating food are all different. Who does the food selection? In an extended family, who buys the food and who does the cooking? In more and more instances, young children are making food selections themselves, especially when they receive money to buy something for breakfast or after school. |12 |Send a message through the children: Children may be an avenue for getting nutrition information to parents. They can take home |
| |what they learn in school or at Head Start. |

|13 |Involve the family shopper: Find out who does the shopping for the family. Don't assume that it is the person who cook the food.|
| |And don't assume it's the woman. Its your job to discover who plays what part n making family decisions. |

Acknowledge the Importance of the Age and Experience of Family Members
Older adults may be resistant to accepting changes in the family's diet, especially for young children. This will be important to keep in mind as the number of grandparents in the parenting role increases.
Learning to communicate effectively with individuals and families is a very important part of nutrition education. It is also important to find out about the community in which they live, the places where they buy their food, and their sources of information. All of these things will have an effect on the kind of approach you should use for nutrition education and on the way your message will be received.
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Chapter 6: Working Within the Community
As a nutrition educator, you will be more successful if you work within the community rather than approaching it from the outside to offer your help. Getting to know the community, its people, and its resources will help you identify useful strategies for providing nutrition education. People may be more receptive to nutrition education messages received in a setting where they are comfortable and from people who are like them.
Defining Community
Community can be defined in several different ways. It can refer to the people who live within a geographic boundary. It can refer to those who are served by a certain agency or government. It can also refer to a group of people who have similar beliefs, a similar culture, or shared identity and experiences.
Learning About the Community
Once you have defined the community you will be serving, you should begin to develop a community profile. What is unique about the community? What are its resources, and what are its needs? How might you address them?
Here are some suggestions on ways to gather this information: • Observe. If your community is located within geographic boundaries, walk or drive around to get an idea of its physical layout. Where do people gather? What types of stores are easily accessible? Which restaurants are popular? Where are service agencies such as WIC or Head Start located? What is being advertised in store windows and flyers? What language is used in the ads? • Ask questions. If you want to serve the community well, you must first find out what the people need. The best way to do this is to ask them. They may perceive their needs to be very different from the ones you might identify. • Tap community resources. People are your most important community resource. Identify community leaders to answer your questions about the community and to serve as spokespersons for your messages. These could be the tribal leaders, elders, healers recognized by the community, or church leaders. Check with the WIC clinic, Head Start, community center, and local churches that provide services to immigrant groups for information about the cultural groups in the community. Public libraries that provide programs for people for whom English is a second language can provide information about new groups in an area.
|14 |Seek out the leaders: Identify the natural communicators. Once identified as resource people, they are sought out by |
| |the community. Aim to reach leaders rather than just reaching for the lowest literacy level. |

• Learn about "community markers". To get an idea of the degree of acculturation, visit "community markers" such as local restaurants, churches, supermarkets, second-hand stores, and "store front" operations. Ethnic markets in the community suggest that people are still closely tied to the traditional foods of their culture.
|15 |Locate ethnic food sources: Find out where foods that are familiar to your clients may be purchased. You can speak |
| |with operators of ethnic restaurants in your community to find out where they buy familiar spices and seasonings. |

|16 |Go shopping: Visit a local supermarket, paying particular attention to the produce section and the meat and fish |
| |coolers. Notice what items are placed as "specials" or lead items at the ends of the aisles. Of course, visit ethnic |
| |food markets. |

• Check out community groups. Informal community networks can provide valuable information about the community. These networks might include beauty parlors, lodges, block associations, senior citizens' groups, parents' groups associated with local schools or Head Start, women's clubs, and auxiliaries frequently linked with men's groups. Such groups may be quite influential at the grassroots level. • Attend functions. To get a feel for the community, attend functions such as church, picnics, festivals, and socials; community dances; yard sales; street or craft fairs; flea markets; sports activities; and local businesses and club gatherings. Visit schools and places of entertainment. Be sure to have a positive attitude and show interest in what is happening. • Be alert for food-related concerns of immigrants. Find out what kind of information they want and where they are getting that information. Nutrition educators can address immigrants' food-related concerns in helpful ways
Food-Related Concerns of Immigrants |Concern |Possible Solutions |
|Difficulty obtaining familiar foods and spices in the United |Take a field trip to stores that carry familiar foods and spices to |
|States. |help attendees learn how to get them. List the bus route for future |
| |trips to the store. |
|High cost of familiar foods, compared with cost in homeland. |Fill in chart at supermarket showing differences in cost and possible|
| |solutions. |
|Complexities of shopping in American supermarkets. |Have class plan ahead for a field trip to the supermarket. Go by twos|
| |to practice. Set up a mock grocery store within a WIC clinic or |
| |educational center. |
|Limited knowledge of English words for identifying foods and |Prepare a chart showing English words for a list of foreign foods and|
|spices, and inability to read labels. |spices. |
| |Collect food labels and match them with labels brought in by |
| |immigrants. (WARNING: Use very simple words and many pictures. |
| |Volunteer to teach a nutrition lesson at a local program. |
|Lack of knowledge of how to use kitchen appliances such as |Demonstrate at sites (including appliance stores) where the real |
|refrigerators, garbage disposals, dishwashers, and ovens. |thing is available. |
|Lack of knowledge of proper ways to store perishable foods, |Prepare handouts using pictures to show each kind of food and the way|
|including which foods should be stored in the refrigerator and |to store it safely. |
|which should not. | |

Working Together: Paraprofessional and Professionals from the Community Nutrition professionals and paraprofessionals -- including peer educators and community outreach workers -- can work together to form a successful team. Each has unique knowledge or abilities to bring to the partnership. Nutritionists have the technical knowledge, and peer educators have valuable hands-on knowledge. Because paraprofessionals are a part of the community, they are in the best position to share information with their peers in a culturally appropriate way. When potentially dangerous practices of community members are involved, paraprofessionals can be invaluable in getting the message across and finding realistic solutions. They can provide a link between professionals and the community, transmitting important ideas and explaining the values of community members. Nutrition professionals can help paraprofessionals increase their knowledge and skills, and paraprofessionals can help nutrition professionals learn how to work more effectively with families in the community. Peer educators know people like themselves who are good cooks and are respected as wise members of the community. They may also be able to recruit community members to serve as resident experts on food, speak about food habits, or think of ways to incorporate traditional eating patterns as new people adjust to the community. |17 |Recruit community members: As you go out into the community, be on the lookout for people who want to get involved, get ahead, |
| |have input, or make a difference in their community. Many times, active volunteers end up being the best paraprofessionals. |

Taking the Message to the People Nutrition educators around the country say that the best way to reach people with nutrition education is to take it to them where they are. Don't wait for people to come to you. New members of a community may feel uncomfortable coming into a health department or similar setting, so investigate places where people already gather for other reasons. |18 |Use local media: Try contacting a local radio station to broadcast a nutrition message. This was well received by the Haitian |
| |community in New York City. |

|19 |Introduce new employees: Advise new employees not to go into the community with the idea of making a lot of changes right away. |
| |Unless they were recruited from the community, they need to take their time, become acquainted with the people, and let the |
| |people become familiar with their presence and personality. |

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Chapter 7: A Special Challenge -- The Multilingual Environment
Do you speak the same language as your students? If not, overcoming the language barrier may be a big challenge for both you and your clients. Here are some guidelines working in a multilingual environment.
Addressing the Language Barrier
Even if you do not speak the language of your client, there are some things you can do. Learn a few key phrases to use with the client before the interpreter arrives. Your interest and caring will be evident despite the language barrier. You do not have to master a language to be an effective communicator. |20 |Establish the language to be used: Find out which language people prefer to use with you; don't assume that they will prefer |
| |their native language if they also speak English. |

|21 |Introduce English words: If English is your clients' second language, introduce basic words related to food and nutrition. Have |
| |them practice saying the new words. You can practice saying the words in their language at the same time. Ask your clients to |
| |teach you. |

|22 |Be alert to subtleties: Consider subtle differences in usage of words, not just differences in language. For example, clients |
| |may use the terms "high blood" and "low blood" to refer to two unrelated conditions, hypertension and anemia. |

Tips for Working With People Who Speak Another Language • Don't think that people who are struggling with English are stupid. Applaud them for trying to make things easier for you. They are trying to learn your language instead of asking you to learn theirs. Try learning a few words in their language. • Learn greetings, titles of respect, and attitudes toward touching. • Write numbers down for the person -- for example, with recipe amounts. People easily confuse numbers spoken in a new language. • Ask questions in several different ways. People may use only the words they know in English to answer your questions. • Learn the proper pronunciation of names. For example, in Spanish, say "ah" instead of "uh," as in Maria. • Be friendly, accepting, and approachable. Everyone relates to a smile.
A Picture Is Worth a Thousand Words
Many people learn first by listening and watching. Try to provide nutrition information without written words. It makes quite an impression! Try pictures, food models, videotapes (especially those in the person's native language), hands-on food demonstrations, flip charts, and games. Use several approaches. |23 |Use recipes that can be memorized: We have found that many people cannot read a recipe or do the math needed to measure or |
| |adjust to their family size. We try to make the recipes easy enough to memorize. Demonstrating helps. Tasting is essential. Many|
| |people cannot afford to buy foods their families might not like or accept. |

|24 |Consider needs of people who are hearing impaired: Try a visual or written approach when working with people who are hearing |
| |impaired, and try to use some signs, too. Don't judge their intelligence based on their ability to speak or read lips (consider |
| |words that are easily confused like 60 and 16). Teletype machines are essential for communicating by phone. |

Interpreters and Translators
One question that may come to mind when you serve a person or group of people whose language you do not speak is whether you need an interpreter or a translator. And if you do, which one is right for your needs?
By definition, interpretation is the conversion of the spoken word into another language, and translation is the conversion of the written word into another language. Usually, you'll find someone who is either an interpreter or a translator, but not both. The skills needed to be a good interpreter are very different from those of a good translator. If you're dealing with written information, you will want a translator; if your need is to interpret spoken words, you'll want an interpreter. Consider your particular needs as you plan.
Working with an Interpreter: Guidelines to Follow
For You • Speak clearly in short, simple sentences. • Avoid technical terminology and professional jargon. • Look at and speak to the client rather than the interpreter. Maintain your role in the exchange. • Listen carefully to your client and watch for and respond to nonverbal cues. • Use comments and questions such as "Tell me about..." and "Did I understand correctly..." to elicit cultural information and avoid misinterpretation. • Remember that sessions with an interpreter take longer. Communication is the goal, so it's worth the extra time.
For the Interpreter • Use the client's own words rather than paraphrasing so that the person for whom you are interpreting receives the richness of the client's context. • Avoid inserting or omitting information. • Have the client repeat the instructions or general content of the discussion to check understanding.
Choosing and Interpreter
Remember that just as there are cultural differences between people with the same skin color, there are differences in dialects among people who speak the same language. Just because a person speaks Spanish, for example, doesn't mean he or she will be sensitive to subtle speech differences among Hispanic cultures. |25 |Seek help from others: Try to enlist the help of a bilingual and biculturally trained individual. This person has experience |
| |speaking the language and understands its subtle meanings -- thus providing culturally appropriate education. |

Other Alternatives
Asking a bilingual employee for assistance may be the next best choice. But be aware that, because of other duties, he may not be able to work closely with individual families. Also, he may not be familiar with cultural subtleties. If possible, do not ask clients' family members or friends to be interpreters. This prevents problems such as breach of confidentiality and inappropriate paraphrasing. In addition, be sensitive to the fact that by asking a child to interpret, you may trigger difficulties because of apparent reversal of authority in the household.
All things considered, a trained interpreter may be your best bet -- and well worth the fee.
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Chapter 8: Putting It Into Practice
In the previous chapters, we looked at the ways in which eating patterns might change through acculturation, and at the factors that influence food choices. This chapter provides practical advice for finding out what your clients are eating, sharing important nutrition messages in ways that will be well received by your clients, and using resources available in the community. You will learn ways to help clients with food in a new setting.
Finding Out What Your Clients Are Eating
To provide successful nutrition education, it is important to find out what your clients are and are not eating. For example, is your pregnant client practicing pica? If your client is a vegetarian, you might need to discuss acceptable sources of protein. If she is lactose intolerant and does not drink milk, you could talk about other sources of calcium.
Here are some useful questions for finding out about changes in eating patterns:
Traditional Foods • What traditional foods did you eat daily? Weekly? • Do you still eat those foods? How often? • If you do not, why not? • Are there any similar foods in this community? • What do you substitute for those foods?
Favorite Foods • What was your favorite cultural or traditional food? • Do you still eat that food? • If yes, is it still a favorite food? • If you do not still eat that food, why not? • Is there any food similar to that food here in this community? • What do you substitute for that food?
New Foods • What new foods have you tried since coming to this community? • Which of these do you like best? • Do you eat them regularly? • Do you eat these foods in place of other foods? Which one(s)? • Which foods do you dislike, and why?
Food Acquisition • Where do you get most of your family's food? (Examples: neighborhood supermarket, ethnic food market, convenience store, bodega, street food carts, open market in your neighborhood, commodity supplemental food warehouse.) • How do you get to the market? Who goes with you? Do they speak English?
Questions like these will give you an idea of changes that have already occurred in your client's diet or are likely to take place soon. If the changes are appropriate, encourage them. But remember, change is not always desirable.
Traditions: Encourage Healthy Ones
Many traditional foods are excellent choices. When t his is the case, compliment your client on the use of healthy traditional foods or methods of preparation.
Take a look at the Dietary Guidelines for Americans or the Food Guide Pyramid and notice how closely many traditional eating patterns fit the guidelines. Traditional staple foods are usually at the base of the pyramid in the bread, cereal, rice, and pasta group. Protective foods are found mainly in the vegetable and protein categories. Status foods, which are often high in fat and sugar, are usually eaten less often. Encourage families to continue positive traditions, but caution them about switching to high-fat, high-sugar American Foods. |26 |Encourage positive traditional choices: Promote identification of practices that are healthy, and then carefully suggest |
| |incorporation of new foods. |

|27 |Keep it familiar: Offer recipes that include foods that are familiar, or give out vegetable seeds of favorite foods. |

|28 |Supply a resource list: Have a list of places to find familiar foods (e.g., ethnic grocery stores or farmers' markets). |

Be Alert for Unhealthy Traditions
Some food practices may need to be modified. For example, some Mexicans use large amounts of lard in cooking. Once in the United States, the intake of lard often decreases, but it may be replaced by vegetable oil, mayonnaise, and salad dressing, resulting in foods that are still high in fat. American Indians and Alaska Natives, who may be accustomed to eating raw meat when they hunt, should be warned not to do this when they buy meat from the store. You should help your clients make modifications that don't interfere with important traditions. Try to share the idea that maintaining traditional food customs and good nutrition are both very important.
You may need to suggest ways to reduce the fat a calorie content of the commodity supplemental foods distributed on American Indian or Alaska Native reservations. Encourage people to scoop visible fat from the meat after opening the can and rinse the meat before cooking. If excess calories are a problem, encourage people to drain the syrup from canned fruits (it contains added calories but no additional vitamins). Because many canned vegetables are high in sodium, suggest that people not add salt during cooking or at the table.
Using Yin and Yang in Nutrition Education
If you are talking with a family who follows the yin/yang theory, ask questions. Classification of a food as yin or yang may change depending on the time of year, the seasonings that are used, or whether the person eating the food is male or female. Classifications can change from region to region and even from family to family within a region. Whenever possible, work within the family's belief system to provide nutrition education. Always show respect for traditional practices. However, if you discover that a specific practice is potentially harmful or that some of the traditions are nutritionally questionable, you will need to explore ways to help the family make needed dietary changes.
Don't Forget "American" Foods
While encouraging positive cultural food habits, you should also be teaching clients about "American" foods. People want and need to learn about American foods for many reasons. This is especially helpful for those who need to find substitutes for foods that aren't available. Parents should know what their children are eating at school and with their friends, to help them develop healthy eating habits. Learning about new foods is an important way for a newcomer to better understand the new community. |29 |Create hands-on experiences: At Head Start, hands-on experiences seem to work best -- giving parents the opportunity to touch |
| |and compare foods, prepare and taste new foods. |

Promote Nutrient-Rich Foods
Nutritional needs are met using a variety of foods. We asked nutrition educators for the names of vegetables eaten by the people they serve. The resulting list contains over 120 vegetables that are good sources of nutrients (e.g., iron, vitamin A, vitamin C, and/or folate). Become familiar with good nutrient sources among the foods eaten by your clients.
Nutritional needs are met through a variety of foods. This chart shows some of the many vegetables eaten by people of different cultures. It was developed by asking nutrition educators for the names of vegetables indigenous to the populations with which they work. We found that more than 120 different kinds of vegetables are eaten in the United States, many closely linked to ethnic background. In some cases, only certain varieties or certain parts of the plant are safe to eat, or special preparation methods are needed. |Arame |Brussels |Daikon |Green Peppers |Locust Beans |Pig Weed |Sweet Potato |Wild Onions |
| |Sprouts | | | | |Leaves | |
|Artichokes |Burdock Root |Dandelion |Green Tomatoes |Long Beans |Plantain |Swiss Chard |Wild Spinach|
| | |Greens | | | | | |
|Asparagus |Cabbage |Dasheen |Harissa |Malanga |Potatoes |Tabil |Wild Turnips|
|Avocados |Callaloo |Eddoe |Heart of Palm |Manioc |Prickly Pole |Takawan |Wild |
| | | | | | | |Watercres |
|Bamboo Shoots|Carrots |Eggplant |Horseradish |Milkweed |Pumpkin |Tannia |Willow |
| | | |Leaves | | | |Leaves |
|Banana Heart |Cassava |Egusi |Horseradish |Mushrooms |Purple Hulls |Taro |Winter Melon|
| | | |Stalks | | | | |
|Boabab Leaves|Cauliflower |Endive |Iru |Mustard Greens |Radishes |Tomatillos |Won Bok |
|Batatas |Celery |Escarole |Jerusalem |Napa Cabbage |Red Chili |Tomatoes |Yams |
| | | |Artichokes | | | | |
|Bean Sprouts |Celery Root |Ewedu |Jicama |Netetou |Rhubarb |Tsamia |Yam Bacara |
|Beets |Chayote |Fennel |Jinga |Nettle Plant |Rutabagas |Turnip Greens |Yautia |
|Beet Greens |Chilies |Fiddlehead |Kidney Beans |Nopales (prickly |Salsify |Turnips |Yellow Beans|
| | |Ferns | |pear cactus leaves)| | | |
|Bell Peppers |Chinese |Fireweed |Kale |Okra |Scallions |Verdolaga |Yucca |
| |Broccoli | | | | | |(cassava) |
|Bitter Leaf |Chinese |Garlic |Kohlrabi |Onions |Snap Beans |Water Chetnuts| |
| |Cabbage | | | | | | |
|Bittermelon |Chinese |Garbanzo Beans|Labas Root |Palm Nut |Snow Peas |Watercress | |
| |Celery | | | | | | |
|Black-eyed |Cilantro |Goa Beans |Lahano |Parsley |Sorrel |Wax Beans | |
|Peas | | | | | | | |
|Bok Choy |Collard |Gourds |Lansur |Parsnips |Spinach |White Radishes| |
| |Greens |(kampyo, upo) | | | | | |
|Bora |Corilla |Green Bananas |Leeks |Patechoi |Sprouts |White Turnips | |
|Bread Nut |Corn |Green Beans |Lemongrass |Peas |Squash (acorn, butternut, |Wild Asparagus| |
| | | | | |hubbard, spaghetti, yellow, | | |
| | | | | |zucchini) | | |
|Breadfruit |Crowder Peas |Green Chili |Letttuce |Pea Pods |Swamp Cabbage |Wild Celery | |
|Broccoli |Cucumbers |Green Onions |Lima Beans |Peppers |Sweet Potatoes |Wild Mushrooms| |

|30 |Develop food lists by talking with members of your target population. |

Food Selection, Preparation, and Storage
When investigating nutrient sources, be sure to find out if cooking methods can strongly affect their nutrient content. Examples of such methods include cooking bones in an acidic liquid, which contributes considerable calcium to a soup; using organ meats to add extra vitamins and minerals; and using undiluted evaporated milk in coffee, cooked cereal, and fruit juices, which contributes calcium, riboflavin, vitamin D, and other nutrients.
Consider Special Restrictions
To learn about food use in the lives of clients settling in a new community, consider asking some questions below:
Amount and Quality of Food • How do you describe the quality of the food you buy? • Do you have enough food to feed your family each day? • How do you divide up the food among family members if you are running short? • Are you able to get the types of foods and beverages needed by everyone in your family?
Food Preparation • Do you have enough time to prepare the kinds of foods your family enjoys? • Do you have the equipment you need for cooking and preparing the kinds of foods your family likes to eat • Do you have enough space for food preparation?
Family Interaction Around Food • Do the children in your family like the foods enjoyed by the adults? • Have school-age children adapted to school meals? • Do you have recipes of foods that your family enjoys? • If so, do you exchange recipes with family and friends?
By gathering this information, you will be better equipped to guide family members appropriately as they make dietary changes -- whether from desire or necessity -- as a part of the acculturation process.
Some clients may rely on commodity food distribution programs, donations from a food bank, or WIC vouchers for much of their food. In these instances, they often have no choice but to change some foods and methods of preparation. Work with these clients to offer tips on preparing unfamiliar foods, information about low-cost sources of nutrients, and the opportunity to taste-test. |31 |Helping with WIC: One of the most effective strategies used was bringing a couple of refugee wives to the supermarket to use WIC|
| |vouchers. |

|32 |Introducing new foods: Food demonstrations have proven most effective a the clinic where I work, whatever the topic. Introduce |
| |"new" vegetables or fruits. Having the new food on hand as opposed to a picture gives the participants a truer sense of what I |
| |am describing. Sometimes when a dish is prepared using the new food, clients get to taste it and take home a recipe also. |

Use Creative Ways to Expand Awareness
Here are some additional ideas shared by nutrition educators for making clients aware of new foods or new methods of preparing foods. |33 |Develop a multicultural cookbook: Dietitians in one community developed a multicultural cookbook. They experimented with |
| |different foods and substitutions, adapted recipes, and held taste-tests in the community. The favorites were included in the |
| |cookbook. Make sure you know what the traditional food tastes like before you make changes, and create substitutions that make |
| |it healthier without changing cultural traditions. |

|34 |Explore a single food: The strategy of involving clients in activities has always proven the most successful for me. For |
| |example, ...the main focus was a festive look at corn (maize). We invited clients from the audience to share with us how corn is|
| |used in their home. We made cornbread for all to taste -- and gave a recipe as a handout. On display were many products made |
| |with corn. (Another educator mentioned a similar activity with meatballs or rice.) |

|35 |Hold food preparation workshops: One of our nutritionists taught how to make bread and chicken soup at a health fair. Everybody |
| |got to try the techniques and all went home with a loaf of bread. |

|36 |Budget for food: If you do a lot of food demonstrations, remember to think about how you are going to pay for the food. Consider|
| |including a line item in your budget or contacting retail stores to discuss contributions. |

Teach About Food Shopping and Storage
With new food buying practices and forms of food, people may need to learn about the storage of perishable foods. People of many cultures value freshness and shop for groceries daily, especially in developing nations where they do not have refrigerators. When they move to the United States, daily shopping isn't always possible because of constraints like lack of time and lack of transportation. Foods that are bought in quantity to save money or to meet food program purchasing requirements must be stored adequately. Frozen foods may be a good buy, but only if properly stored and cooked. By understanding the special limitations your clients face, you can help them learn to buy, store, and serve nutritious meals in spite of these limitations. |37 |Visit a grocery store: The most effective strategy used was a grocery store tour with individual families. We purchased $75 |
| |worth of food -- as we went through each food section, we purchased food and discussed choices (for example, fresh versus |
| |canned), ways of preparing food, storage issues, etc. |

|38 |Visit each aisle: Orient the client to sections of the supermarket, one aisle at a time. Familiarize them with what they should |
| |look for and expect to find. Suggest one or two best selections for each section. |

|39 |Bring the food home: After touring the grocery store, return home with the family and help them store the food properly in the |
| |refrigerator, on the shelf, etc. Answer any questions and talk about practical ideas that work in the actual household setting. |
| |Although this is a time-intensive project, the results are tremendous. |

In Closing...
We hope that the information, ideas, and strategies provided within this guide will be of value as you continue to work within your community. To meet the challenge of providing nutrition education to a changing population, it is important to learn to respect and appreciate the variety of cultural traditions related to food. It's important to let go of preconceived notions about what other people eat -- formed by what we think a group is like. It's rewarding to discover the wide variation in food practices within and among groups. Take advantage of opportunities by sharing food experiences, asking questions, observing the food choices people make, and working within the community. We think you'll find that this exciting challenge makes you both a strong communicator and an effective partner in today's multicultural environment. Let's celebrate diversity
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Division of Nutrition & Health Services
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