Introduction written by Jessica Schierbeck, Director, Strategic Solutions, who is the lead for the People-Centred Care Leadership Program
Our People-Centred Care Leadership Program includes regular opportunities for learners to compare what they have learned against experiences they have had either as healthcare professionals or as patients or family members. This kind of reflection is important to bring learning to application in real-life practice and to push us to really think about what and how we or our organizations are doing in real life. This is a very important learning and sharing opportunity. In our program, we are seeing some exceptional and fascinating reflections being shared.
Recently, one of our learners, Erin Culhane, posted a reflection connecting cultural safety to food; as CHA Learning also has a keen interest in food as it relates to the health system and runs a Food Service and Nutrition Management Program, we asked Erin to elaborate on her reflection for a blog post we could share with others. We are grateful to Erin for allowing us to share her reflection on this important topic! In honour of the start of Nutrition Month, we are sharing this post today.
At our organization University Health Network (UHN), we have Patient and Family Learning Centre which allows patients, families, members of the public and staff to access reliable, current health information at no cost.
While we don’t provide medical advice, we do connect people with a wide range of resources from within and outside of our organization, to help better understand their health and become an active member of their care team.
As a librarian, I work to provide consumer health reference services to the public, and have done so for about 6 years. During this time, I observed a number of barriers to health literacy and engagement related to a lack of cultural competency and safety.
Our most frequently requested type of health information always related to food. Everybody eats, after all! Often, patients and families would come to me looking for very specific information about foods that fit into a newly-prescribed diet or lifestyle, yet also fit into their cultural/ethnic preferences, religions guidelines, or their values (i.e. vegetarian).
This may not seem like a serious threat to cultural safety, but it happened so frequently and had such an impact on people trying to self-manage their health, I think it’s worth reflecting on. I believe this simple example can also be scaled to larger discussions around cultural awareness, competence and safety.
In my experience, people were often given a very basic set of “healthy living” instructions by their health care team, and then expected to find more information out on their own, or from their primary care provider. They were given generic instructions like “reduce sodium intake” or “increase fibre” with maybe a set of basic examples of meals or snacks that meet this criteria.
Often, these examples were from a very “western” diet, and weren’t reflective of the way these patients and their families would eat on a normal day. Caregivers often expressed difficulty with this challenge – how to balance these new requirements while still cooking traditionally for other family members in the household. Or, how to convince their loved one to make important changes after a long life of eating a certain way. This would often lead to confusion about how to manage, frustration, and ultimately, “lack of compliance.”
Unless these patients had a consult with a dietitian to help create a tailored meal plan, they were left to navigate a huge lifestyle change without resources that take into consideration their cultural, ethnic or religious traditions or requirements. This is not even considering the lack of access to fresh, healthy food, which we know is a challenge for those in remote communities or those with socioeconomic or nutrition-literacy barriers.
In some cases, with common conditions like diabetes or kidney disease, culturally-specific diet plan samples and food lists exist in books, online, or through materials from national or provincial organizations, or from other countries. People aren’t often made aware of these resources by their care providers, though, and end up seeking advice from neighbours, community groups, or online… or they give up. I believe this is partly due to a lack of awareness by providers that these resources exist, but also because we don’t often take the time to ask people about their culture, preferences, needs and potential conflicts or barriers to following a recommended plan.
To meet these repeated requests and gap in info, our team focused on ensuring any materials that existed were available through our Learning Centres. This included condition-specific cookbooks written for specific populations, food guides or healthy lifestyle guides written by/for specific populations, web resources like recipe indexes and apps with food lists and nutritional values. This information, though, only made it to those who knew our services existed and sought our help.
From my experience, I believe the dietitians working in our organization, and at provincial or national organizations, are quite culturally aware and work with people to help them determine healthy meal plans and make suggestions that work for the individual and their family. Unfortunately, access to these services is not consistent across the organization, our province or country, and often people need to know to ask for these services to gain access.
Something our team, the Patient Education and Engagement Program, and other similar, corporate programs like ours can do more of is to share the resources that we know already exist, and make it easy for providers and patients to access these materials. This supports care providers in being more culturally aware and competent.
It is also within our program’s scope to give clinicians tools they need to have meaningful conversations with patients and families about their needs, preferences, assumptions and restrictions. Helping to build questions into the care encounter to facilitate these important discussions can help to ensure that patients are being given a plan that aligns with their day to day life.
The best way to ensure that the materials we develop, and the questions we ask, will be most impactful to patients, is to ensure that the patients and communities we serve are engaged in planning from the start. Partnering with community leaders to hear directly about the barriers various groups face when it comes to following a specific care plan, what strategies have worked for them or others they know, can help us to co-design solutions that are meaningful, safe, and effective.
About the author
Erin Culhane is a Health Information Specialist on the Patient Education & Engagement team at University Health Network in Toronto.