Validation of Multicultural Nutrition Counseling Competencies for Registered Dietitians

Objective: To validate the multicultural nutrition counseling competencies for entry-level dietitians in the next 10 years.

Design: An expert panel was asked to review the original 46 competencies and make appropriate changes. Their responses were compiled and incorporated into a survey. The survey was administered by mail and consisted of 56 competency items that subjects rated on a Likert scale of 1 to 7 (1=Somewhat essential to 7=Absolutely essential). Following the mail survey a post card reminder was sent followed by a follow-up survey to non-respondents, another post card reminder, and a final survey to a random sample of the remaining non-respondents.

Subjects: The expert panel consisted of five members ranging in geographic location, job, and race/ethnicity. A random sample of Registered Dietitians (RDs) was obtained from the Commission on Dietetic Registration. A total of 799 surveys were mailed.

Statistical Analysis: For the demographic information, descriptive statistics, including means and frequencies, were used. The competencies were analyzed using generalized least squares factor analysis. MANOVA was used to determine if dimensions extracted differed among respondents on a variety of factors. Reliability coefficients (Cronbach's alpha) were also calculated.

Results: Of the 53.3% who responded, most were Caucasian, not Hispanic or Latino, spoke English as their primary language, had either a bachelor's, or master's degree, worked in a clinical/acute/longterm care setting, and 50.3% provided nutrition counseling to culturally different clients. Generalized least squares extracted six factors with 40 competencies loading on them: Cultural Encounter, Culturally Appropriate Nutrition Intervention Skills, Multicultural Self-Awareness, Awareness of Social/Cultural Determinants of Health, Multicultural Knowledge of Food Practices, and Role of Culture in Communities and Agencies. There were no significant differences between RDs who were bilingual, where they lived, or what dietetic practice group membership they had. There was a significant difference between individuals who counseled more than five hours per week and those who counseled less than five hours per week. There was also a significant difference between those who had either a cultural competence course, nutrition counseling course, or both and those who had neither.

Conclusion: Multicultural competency is a requirement for every Registered Dietitian, not a luxury. By validating these competencies, agencies and organizations can implement policies to further competence in this area. RDs can also use the competencies to determine which individual skills need to be developed. This Is important, as multicultural competence becomes a necessary skill for all health care professionals and the United States continues to work towards the goal of eliminating health disparities.