Dietetics Practice and Culturally Safe Care in the Diverse Pacific Region.

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2017-05

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ntroduction. The prevalence of non-communicable disease (NCD) rates in the diverse Pacific region is deeply concerning. The impact of these diseases and associated complications is overwhelming to families and communities and are a common point of discussion in medical, political and social domains. While much research has been dedicated to the prevention and treatment of NCDs, less research is focused on interactions between health care practitioners and their patients with NCDs. With the Pacific region representing a very diverse community of Indigenous peoples, migrated groups and new-comers; this creates a consequential mix in cultural worldviews and values. Health care providers are challenged with recognizing and understanding these cultural values. Registered Dietitian Nutritionists (RDNs) are particularly challenged as their scope of practice includes having knowledge and expertise in the dietary and lifestyle values of the populations they serve. Cultural safety, a theory of practice in regions with similar demographics as the Pacific, will be used to guide and inform this research. Objectives. To examine the practice of dietetics in the Pacific region to understand specific needs and unique practices relevant to the culturally diverse populations served. To identify dimensions of dietetics practice that describe culturally safe care. Methods. Descriptive analysis will be conducted using data from a dietetics practitioner survey. Interpretative Phenomenological Analysis will be used to identity RDN experiences that reveal culturally safe care in the Pacific from key informant interviews. Findings. Survey results describe the practice of dietetics in the Pacific region (n=106), by demographics of RDNs and populations served, and RDN identified needs for culturally relevant and disease-specific nutrition resources, particularly resources for Pacific Islander and Asian populations and NCDs. Key informant interviews (n=18) of practicing dietitians in the Pacific reveal dimensions of cultural safety in the following themes: (i) self-awareness and self-reflection to one’s own historical and social culture and location; (ii) relationship building and creating an environment of respect, caring, trust, empathy, and acceptance between client/patient and RDN; (iii) working through a social justice lens, recognition of power imbalance or struggles, and potential for repressed cultural identities as described through their practice experiences. Conclusion. Understanding dietetics practice in the Pacific as unique with needs specific to the region is important to inform the identification and development of the necessary nutrition resources to enhance dietetics practice and patient care experiences. Identifying and describing practice experiences of culturally safe care could inform new practice guidelines in the dietetics profession. This has promising implications for improving health care services in the Pacific region, and to places where Pacific groups have migrated in other parts of the world.

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Dietetics, Pacific Islands, Cultural Safety

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