Nutrition 510- SDSU

Rupp

Interviewing - Session 1

Name I fM\i

Counselor Role & Prep 50 4

Background research
Communication style 10 ID
Cultural foods/prep 10 /Q
Health beliefs 10
References 5 ^
Questions to ask 15

Client Role & Prep 50 ^3

Background research
Communication style 10
Cultural foods/prep 10 /o
Health beliefs 10 d
Three day food record 15 /3
References 5 6

TOTAL 100 *77 _

17
 Aliya Levy
Nutrition 510 - Group 2B
September 26, 2017
Dietitian Role

Mrs. Therese Kim is a 42 year-old second generation Japanese person living in

the States with her children and husband. Mrs. Kim stands at 5 feet 4 inches, weighing
154 pounds (70kg.), which puts her BMI at 26.5 kg/m^ meaning she is in the ovenweight

category. As she is barely breaking into the overweight category, this is important;

however, what is more pressing is Mrs. Kim's glucose tolerance test in which she tested

borderline for diabetes. However, these numbers aren't all that make up Mrs. Kim. More

than these numbers, the knowledge of the health beliefs and culture that Mrs. Kim

comes from will help the Dietitian move forward helping to improve her health.

The Japanese believe in brevity in the way they speak; they commonly use the

phrase "Hear one, understand ten," Meaning someone should be able to say what they

are conveying in one word, although it will give the message of ten words. Japanese

use non-verbals to carry much of their message including posture, tone of voice, facial

expressions, body language and non words such as umm, hmm, and ahh (1). The

Japanese will rely on facial expressions along with the non-verbal messages such as

frowning while someone is speaking, as it is seen as a sign of disagreement. It is

important to note what Japanese culturally find disrespectful when interviewing a client

from that culture; For instance, the Japanese consider it disrespectful to stare into

another person's eye, especially if that person is older than you (2).
 Typically in the United States many people tend to extend conversations on, and

culturally in English people use many words to get small points across. This is important

to note because as a dietitian working with a client that is from a different culture,

communication styles will need to be adjusted to work with the client as successfully as

possible. As many Americans can be extremely straight fonward in their wording and

their ability to turn down an idea, the Japanese believe that turning down a person's

request would be rude and cause embarrassment to the person, so instead of

disagreeing or turning someone down they will tend to use avoidance words. The

Japanese are part of a non-confrontational and have a difficult time saying no, but as

they also use their body language as a communicator it is important to pay attention to

see if they are giving other cues. It is also important to note that although many

Americans tend to be okay with standing and sitting close to one another, the Japanese

^ prefer to have at least one arm's distance for personal space (2).
Growing up in America you learn that independence is very highly valued;

Because of this self-care becomes a necessity in America. American's put priority on

being able to do everything by themselves and not asking for help, where in Japanese

culture the emphasis is on family interdependence. Many Japanese people live in large

homes where extended families all live together. These living situations typically mean

that when they grow old and need help with daily tasks, there is usually someone who is

able to be home with them and help them (3).

The Japanese health belief is very spiritual, linking the mind, body and spirit.

They believe in having great respect for the body and it is even seen as holy and
sacred. Many Japanese believe that illness is a force that is outside of an individual's

control. This sometimes can become a problem as many of them believe that since

there is nothing they can do about their illness they choose to not treat it. The Japanese

culture has many taboos and traditional practices such as wearing a mask at all times

when sick and always taking shoes off when coming inside. All of these things that the

Japanese do always lead back to respect, as it is something they prioritize very highly

(4).

Japanese food has many influences from Korea, China, and Southeast Asia;

However, it does have its own distinct identity. The Japanese use white rice as a staple

in almost all of their meals and then will add in ingredients such as fish, pork, soy

products and vegetables. When looking at a typical Japanese diet vs. the typical

American diet the Japanese eat almost twice as much fish as Americans (5). The typical

Japanese meal will involve a number of dishes on the table rather than one main course

(2). Japanese tend to eat much smaller meals and also will typically stop eating before

they are completely full. In more recent years many Japanese Americans have been

adapting a style of eating that includes many of their cultural dishes but also

incorporates many of the fast food and pre-made dishes that Americans typically find in

their diet(5).

As a dietitian, all of this information is incredibly important when reviewing the

history of a new client. It is important to know any culturally relevant information to make

sure the dietitian is able to make a strong connection with the client, as this will make
the client more likely to adhere to any advice that is given during their appointment

together.
 Works-GHM^

(1) Kopp, Rochelle. "Hear One, Understand Ten" Sums up Japanese

Communication Style. Global Manager Magazine. 2012.

(2) Guide to Japanese Culture, Customs, Business Practices & Etiquette.

CommisCEO Global.

http://www.commisceo-global.eom/country-guides/japan-guide#c3: September,

2017.

3. c ^ C.
(3) Galanti, Geri-Ann. Japanese Americans and SelfjCare: AJiesson in.^oss

Cultural ^are. Western Journal of Medicine. 2001; 174(3): 208-209

(4) Kalland, Arne. Facing the Spirits: Illness and Healing in a Japanese Cori^unity.
Folklore, http://www.folklore.ee/rl/pubte/ee/usund/ingl/kalland.html: September,

2017.

(5) Campbell, Meg. Japanese Diet Vs. American Diet. Livestrong.

http://www.livestrong.com/article/417729-japanese-diet-vs-amej;ican-diet/:

January, 2015. September, 2017. '

 Client Role

Maria Fierro is a 27 year old second generation Filipino American who lives with

her three small children, aged 1, 3, and 6 and her husband. Maria lives on a very tight

budget and tends to prioritize feeding her family over feeding herself, which has led to

her hospitalization due to severe malnutrition. Maria weighs only 95 lbs(43 kg) while

standing at 5'3"(1.6m) which puts her BMI at 16, putting her in the unden/veight

category. Maria has been told by doctors and dietitians in the past to make sure she is

eating a high protein diet, however they have recommended proteins that are far too

expensive for her budget so she has yet to adhere to these recommendations. Playing

the role of Maria means putting myself into the mindset that money is tight, and this is

not something that will change anytime soon. For Maria the children come first and they

always will; In order to find a solution it needs to be in a way that not only benefits her,

but also will benefit her children. As long as the dietitian is understanding of her

situation and works with her, it may well be a great fit and exactly what Maria needs to

get her health back on track.

As a Filipino American Maria has grown up in a culture of hospitable and friendly

people. In the Filipino culture it is found that everyone seems to smile, no matter how

they are feeling. Public displays of emotions like anger and sadness are typically not

acceptable, instead Filipinos will pretend to be happy while they are around other

people. A smile can mean many things in their culture, for instance if they are asked a

question they do not want to answer they may just smile instead. The Filipinos base
much of their communication on the nonverbal aspect using hand gestures, pursing of

lips and rsiising of eyebrows in place of spoken word (1).

Although there are many different communication styles even within the Filipino

culture there are some standard non-verbal cues that they will give. For Filipinos when

they raise their eyebrows or lift their head that typically means "yes"; when they use

their index finger to point at a person it is seen as rude and aggressive so instead they

will either say something to describe it or nod towards it; If a Filipino were to fall, they

would rather smile than cry in spite of the pain, they will sometimes even just make a

joke out of themselves for falling (2).

The Filipino culture is very family oriented that tends to stay very close to their

family so a great conversation starter is asking about their family. Filipinos do not mind

talking about their personal life so it should not be found as a shock if they ask someone

about their own personal life (1). Although the Filipino culture tends to be very straight

forward and open in normal conversation they are typically non-confrontational. Similar

to many other Asian cultures the Filipinos would rather say yes even if they mean no as

to not be seen as unfriendly or confrontational (3).

Many Filipinos believe in the principle of bcilance that includes a set of principles

and a range of "hot" and "cold" beliefs concerning balances in the body. Some of these

beliefs include rapid shifts of hot to cold will lead to illness, cold drinks or cooling foods

should be avoided in the morning, and a layer of fat is preferred to maintain warmth and

protect the vital energy in the body. They believe in different explanatory models for their

illness such as mystical, personalistic or naturalistic causes. They believe that mystical
causes happen due to experiences or behaviors; Such as unfulfilled obligations that

may cause a nightmare after eating a heavy meal and in the end resulting in death. Bad

things happening in one's personal life may be attributed to social punishment or

retribution by supernatural beings, although a stronger spirit can counteract these forces

and for protection many will use holy oils or wear a religious object at all times.

Naturalistic causes can be from nature events, excessive stress, incompatible food and

drugs, or infection.

Their basic logic consists of prevention in the form of avoiding inappropriate

behavior that leads to imbalance and their curing would be the restoration of the

balance. The Filipino culture keeps an emphasis on cleanliness, orderliness,

appropriate social conduct and avoidance of social, emotional or psychological distress

in order to prevent disequilibrium and keep the body strong. Although they have all of

these cultural beliefs they do still adhere to many of the medications and practices of

modern western medicine, using a dual system of health care (4).

Food is a huge part of the Filipino culture, in fact the local word for "Hello" can

actually be translated into the phrase "Have you eaten"(6). The Filipinos do not typically

follow a 3 meal per day schedule, but instead will tend to have breakfast, mid-morning

snack or second breakfast, lunch, mid-afternoon snack, and then dinner. This tradition

actually began pretty far back to when the day would start at 4 am so it was necessary

to grab snacks throughout the day. Rice is a staple in the Filipino diet, even if the meal

is already pretty filled with carbs they will still add a bowl of rice on the side. Filipinos

also enjoy having condiments with their meals either on top of their meal or on the side
for dipping, such as soy sauce, fish sauce, ketchup and shrimp paste(aiso known as

bagoong or alamang)(5).

Utensils are not commonly used with the Filipinos, instead they prefer to eat with

their hands and this goes all the way back to early times when they did not have the

income to buy a spoon and fork. Many of their meals can be presented or served in

banana leaves to combat this lack of utensils (5). The typical filipino diet revolves

around those main local foods, however they are very familiar with western foods and

they will now add these into their diet on a typical week (6).
 /■

Works-Cited

(1) Cultural Information - Phillipines. Global Affairs Canada.

https://www.international.gc.ca/cil-cai/countryJnsights-apercus_pays/ci-ic_ph.as

px?lang=eng: June, 2017. September, 2017.

(2) Antonio, Anton. The Unique Filipino Communication Style. Thoughts to Promote

Positive Action.

http://antonantonio.blogspot.eom/2014/09/the-unique-filipino-communication-style

.html: September, 2014. September, 2017.

(3) Warburton, Keith. Filipino Communication Styles. Global Business Culture.

https://www.worldbusinessculture.com/country-profiles/philippines/business-com

munication-style/: 2017. September, 2017.

(4) McBride, Melen. Health and Health Care of Filipino American Elders. Stanford

Geriatric Education Center - Stanford School of Medicine.

https://web.stanford.edu/group/ethnoger/filipino.html; 2004. September, 2017.

(5) Jeric. Five Eating Habits of Filipinos. Philippine News.

https://philnews.ph/2013/10/22/five-5-eating-habits-of-filipinos/: October, 2013.

September, 2017.

(6) Hays, Jeffrey. Food and The Philippines: Diet, Eating Customs and Cooking for

the U.S. President. Facts and Details.

http://factsanddetails.com/southeast-asia/Philippines/sub5_6e/entry-3163.html:

June, 2015. September, 2017.

 Questions

• How are you doing today?

• What can i do for you today?

• Can you tell me a little about yourself?

• Is it alright that I take some notes while we talk today?

• It looks like right now your body weight is around 154 pounds, is this pretty

typical for you?

o Or have you seen weight gain or loss recently?

o How much has your body weight changed recently?

o Was there anything in your life that changed that possibly coincided during

these body weight shifts?

o How do you feel about your current weight? Is this a pretty comfortable

weight for you?

• I see that you are an elementary school teacher. What does a typical weekday

look like for you while you are at your elementary school teaching?

• Do you enjoy exercising?

o How often do you exercise?

o What types of exercise do you enjoy?

o Do you have the time or would you be willing to change the amount of

activity that you typically do?

FOOD

• Do you ever feel uncomfortably stuffed after your meals or just a normal full?
• Are you following any kind of special diet currently?

o If so, how willing would you be to adjust the diet you are currently on?

• Can you describe to me your usual eating environments.(in the car, at a desk, in

front of the TV, at a dining room table)

o On a scale of 1-10 how willing or how able are you to change the

environments that you typically eat in?

• Do you have any food aversions, restrictions, foods you dislike, or foods you

typically avoid?

• Do you have any favorite foods that you love having in your daily diet?

• Are you the one who typically does the grocery shopping in your home?

• Are you the one who typically does the cooking in your home?

o If not, who does?

• How many times per week do you and your family typically eat out at either fast

food or sit down restaurants?

o On a scale of 1-10 how willing are you to decrease the amount of times

your family eats out?

• Are there any restaurants specifically that you go to commonly when you go out

to eat?

• Do you mind if 1 take a moment to take a look at your 3 day food record?

o Are these foods typical?

o Do you typically have set meal times?

o Do you ever skip meals for any reason?(Time, lack of appetite, etc.)
 o If no beverages on the sheet, ask: What type of beverages do you enjoy?

Do you prefer soda or juice over water?

• Are you taking any vitamin or mineral supplements daily?

• Do you drink alcohol? If so how many drinks each week?

• When you have attempted to lose weight in the past, what were the methods you

tried?

o Was there anything that you tried out during any of these attempts that

you did enjoy? (e.g. the exercise routine, the food, etc.)

<iT> ^
 Three-Day Food Record for Maria Fierro
Day 1 of 3

Day of the week Thursday

Date 09/14/2017

Time Food Item Description & Preparation Quantity

6:00 am Green Tea Steeped 8 oz

6:00 am Banana Sliced 1/3 T

11:30am Rice - White No spices 1/8 cup

11:30am Chicken With garlic, ginger, salt and pepper 2 oz

T
2:00 pm Peanut Butter Jiffy Itbsp

2:00 pm White bread Has peanut Butter on it 1 slice

6:00 pm Applesauce No sugar Added 2oz

6:00 pm Black Beans Canned 4oz

6:00 pm Rice - White Garlic, salt and pepper Va cup

6:00 pm Ground Beef Garlic salt, salt, pepper 2 oz

Did you take any supplements? No If yes, please specify:

 Day 2 of 3

Day of the week Friday

Date 09/15/2017

Time Food Item Description & Preparation Quantity

6:00 am Green Tea Steeped 8 oz

7
6:00 am Apple - Gala Sliced 1/2 vt

11:30 am Rice - White Boiled - No Spices Vi cup

11:30 am Ground Chicken Sauteed 2oz

u
2:00 pm Tomato Soup ^ cup

2:00 pm White Bread Toasted 1 slice

6:00 pm Rice - White Va cup

6:00 pm Black Beans 3oz

6:00 pm Adobo - Chicken Breast Garlic, Pepper, Soy Sauce 3 oz

9

Did you take any supplements? No If yes, please specify;

 / 1 -o

Day 3 of 3

Day of the week Saturday

Date 09/16/2017

Time Food Item Description & Preparation Quantity

6:00 am Green Tea Steeped 8 oz

6:00 am Banana Sliced 1/2 /Wet?

11:30 am Rice - White Boiled, Cooked in Chicken Bouillon Cube Va cup

11:30 am Carrots Steamed 1 cup

11:30 am Leftover Chicken Adobo 2 oz

2:00 pm Peanut Butter Brand: Jiffy loz

2:00 pm White Bread Brand: Bimbo 1 Slice

6:00 pm Russet Potato Boiled, then Mashed 4oz

6:00 pm Butter, Unsaited 2 tbsp

6:00 pm Pork Belly Baked with Spices 2.5 oz

Did you take any supplements? No If yes, please specify: