Jessilyn Cauble

Nutrition 510
Interview
An interview is a guided communication between two people that, through an exchange
of questions and answers, discloses information and achieves a predetermined purpose. An
inherent component of this process, if it is to be effective, is the underlying necessity of the
interviewer to develop rapport. To successfully establish rapport, a dietician must acquire in
depth knowledge on the clients ethnic background to assure the client feels accepted and
understood. As a dietician, I will be interviewing Mr. James Hamilton, a 55-year old African
American male. He was admitted to the hospital on the basis of chest pain, has elevated lab
results for total cholesterol (285) and triglycerides, and was diagnosed with angina. He is 61
and 280 pounds. At his current weight, he is classified as morbidly obese with a BMI of 37.19
kg/m2 and is 102 pounds above his ideal body weight (178 pounds). It is my responsibility not
only to assess his heart disease risk and offer advice but to create a respectful and trusting
environment to discuss my clients concern. Communication is an expression of culture and
ethnicity. To successfully communicate and connect with my client, it is essential to understand
Mr. Hamiltons ethnic background and its contribution to his communication style, health beliefs,
and food preparation techniques and possible foods.
African Americans communication style is viewed as animated, expressive, and riddled
with gestures. Their culture tends to correlate passion with authenticity and the necessity to
advocate what you believe in.1 As a dietician a neutral or objective attitude can be off putting and
could inadvertently decrease my credibility. Instead, I must express emotions and make my
genuine desire to help evident. They believe that the truth is revealed through argument and
debate, a mode of behavior often coined as confrontational and aggressive from other cultures.

As the dietician I must be prepared to be questioned and prepare accordingly. African Americans
are perceived to speak with an elevated speech volume but in reality range and pitch vary
depending on the situational context and audience.2 I am interacting with Mr. Hamilton in a
hospital setting under the precept that he is experiencing health concerns and needs to make
changes. The combination of a formal environment and interaction with an individual outside his
race, me, leads me to assume he may appear reserved, speak with a low volume and steady pitch.
When carrying on a conversation I must be aware of any and all nonverbal cues Mr. Hamilton
may be expressing to convey it is his turn to talk and know that he will speak the moment he
feels moved to. His culture believes urgency, status, and the ability to command attention are the
determining factors of who speaks first.1 It is paramount that I speak first so he understands the
urgency of his condition and sees my genuine passion to help. In the process I hope to garner his
respect and establish myself as his dietician. It is the social norm for African Americans to have
greater eye contact while speaking and less when listening,2 a direct contradiction to the
European American way. Thus, I must not interpret their intense eye contact as hostile and
acclimate myself to look more while I am talking to avoid coming across as bored or
disinterested. It is common for this ethnicity to sit in close proximity to one another and touch
often to reinforce the connection and bond between individuals. However, interracially this is not
practiced and in its place an indifferent, uninvolved attitude can be displayed. African
Americans, in reference to identity, view the self in a collateral orientation. How my clients
actions will affect other members of his group will be a prominent, consistent thought. Through
their communication style African Americans attempt to personify four basic values of their
culture; sharing life with family and friends, uniqueness or individual style, affective humanism,

and diunital logic.2 Overall, in depth knowledge about my clients ethnic background enables me
to embody his culture and parallel his communication style, factors essential to building rapport.
Health beliefs illustrate a cultures theories on what causes illness, how illness is cured,
and who is able to treat said illness.3 One possible explanation for these questions amongst
African Americans is that disease is caused by evil influences and that illness comes to the
individual via supernatural force.4 They possess diunital logic, the thought that good and evil
coexist together and that all events in life are interconnected. Life is perceived as being in
harmony with nature.5 As a dietician I have to be conscientious of these esoteric beliefs when
discussing preventative measures, steps that may be viewed as tampering with the way nature
intended it to be. Pain and suffering is seen as inevitable and thus is often endured with the only
mode of healing pursued is prayer. It is important that I reinforce the importance of regular
doctor visits, always being honest about your current condition, and being proactive with one is
not experiencing optimal health. Those of African American decent illustrate a core value in the
importance of family in all faucets and the church as a support system. In general the kinship is
matrifocal in nature with a specific, predetermined member selected to oversee all important
health-related decisions.3 Mr. Hamilton is an established tech company executive with his own
family. It should not be assumed he practices this cultural component, instead probing questions
should be asked to uncover his family dynamic. A common health belief among this culture is
that a good appetite translates into a healthy person. Some additional weight to African
Americans is vital because it acts as a reservoir, extra weight that one can afford to lose, if they
became ill.5 These thoughts could potentially effect Mr. Hamiltons perception of what a healthy
weight is and ability to identify and successfully consume correct portion sizes. Lastly, a health
belief among African American ethnicity is a state of high blood verse low blood with optimal

being balance. Individuals with high blood are thought to have thick blood, often suffer from
hypertenstion, and are informed to avoid rich and red foods. Conversely, low blood is
representative of thin, acidic blood, causes anemia, and rich, red foods are recommended to
thicken blood.5 Therefore, it is paramount for the dietician to familiarize themselves with their
clients ethnic health beliefs that affect adherence, utilization of health care services, and lifestyle
decisions.6
African American culture places significant value on cooking and eating viewing meal
time as an opportunity share. Preparing food for the family enables the opportunity to express the
group feeling of soul. Soul foods were established as foods able to nourish the body and spirit
and became a southern tradition handed down through generations.5 Food preferences can be
identified with slavery and the foods consumed during this era. Root plants, such as yams and
sweet potatoes, are a staple symbolically representing being grounded and the cultural desire of
stabilization. It was not uncommon for African American slaves to possess seeds, enabling them
to carry traditional foods with them wherever they go. A common stereotype is the connection of
African Americans and the consumption of watermelon, a correlation created from slaves
consistently having watermelon seeds in their possession.7 Culturally, it was necessary for
African Americans to acquire the ability to create something out of nothing and transform
leftovers or throw aways into a palatable meal. For this reason, all parts of animal products are
utilized leading to the consumption of chitterlings, ham, pork fat, salt pork, fried meat parts,
oxtails, hog jowls, giblets, and chicken wings. Vegetables are cooked in fat rather than eaten raw
with collard greens, okra, and corn being most prevalent. Food is usually fried or barbequed and
accompanied with various gravy and sauces. Cornbread, biscuits, grits, and sweet potato pie are
other Southern favorites. The traditional Southern diet is high in fat, cholesterol, and sodium. Mr.

Hamiltons elevated total cholesterol and triglyceride levels leads me to assume soul foods are
mainstays in his diet. Often the clients attempt to eat healthy can be overcome by tradition and
social pressures to continue cultural practices8 factors that must be considered by the dietician.
However, food patterns are adaptive to external factors and influenced by economic conditions9
allowing Mr. Hamilton, a tech executive, to sway some from the social norm.
As the client, I am depicting Elia Hirmez a first generation Iranian women. I am a stay at
home mom of a 3 year old son with another one on the way. Entering my third trimester I finally
overcame my stent of morning sickness, have gained 6 pounds, and possess an inner fear of
gaining any more. I am 54 with a usual weight of 122 pounds, classifying me before my
pregnancy as normal with a BMI of 21.1 kg/m2. It is ideal for a women at a healthy weight to
gain 25-35 pounds to adequately provide all possible needs to my growing baby. Elias anxiety
concerning her appearance and husbands approval give insight into her cultural beliefs and
priorities. Being first generation one can assume she will still carry with her the habits,
behaviors, and social norms from her homeland. To act appropriately it is essential to research
her ethnic background extensively and uncover the communication style, health beliefs, and food
techniques and possible foods of Iran.

The common communication style displayed by Mrs. Hirmez, a first generation

immigratnt from the Middle East, is very reserved and respectful. She, like most Iranian females,
is acculturated at a young age, through the teaching of Arabian history, to be submissive and nonconfrontational.10 Females of this ethnicity are conditioned to behave in a particular manner
because any sign of confrontation in this culture is considered an act of disobedience.
Disobedience, a punishable offense, can result in disciplinary actions from the husband.11 Iranian

women often come across as second rate citizens to their male counterpart and possess miniscule
authority. Iranian women have little, to no say in household decisions due to her husbands
insistence to be in control and in charge of making all decisions pertaining to it. An Iranian
females physical beauty and fecundity determine her worth in society. A loss of either places
women at risk of being devalued, an event that subjects her to separation or divorce if her
husband deemed necessary to protect his lineage.12 This provides insight into Mrs. Hirmezs
situation, validates her fears, and provides a greater understanding of what she is going through.
She understands living in America has given her more freedoms compared to Iran, but her
upbringing has deep rooted her into respecting her culture and her roles in Iranian societies. She
is numb to the idea of female equality because it is a cultural norm12 and that she subconsciously
accepted it at an early age. Collectivism is a common value of this ethnicity teaching the
importance of the family over individual needs. This parallels Mrs. Hirmez actions of focusing
her attention on her husbands approval to assure her values maintained rather than a healthy
pregnancy being her priority. Indirectness, a concealment of ones desired wants, needs, or goals,
along with high context communication is the norm. An Iranian values being courteous and save
face over getting their point across. This culture uses rich, expressive language and elaborateness
that can be misunderstood by Americans as the inability to express ideas clearly and concisely.13
Many hand gestures can be considered inappropriate and the physician or caregiver should
refrain from making any for that it may insult her. A simple nod as a form of greeting is most
preferred.
She does not permit herself to be in contact with any other male in a public setting besides her
husband. It is a cultural belief stemming from a patriarchal society, that in public setting, females

are to not come in contact with the opposite sex as it may jeopardize her purity and loyalty to her
husband.10
A common health belief of the Iranian culture is that of the folklore. There are two main
beliefs that determine the health of an individual. One of which is illness causation, such as the
Evil Eye, in which anything that provokes jealousy in another will cause illness or misfortune.
Mrs. Hirmez may be fearful of her hospital stay and being administrated after falling down the
stairs, an event that may have resulted from a bad omen. Being a part of a superstitious culture
she may view this misfortune as a sign she may lose the baby and subsequently her husband. The
other belief is that balancing food between so called hot and cold can result in good or poor
health. Illness can result if both hot and cold are poorly imbalance. Hot and cold are not
determined by its actual temperature but more based on its properties and how it affects the body.
Hot food, for example can be fried, red in color, high calories, spicy, or bitter. Cold food, are
usually cooler in nature, such as watery, green and white in color, low calories, or sour/cooling.
Its always a belief to complement one with the other. Too much of hot and not enough cold food
could result in poor health or illnesses.14
Mrs. Hirmez being a first generation Iranian, her diet and food preference models that of
Middle Eastern. She has not been in the States long enough to be influenced by American
cuisines. Any new food acquisition is foreign and unpleasant. It is a belief that American food is
unhealthy compared to food from her homeland.14 Iranian food has been passed down from
generation to generation safeguarding their survival and becoming a staple of success in raising a
family. Iran experiences seasonal and temperate conditions that determine the availability of food
choices. The abundance and endless options of all food products seen in America differs from the
shortages and disparities relative to Iran. In the Iranian culture food preferences are developed

based on socioeconomic status and any financial hardship can contribute to malnutrition.14 A
common meal representative of Mrs. Hirmez culture is homogeneity of long grain rice or
hummus and wheat bread with lamb and vegetables. An important food preparation is seasoning
with variable spices such as saffron, turmeric, cloves, cinnamon, and cardamom being
implemented. Other spices are used too but what listed are most common. Long grain rice is
consistently served acting as the staple of every dish. The consumption of refined grains,
legumes, and broth is prevalent.15 The preferred protein source is lamb, followed by chicken or
fish. Pork is prohibited in her culture. Goat cheese and yogurt can accompany meals or act as a
protein source. Her choices of vegetables consist mainly of eggplants, tomatoes, potatoes and
squashes. They are prepared in multiple ways, grilling, sauting, or served raw, to complement
the dish recipe. The Iranian culture consumes a wide variety of fruits, such as fresh dates and
figs, oranges, apricots, peaches, cherries, apples, plums, pears, pomegranates, grapes and melon.
They can be dried too if its not seasonally available. Hot tea is the beverage of choice to start the
day and often will accompany each meal.14
As the client I intend to parallel the social norms of Iran and act submissive, chaste, and
respond courteously. The possibility of premature labor evokes fear over losing my baby and
anxiety of not giving my husband another son to add to his lineage. I am anticipating the RD will
suggest I increase my intake, stress the importance of gaining weight, and will be judgmental
towards my take on the situation. I will be shy and if the RD is a male highly uncomfortable and
closed off as to not upset my husband.

References
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Questions

Would you prefer to be addressed as Mr. Hamilton or James?

Your physician ask me to come and visit you, can you tell me a little about why that is?
What are you concerns right now you have about your current health state if any?
Can you tell me a little about yourself?
Can you describe for me your usual eating environment?
Who in your home plans and prepares your meals?
What are you favorite foods? Tell me about what you enjoy eating.
Can you discuss with me what a typical day for you looks like?
Tell me a little about your usual activity level? Do you have time to exercise? How sedentary is
your job or is it active?
I wonder if you could tell me a little about your family history? Any illnesses or chronic
diseases?
Tell me what about your current health condition you would change?
Can you tell me what your goals are for once you leave the hospital? Any changes you can see
yourself making?