Helen Osborne: Welcome to Health Literacy Out Loud. I’m Helen Osborne, President of Health Literacy Consulting, founder of Health Literacy Month and your host of Health Literacy Out Loud. In these podcasts, you get to listen in on my conversations with some really remarkable people.

Today, I’m talking with Janet Ohene-Frempong who is a plain language and cross-cultural communications consultant with over 25 years of experience in consumer communication. Janet brings to this work a passion for health literacy and background as a registered dietician.

Janet often is invited to speak at national conferences and provides consultation on plain language and cross-cultural communications for a wide range of health information providers. Deservedly, Janet has received many honors and accolades for all her work.

Janet and I have known each other as health literacy colleagues for many years, yet I learn something new every time I hear her speak up.

Recently, it was about how to communicate about food in a multicultural world. I knew right away that this would be a great topic for Health Literacy Out Loud.

Welcome, Janet.

Janet Ohene-Frempong: Thank you, Helen. I’m glad to chat with you about this.

Helen Osborne: It was like an aha when I heard you asking a question or making a statement about food in a multicultural world. Why is that something we need to consider in all our work about health literacy?

Janet Ohene-Frempong: One of the important issues that comes up often in the field of healthcare has to do with food. Many of our major conditions, like diabetes, heart disease, congestive heart failure and various types of heart diseases, including liver and also kidney disease, involve giving people advice about how to eat.

Helen Osborne: How to eat, what to eat, what not to eat or how much. We’re always writing about food. What about the cultural parts of that?

Janet Ohene-Frempong: We’ve come, I think, fairly far in terms of what we know about food, and that’s actually a good thing, but it also presents a problem for people. As we learn, science changes and then the directives that we give people change as well, so that can be a source of confusion. We can chat about that.

In our attempt to give people a sense of what to do, especially the USDA, or the US Department of Agriculture, has been valiant in their efforts to give us some sense in how to approach food on a daily basis.

Right now, we have the model of MyPlate. Actually, that’s what brought up the question the last time we were together at a conference. We were talking about how to advise people about what to eat.

Helen Osborne: I remember in MyPlate, it’s really just a picture of a plate and the proportions of the different types of food groups that fill each part, like the protein, carbs, veggies and fruits. That replaced the old Food Pyramid, I think.

Janet Ohene-Frempong: Exactly.

Helen Osborne: In that, is it just looking at the proportions? I know that was very visual.

Janet Ohene-Frempong: Which was a good thing because we used to have lists, but this is very visual. It’s what your plate might look like.

I looked at the plate and I thought, “This is not the way I eat. It’s not the way I feed my family.” I’ve got a large family and we’re multicultural.

My question was “How do we translate this across cultures where we’re not just baking and broiling, but we’re actually stewing foods and serving them as mixtures, sort of combination foods, over rice, with plantains or with yams?” Trying to separate food out on a plate is not what our food looks like in this house.

We eat mostly a West-African cuisine and it’s not a meat, starch and vegetable type of look on the plate. Even though that’s what it basically is, it certainly doesn’t look like that. It’s stews and soups.

Helen Osborne: That’s so interesting, Janet. I never thought about that mixture. I was just thinking about the different types of foods we would put in each category.

I have certain food preferences and food habits and I wouldn’t be eating certain foods on that plate, but you’re saying that your plate doesn’t even look like that. It’s a whole mishmash, but in a loving way of that, of how foods come together in there.

Janet Ohene-Frempong: Exactly. It’s a delicious mishmash, too.

I’ve been married for 46 years to a wonderful man from West Africa. I always joke about this, but it’s actually pretty serious. The reason I’ve been able to manage for 46 years with him is that I cook like his mom cooked.

We’ve raised our children on those foods because we wanted to be able to take them back and forth between here and West Africa. We’ve got a huge family. It’s more like a clan of people over there. I didn’t want them going over there looking for a meat, starch and vegetable, and hamburgers. I thought it would be disgraceful.

Helen Osborne: Janet, then what do we do? Let’s put on our health literacy hats that you and I are both very comfortable in. We’re writing, we’re helping organizations write information and we know we need to tell people about food groups and types of foods to eat and not eat.

How can we do this in a manageable way when people are from all over the world and then we’ve got blended families of eating from many different cultures? How can we portray that?

Janet Ohene-Frempong: Actually, I think it’s a challenge. It’s something I haven’t really thought about very much from a professional level. In terms of my own family, we manage the best that we can.

It’s something that we need to address in the field of health communication, how to talk with people. It means that we really have to understand what people are eating.

In Asia, people mix foods together, like vegetables, meats and so forth. I think in South America and Southern Europe they do as well. Certainly, in Africa, people do.

People are very visual. Eating is a sensual affair, as well as a chemical one. Before you even see food, you’re smelling it. If you’re writing or doing a video, you’re going to lose the sense of aromas, but people want to be able to see foods that they eat.

I know, for example, the American Diabetes Association has a very nice interactive piece that’s based on the same MyPlate situation and you can choose the meat, the starch, the vegetable and the fruit. You can pick them and it will put them on the plate. It looks very lovely if you come from a certain culture, but it looks totally unappetizing if you come from another culture.

Helen Osborne: Let’s think ahead. No one else has thought of this. That’s why I was so wowed by your questions. What would be on your wish list of what we could do to communicate about food in an informative, but respective and inclusive way?

Janet Ohene-Frempong: I think that would start with interviewing people from different cultures, because that is practicing what we preach in terms of how we communicate with people. You’ve got to really talk with people and find out what their own issues are and then find ways to deal with those.

As I said, I think one thing that’s really important is if you’re talking about people and what they eat, they need to be able to see it. They need to see pictures of the food that they eat looking appetizing.

Then we have to be able to negotiate with people about how they can have many of the things that they like and are emotionally attached to, and financially. People have to pay for food.

Helen Osborne: I was wondering about that too because you hear the term sometimes “food deserts,” where it’s hard to get access to good, fresh fruit and produce. It also can be not affordable, so we need to consider that too. It’s not just preferences and traditions, but access to these foods.

Janet Ohene-Frempong: Helen, you’re so right. There are a number of issues. One is that the food has to be available. It needs to be affordable. Sometimes it’s there, but you really can’t afford it.

It needs to be convenient. Some people stay at home and have all day to cook. Other people are working one, two or three jobs and they don’t. They need to have convenience.

You have to take into consideration people’s emotional issues. Many people are dealing with a lot of stress. Some people, even worse, are dealing with issues with depression, so we need to be able to acknowledge that when we’re talking to people about food. We can’t talk as though it’s just a biochemical situation. We have to be able to talk about how people relate to food.

People are stressed and people are eating. If you can’t deal with the stress, very often you can’t deal with your diet, whatever it is you’re supposed to do. We’ve seen this for years.

There are issues, of course, of culture, which is one of the things we’re talking about, to a changing science. People in many cases have begun to actually not even pay attention to some of the things that we are advising because things keep changing and they don’t understand that.

Helen Osborne: I’m glad you added that. I think of all the examples. Is wine good or bad, is chocolate good or bad? It goes on and on and those are the foods I’m familiar with. It’s an ever-changing way.

I used the word mishmash or you use the word stew about foods coming together. It sounds like how we communicate about food is also a stew or a mishmash of all these different variables, like the access, emotion, affordability, convenience and changing science. Wow.

Janet Ohene-Frempong: Well put. We said carbs were good and fats were bad, and then we turned around and said, “No, carbs are bad and fats are good.”

Helen Osborne: Janet, we communicate in so many ways. Our listeners of Health Literacy Out Loud care so much to do a good job on this.

You’ve raised all our consciousness about some of the problems. I’m just looking for some brainstorming with you, whether we’re communicating in person, in print or, perhaps, in video or other ways. What would be on your wish list of what we can do?

Janet Ohene-Frempong: I think role models would really be helpful. We talk about cultures in a broad sense. We can talk about West-African culture and we can even talk about so-called American culture. I lived in New Orleans for a while. The way people eat in New Orleans and the way people eat in New York in general . . .

Helen Osborne: It’s a big deal.

Janet Ohene-Frempong: If you can have people who are cultural brokers and people who are actually dealing with some of the dietary requirements of managing diabetes, hypertension or obesity, for example, talk to those folks. Write, or videos are extremely effective these days.

Talk to people about what they do and how they have managed to change and make adjustments in the foods that they know that people from their area, such as Puerto Rico, Ghana or Vietnam, have made to adjust to the health needs of whatever situation they’re dealing with. That’s what I did with my family and friends.

I was trying to lose a little weight and I substituted cauliflower for yams. I had to talk about it in a way that wouldn’t turn everybody’s stomach.

Helen Osborne: Talk with folks and get that background. As you’re giving these examples, my mind is just going in a million directions for all these kinds of conversations and instances I’ve been with.

Let’s say we’ve talked with people, and we have a sense of their preferences and all the considerations for right now. What about when we need to invest a little bit or someone’s paying us to put it in writing or on a video in some way that has some permanence or semi-permanence to it? How would we communicate then?

Janet Ohene-Frempong: Since people are very attached to their food preferences based on their culture, their upbringing and also just personal tastes and so forth, again, who is talking to you about your food counts.

When we were doing some studies on obesity in the area of the country that I live in with the University of Pennsylvania, for example, we talked with low-income, African-American women. I’m an African-American woman, and they had some really insightful contributions to that whole discussion on attitudes.

Rather than having somebody who they do not think understands their sense of body image, their situational barriers and their cultural preferences, I think that they would really prefer to hear these messages from somebody who has dealt with some of the same issues.

Again, this is role model. You know very well because you’re a very good storyteller and you understand the power of role-model stories.

Have it come from somebody who looks like them, thinks like them, eats like them and has felt the same medical issues as they have. Come up with some compassionate, thoughtful, practical solutions to how to translate their foods that they like into something that will keep them healthy. It’s not only the food that they like, but it’s to be able to prepare them in ways that are convenient and realistic for them.

I remember a long time ago when I first started in the field of nutrition, and this was years and years ago, I realized that not everybody had refrigeration or a working oven.

I was working with social workers and we were talking about baking and broiling. They couldn’t because they didn’t have ovens. They had to have canned foods because they only had marginal refrigeration.

When you see these things and you’re aware of these things, it changes the way you talk with people about food. When you’re asking people to make changes, you don’t say, “It’s just as easy as doing this. All you have to do is that.”

Helen Osborne: You don’t even put your value judgments on it there about “Just go down to the store. This is easy.”

Janet Ohene-Frempong: You acknowledge that sometimes it’s not easy, but here’s what you can do. We’ve worked on a number of projects that have incorporated that approach.

You can say, “Try to cut down on salt. Don’t just eliminate salt, but try to cut down on salt. First try this and then try that, and soon you’ll find that the taste of salt isn’t as pleasant as it used to be.” You have to talk to people’s emotions and their situations.

Helen Osborne: I’m hearing all this wealth of suggestions from you. Talk with people. Know your audience. Work with them. Work together to create a message people can understand. That’s an abiding health literacy principle. That’s been resonating with me and I assume with you for as long as we’ve been doing this work.

It sounds like there are so many challenges and variables we need to consider when we do this. Are there any parts about this that you see as easy?

Janet Ohene-Frempong: Not easy, but fun.

Helen Osborne: What’s the fun part about this? This sounds a little bit daunting to be considerate of all these elements. What’s fun?

Janet Ohene-Frempong: I think you can get clear about what many of the elements are. The fun part about it is the little trip that you take into somebody else’s universe. It’s really pleasurable.

People that don’t enjoy it shouldn’t do it, but it really is very nice to find out how other people see things, listen to what they are dealing with and see things from their point of view. It’s like a little journey out of your universe into theirs.

The other thing that is deeply satisfying, at least it has been for me for years, is the relief and gratitude that people have when they finally have something that they can relate to. My experience with people is that they really want to be healthy. They want to be okay.

A lot of times, we talk at people instead of talking with them, especially about food, and that tends not to work, I think. It is something you can make manageable within your budget if there are budget constraints or time constraints. You have people who see this as a mission, not only moving across literacy levels and languages.

By the way, MyPlate is translated into something like 20 languages, which is very nice, but what we haven’t really successfully done, I think, is to translate them across cultures. We see the same plate that doesn’t look like many of the plates around the globe. We understand it, but can we relate to it? Probably not.

Helen Osborne: Janet, you can’t tell because we’re doing this by phone, but I have such a big smile on my face as you were talking about the satisfaction of doing this work, the gratitude and taking a journey into someone else’s universe. Food can do all that. You’re a leader and a navigator helping us get through all that.

Janet, thank you do much for doing all you do and sharing your wisdom, your thoughtfulness and your experience with listeners of Health Literacy Out Loud.

Janet Ohene-Frempong: It’s totally my pleasure. This has been quite a journey and we continue on. It’s nice to be in the field with you and all the light that you shed on these various issues, so thank you so much.

Helen Osborne: Thank you, Janet.

As we just heard from Janet Ohene-Frempong, it is so important to consider our audience and their culture, their values and all that’s important to them when we communicate about health, and specifically when we communicate about food. But doing so is not always easy.

For help clearly communicating your health message, please visit my Health Literacy Consulting website, www.HealthLiteracy.com. While you are there, feel free to sign up for the free monthly enewsletter, What’s New in Health Literacy Consulting.

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Until next time, I’m Helen Osborne.

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