Development of culturally competent food-frequency questionnaires.

Health-related behaviors, including food choices, are culturally determined. Culture is the medium through which people interpret their world and the tool individuals use to guide decisions. Recognition of the effect of culture on health-related behaviors has led public health investigators, including nutritionists, to address the concepts of cultural relevancy as applied to intervention strategies and assessment techniques. Drawing on a project involving the development of food-frequency questionnaires for Native American communities, I provide definitions of cultural awareness, cultural sensitivity, cultural appropriateness, and cultural competency. Cultural competency, which involves working within the cultural context of a culturally distinct population, is the approach most likely to reduce miscommunication between investigators and participants and to yield reliable and valid data. Step-by-step guidelines for creating a culturally competent food-frequency questionnaire have been developed.