Practice Resources

Cultural Competency, Health Literacy and Numeracy

Successful self-management stems from care that is personalized. It is incumbent on the diabetes care team to assess a person’s ability to understand and process health information, gain insight into their life experiences and social support, and most importantly, make efforts to meet a person in their cultural space. When the whole person is taken into context, care becomes person-centered and supportive, leading to improved outcomes and sustainable self-management. ADCES has created a variety of resources to help you understand key concepts in health literacy, numeracy and cultural competence.

Practice Paper

Cultural and Health Literacy Considerations with Diabetes

The way that a person with diabetes processes and utilizes information depends heavily on health literacy and numeracy skills, prior life experiences and social support, each of which are shaped by culture.  This paper breaks down how the diabetes care and education specialist must approach education with each individual to meet their needs.

Key points addressed in this paper:

  1. The role of the diabetes care and education specialist in assessing health literacy and numeracy.
  2. The impact of health literacy and numeracy on diabetes self-management and available tools for screening.
  3. The changing demographics in diabetes and the need for cultural sensitivity in care.
  4. Cultural terminology and strategies to implement them into practice.
  5. eHealth considerations for the diabetes care and education specialist.

Formal Methods to Assess Health Literacy

Diabetes Numeracy Test (DNT) – short 5 item or 15 item long version

Rapid Estimate of Adult Literacy in Medicine (REALM) - 5 minutes

Population-Specific Tip Sheets

Perspectives on Diabetes Care

The Huddle Podcast: Conversations with the Diabetes Care Team

The Huddle is available on all major podcast platforms including Apple PodcastsGoogle PodcastsSpotify and Stitcher. Listen to previous episodes of The Huddle


Crossing Cultural Boundaries in A Faith-Based Setting with Diana Malkin-Washeim

Episode Summary

Individualized care often necessitates the need to not only work with a culture or religion different than your own, but to cross boundaries to understand and support an individual’s unique needs. Diana Malkin-Washeim, PhD, MPH, RD, CDCES, CDN shares her tips for working across cultural boundaries in a faith-based setting to deliver diabetes self-management education and support. 

For practice guidance, tips and resources on working with other cultures, visit

For resources on Ramadan and diabetes, visit


Beyond Cultural Competency: How to Implement Relevant, Culturally Appropriate Care

Episode Summary

Working with individuals from cultures different than your own can come with challenges that directly impact effective self-care. Diabetes care and education specialist Patricia Davidson, DCN, RDN, CDCES, LDN, FAND is the co-author for ADCES’ cultural competency and health literacy practice paper and in this episode, shares her tips to implementing best practices for relevant, individualized care. We discuss why it’s critical to go beyond being culturally competent so that care addresses both cultural sensitivity and humility. We wrap up with tactics to implement culturally appropriate care.

Health Literacy: Tactics to Assess and Overcome Barriers

Episode Summary

Anyone can be impacted by health literacy barriers, no matter their ability or education level. That’s why assessing an individual to determine what they understand is critical to ensuring successful self-management. In this episode, Katherine O’Neal, Pharm.D., MBA, BCACP, CDCES, BC-ADM, AE-C, CLS, co-author for ADCES' cultural competency and health literacy practice paper, discusses ways to assess for health literacy and address barriers that might impact the individual’s ability to understand and follow treatment plans. We talk through the five categories of health literacy, identify how to assess for understanding and we end with tools you can use to overcome barriers.

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