"Cultural competence is the process of becoming;
not a state of being."
Introduction
The following comments reflect the development of Campinha-Bacote's model of cultural competence in healthcare delivery. For more detailed information about the current model, refer to the publication, The Process of Cultural Competence in the Delivery of Healthcare Services: A Culturally Competent Model of Care, 5th edition (2007) published by Transcultural C.A.R.E. Associates. If you are interested in obtaining a copy of this publication, please refer to the following link: Resources. Also, please note that the three figures displayed on the bottom of this web page are copyrighted and cannot be reprinted without formal permission from Transcultural C.A.R.E. Associates. Thank you for your understanding of the legal copyright status of these models.
Background Development
In 1991, I developed the model, "Culturally Competent Model Of Care," in which I initially identified four constructs of cultural competence: cultural awareness, cultural knowledge, cultural skill, and cultural encounters (figure 1, below). In 1998, I revised this initial model of cultural competence. There were several reasons for this revision, including the constructs were very limited in scope, the definitions of the constructs needed to be expanded to include new knowledge in the field of transcultural health care and the pictorial representation of this model appeared linear. I did not feel that the model clearly depicted cultural competence as a "process" and the pictorial representation did not express the interdependent relationship of the constructs. I also felt that cultural competence was more than awareness, knowledge, skill and encounters. I added the fifth construct of cultural desire, modified the pictorial representation of the model to reflect the interdependent relationship between the five constructs, and expanded the definitions of the constructs of cultural awareness, cultural knowledge and cultural skill (figure 2, below). I renamed the model, "The Process of Cultural Competence in the Delivery of Healthcare Services." After internalizing the newly developed construct of cultural desire, I further revised my pictorial model of cultural competence. In 2002, I revised the model to symbolically represent a volcano (figure 3, below). It is this current representation of cultural competence that I now view as the process of cultural competence in the delivery of healthcare services. However, I recognize the dynamic changes in this field and therefore continue to be open to further revisions of my model.
The Volcano Model
"The Process of Cultural Competence in the Delivery of Healthcare Services," is a model of cultural competence that defines cultural competence as "the process in which the healthcare professional continually strives to achieve the ability and availability to effectively work within the cultural context of a client" (family, individual or community). It is a process of becoming culturally competent, not being culturally competent,. This model of cultural competence views cultural awareness, cultural knowledge, cultural skill, cultural encounters and cultural desire as the five constructs of cultural competence. Cultural awareness is defined as the process of conducting a self-examination of one’s own biases towards other cultures and the in-depth exploration of one’s cultural and professional background. Cultural awareness also involves being aware of the existence of documented racism and other "isms" in healthcare delivery. Cultural knowledge is defined as the process in which the healthcare professional seeks and obtains a sound information base regarding the worldviews of different cultural and ethnic groups as well as biological variations, diseases and health conditions and variations in drug metabolism found among ethnic groups (biocultural ecology). Cultural skill is the ability to conduct a cultural assessment to collect relevant cultural data regarding the client’s presenting problem as well as accurately conducting a culturally-based physical assessment. Cultural encounter is the process which encourages the healthcare professional to directly engage in face-to-face cultural interactions and other types of encounters with clients from culturally diverse backgrounds in order to modify existing beliefs about a cultural group and to prevent possible stereotyping. Cultural desire is the motivation of the healthcare professional to “want to” engage in the process of becoming culturally aware, culturally knowledgeable, culturally skillful and seeking cultural encounters; not the “have to.” Cultural desire is the spiritual and pivotal construct of cultural competence that provides the energy source and foundation for one’s journey towards cultural competence. Therefore, cultural competence can be depicted as a volcano, which symbolically represents that it is cultural desire which stimulates the process of cultural competence (see figure 3, below). When cultural desire erupts, it gives forth the desire to enter into the process of becoming culturally competent by genuinely seeking cultural encounters, obtaining cultural knowledge, conducting culturally-sensitive assessments and being humble to the process of cultural awareness.
Conclusion
As we begin, continue, or enhance our journey towards cultural competence, we must continuously address the following question, "Have I ASKED myself the right questions?" The below mnemonic "ASKED" represents the self-examination questions regarding one's awareness, skill, knowledge, encounters and desire.
"Cultural Competency in Healthcare Delivery:
Have I 'ASKED' Myself The Right Questions?"©
(Campinha-Bacote, 2002)
Awareness: Am I aware of my biases and prejudices towards other cultural groups, as well as racism and other "isms" in healthcare?
Skill: Do I have the skill of conducting a cultural assessment in a sensitive manner?
Knowledge: Am I knowledgeable about the worldviews of different cultural and ethnic groups, as well as knowledge in the field of biocultural ecology?
Encounters: Do I seek out face-to-face and other types of interactions with individuals who are different from myself?
Desire: Do I really "want to" become culturally competent?
©Copyrighted by Campinha-Bacote (2002);
not to be reprinted without permission
Although the above mnemonic can assist healthcare professionals in informally assessing their level of cultural competence, healthcare professionals may want to formally assess their level of cultural competence. For this purpose Dr. Campinha-Bacote developed the instrument, Inventory For Assessing The Process of Cultural Competence Among Healthcare Professionals - Revised (IAPCC-R), which is based on her model of cultural competence and has established reliability and validity. Please refer to this website's link on the IAPCC-R for more information about this instrument (link).
Figure 1
©Copyrighted by Campinha-Bacote (1991);
not to be reprinted without permission
Figure 2
©Copyrighted by Campinha-Bacote (1998);
not to be reprinted without permission
Figure 3
©Copyrighted by Campinha-Bacote (2002);
not to be reprinted without permission
*Duplication/Copying of Models: Transcultural C.A.R.E. Associates has a policy preventing unauthorized use of models.
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Last Updated: May, 2008