Pedersen (1988) in the area of multicultural development were combined to develop the constructs used in the model.
DEFINITION OF THE CONSTRUCTS OF THE MODEL
The major constructs of the model The Process of Cultural Competence in the Delivery of Healthcare Services are cul- tural awareness, cultural knowledge, cultural skill, cultural encounters, and cultural desire. To fully understand this model, each construct will be defined and discussed.
Cultural Awareness
Cultural awareness is the self-examination and in-depth exploration of one’s own cultural and professional back- ground. This process involves the recognition of one’s biases, prejudices, and assumptions about individuals who are differ- ent. Without being aware of the influence of one’s own cul- tural or professional values, there is risk that the health care provider may engage in cultural imposition. Cultural imposi- tion is the tendency of an individual to impose their beliefs, values, and patterns of behavior on another culture (Leininger, 1978).
Cultural Knowledge
Cultural knowledge is the process of seeking and obtain- ing a sound educational foundation about diverse cultural and ethnic groups. In obtaining this knowledge base, the health care provider must focus on the integration of three specific issues: health-related beliefs and cultural values, disease inci- dence and prevalence, and treatment efficacy (Lavizzo- Mourey, 1996). Obtaining cultural knowledge about the cli- ent’s health-related beliefs and values involves understanding their worldview. The client’s worldview will explain how he/ she interprets his/her illness and how it guides his thinking, doing, and being.
Disease incidence and prevalence among ethnic groups is the second issue the health care provider must address when obtaining cultural knowledge. This requires obtaining knowl- edge concerning the field of biocultural ecology. Disease incidence varies among ethnic populations, and health care providers who do not have accurate epidemiological data to guide decisions about treatment, health education, screening, and treatment programs will not be able to positively impact on health care outcomes. Treatment efficacy is the third issue to address in the process of obtaining cultural knowledge. This involves obtaining knowledge in such areas as ethnic pharmacology. Ethnic pharmacology is the study of varia- tions in drug metabolism among ethnic groups. In obtaining cultural knowledge, it is critical to remember that no individ- ual is a stereotype of one’s culture of origin but rather a unique blend of the diversity found within each culture, a unique accumulation of life experiences, and the process of accultur- ation to other cultures. Therefore, the health care provider
must develop the ability to conduct a cultural assessment with each client.
Cultural Skill
Cultural skill is the ability to collect relevant cultural data regarding the client’s presenting problem as well as accu- rately performing a culturally based physical assessment. This process involves learning how to conduct cultural assessments and culturally based physical assessments. Leininger (1978) defined a cultural assessment as a “system- atic appraisal or examination of individuals, groups, and communities as to their cultural beliefs, values, and practices to determine explicit needs and intervention practices within the context of the people being served” (pp. 85-86). Cultural skill is also required when performing a physical assessment on ethnically diverse clients. The health care provider should know how a client’s physical, biological, and physiological variations influence her ability to conduct an accurate and appropriate physical evaluation. Examples include differ- ences in body structure, skin color, visible physical character- istics, and laboratory variances.
Cultural Encounters
Cultural encounter is the process that encourages the health care provider to directly engage in cross-cultural inter- actions with clients from culturally diverse backgrounds. Directly interacting with clients from diverse cultural groups will refine or modify one’s existing beliefs about a cultural group and will prevent possible stereotyping that may have occurred. However, health care providers must be aware that interacting with just three or four members of a specific eth- nic group will not make them an expert on this cultural group. It is possible that these three or four individuals may or may not represent the stated beliefs, values, or practices of the spe- cific cultural group encountered by the health care provider. This is due to intra-ethnic variation, which means that there is more variation within a cultural group than across cultural groups.
Cultural encounters also involve an assessment of the cli- ent’s linguistic needs. Using a formally trained interpreter may be necessary to facilitate communication during the interview process. The use of untrained interpreters, friends, or family members may pose a problem due to their lack of knowledge regarding medical terminology and disease enti- ties. This lack of knowledge can lead to faulty and inaccurate data collection.
Cultural Desire
Cultural desire is the motivation of the health care provider to want to, rather than have to, engage in the process of becoming culturally aware, culturally knowledgeable, cultur- ally skillful, and familiar with cultural encounters. Cultural desire involves the concept of caring. It has been said that