The Process of Cultural Competemility in the
Delivery of Healthcare Services

The Process of Cultural Competemility in the Delivery of Healthcare Services” model proposes that cultural humility and cultural competence enter into a synergetic relationship, resulting in a combined effect that is greater than the sum of their separate effects.  This synergistic relationship is embodied in the term, “cultural competemility.”  The origin of cultural competemility is the deliberate blending of the terms cultural competence (compete) and cultural humility (mility) to create the coined term cultural competemility.  Cultural competemility is defined as the synergistic process between cultural humility and cultural competence in which cultural humility permeates the five components of cultural competence: cultural awareness, cultural knowledge, cultural skill, cultural desire, and cultural encounters.  Paradoxically, cultural competemility is simultaneously both the process of becoming and the process of being.  Healthcare professionals must engage in the process of becoming culturally competent while synchronously being engaged in the process of cultural humility.

Cultural humility is defined as a dynamic and lifelong process focusing on self-reflection and personal critique (Tervalon and Murray-Garcia, 1998). 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 educational base about culturally diverse groups. In acquiring this knowledge, healthcare professionals must focus on the integration of three specific issues: health-related beliefs practices and cultural values; disease incidence and prevalence (Lavizzo-Mourey, 1996). Cultural skill is the ability to collect culturally relevant data regarding the patient's presenting problem, as well as accurately performing a culturally-based physical, spiritual, psychological, and medication assessments in a culturally sensitive manner.  Cultural encounters 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 encounters is the pivotal construct of cultural competence that provides the energy source and foundation for one’s journey towards cultural competence. 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.”

In summary, the Process of Cultural Competemility in the Delivery of Healthcare Services model views cultural humility, cultural awareness, cultural knowledge, cultural skill, cultural encounters and cultural desire as the essential components of cultural competemility with cultural encounters being the pivotal construct of this model.  This model begins and ends with the seeking and experiencing of many cultural encounters.  It is only through the infusion of cultural humility into continuous cultural encounters that one acquires cultural awareness, cultural knowledge, cultural skill and cultural desire.  From this perspective, cultural competemility can be viewed as an ongoing journey of unremitting encounters.

As we begin, continue, or enhance our journey towards cultural competemility, 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. Although the below 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 instruments, Inventory For Assessing The Process of Cultural Competence Among Healthcare Professionals – Revised (IAPCC-R) and Inventory For Assessing The Process of Cultural Competence Among Healthcare Professionals – Student Version (IAPCC-SV), which are based on her model of cultural competence and have established reliability and validity. Please refer to the website links on the IAPCC-R (link) and IAPCC-SV (link) for more information and psychometric properties regarding these instruments.

Background Development of the Model (1991-2018)

The following comments reflect the development of Campinha-Bacote’s model, The Process of Cultural Competemility in the Delivery of Healthcare Services. For more detailed information about the model refer to the publication, The Process of Cultural Competemility in the Delivery of Healthcare Services: Unremitting Encounters, 6th edition (2020) 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 https://transculturalcare.com/order-form/. Please note that all graphic/pictorial/ mnemonic figures displayed on the bottom of this web page are copyrighted and cannot be reprinted without formal written permission from Transcultural C.A.R.E. Associates. Thank you for your understanding of the intellectual property and legal copyright status of these models.

1991 - The development of my current model of cultural competemility has been an ongoing process of almost 30 years. This process began in 1991 when I conceptualized and named the model, “Culturally Competent Model Of Care.” In this first version, I identified four constructs of cultural competence: cultural awareness, cultural knowledge, cultural skill, and cultural encounters (figure 1, below).

1998 - In 1998 I revised my initial conceptualization of the model for the constructs were very limited in scope and needed to be expanded to include new knowledge in the field of transcultural health care, and the pictorial representation of this model appeared linear. The first version of the model did not clearly depict cultural competence as a “process” and the pictorial representation did not express the interdependent relationship between the constructs. I also felt that cultural competence was more than just awareness, knowledge, skill and encounters. Therefore, in the second revision I added a fifth construct called cultural desire, modified the pictorial representation of the model as a Venn diagram 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,” to reinforce that it was a process.

2002 - In 2002, the key role that cultural desire played in the process of becoming culturally competence became evident, yielding further revision of the model’s pictorial representation. I enhanced the model to symbolically represent a volcano. In this pictorial revision, cultural desire was identified as the construct that ignited the process of becoming culturally competent. (figure 3, below).

2010 - In 2010, I began collecting evidenced-based research studies using my model and tool (IAPCC-R), and discovered that the pivotal and key construct in the process of becoming culturally competent was cultural encounters. With this added research-base knowledge I amended the pictorial representation to focus and center around the construct of cultural encounter (figure 4 below). This model begins and ends with the seeking and experiencing of many cultural encounters and it is only through continuous cultural encounters that one acquires cultural awareness, cultural knowledge, cultural skill and cultural desire.

2018 - In 2018, the final revision of The Process of Cultural Competence in the Delivery of Healthcare Services model  (figure 5 below) involved three changes: 1) the infusion of cultural humility into the five constructs of cultural competence; 2) a linguistic change from the term cultural competence to the term cultural competemility; and 3) the model’s name change to,“The Process of Cultural Competemility in the Delivery of Healthcare Services”.  These revisions were based on concepts of my model, “A Biblically Based Model of Cultural Competence in the Delivery of Healthcare Services” as well as the ongoing debates centering around the relationship between the concepts of cultural competence and cultural humility.

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

Figure 4

©Copyrighted by Campinha-Bacote (2010); not to be reprinted without permission

Figure 5

The Process of Cultural Competemility in the Delivery of Healthcare Services
©Copyrighted by Campinha-Bacote (2018); not to be reprinted without permission