Introduction
In the medical setting, the provision of health care should be guided by evidence and properly developed theoretical approaches that yield consistency and quality assurance in patient care. The use of theories and models in the health care setting allows for a thorough standardization of the procedures and interventions, as well as the unification of the decision-making processes. Moreover, the use of newly developed models allows for improving the quality of medical services, patients’ experiences, and the overall health status of the population. In particular, each theory is aimed at solving a problem or issue that has a major impact on patient experiences or outcomes in both short- and long-term perspectives. This paper is aimed at exploring the theoretical premises of Campinha-Bacote’s Model of cultural competence and the development of the conceptual framework for the theory. It is claimed that with the adequate conceptualization of the elements of the theoretical premise, the core cultural concepts, including awareness, knowledge, encounter, skill, and desire, form a system capable of guiding the health care delivery system.
Theoretical Premises of Campinha-Bacote’s Framework of Cultural Competence
There are multiple theories that approach health care delivery from a variety of angles. Within the context of the contemporary trends of globalization in all spheres of human life, societies have become more diverse. It poses a challenge for health care providers who struggle to follow the principles of justice through providing equal quality of care to all patients. To succeed in such an endeavor, a professional in the health care field is expected to have cultural sensitivity and competence to address individuals’ needs depending on their cultural background (Sharifi et al., 2019). For that matter, Campinha-Bacote’s Model of cultural competence is essential in equipping healthcare professionals with necessary theoretical and practical guidelines on how to develop and apply cultural competence in the healthcare setting.
Overall, the term cultural competence might be defined in many ways depending on the approach and context. However, one of the most accurate definitions holds that cultural competence is “a set of congruent behaviors, attitudes, policies, and structures that enable an individual to effectively work in cross cultural situations” (Wall-Bassett et al., 2018, p. 275). Thus, the definition implies that this phenomenon is multifaceted and complex since it integrates a system of spheres that regulate and influence it. Indeed, as stated by Sharifi et al. (2019), cultural competence is “affected by the immediate financial, political, social, historical, and cultural context” (p. 1). The complexity of the issue is thoroughly and structurally addressed in Campinha-Bacote’s Model. It is valid to specify that the original title of the model is the Process of Cultural Competence in the Delivery of Healthcare Services (Campinha-Bacote, 2002). Such a title informs about the implementation of the model in the process of the interaction between patients and providers when distributing medical services.
Essentially, the model deals with two core concepts, culture, and competence, which require clarification for further discussion of the framework. According to Sharifi et al. (2019), culture is a set of beliefs, social norms, and features of everyday life that are typical for a group of people at the same time and the same place. As for competence, it is a state of being competent or expert in a field of knowledge (Sharifi et al., 2019). However, the framework revolves around these main categories to explore the structure of cultural competence. The theoretical premises of the model hold that there are five essential concepts in the theory of cultural competence. They include cultural awareness, cultural knowledge, cultural skill, cultural encounters, and cultural desire (Campinha-Bacote, 2002). According to the author of the model, the above-mentioned concepts are the basic constructs that are intertwined and combined in a multicultural environment and should be reviewed in the connection between one another (Campinha-Bacote, 2002). The conceptual framework for the model is covered in the next section of the report.
Conceptual Framework
The theory of cultural competency relevance in the medical settings might be represented through the conceptual framework, incorporating key concepts and their relationships with each other. Given the complexity of the model and the integration of multiple structural components in it, it is relevant to review each of them in separation from others first. After that, the concepts should be presented in the form of a visual, conceptual framework that would demonstrate how the concepts are incorporated into one system. The definitions and explanations of each of the five concepts are presented in Table 1.
Table 1. Concepts of the Model of Cultural Competence in the Delivery of Healthcare Services
As the information presented in Table 1 demonstrates, each of the concepts has its own meaning and contribution to the overall model of a culturally competent health care service delivery. Firstly, the concept of cultural awareness implies that an individual reflects on one’s own “cultural and professional background” in order to recognize it in others (Wall-Bassett et al., 2018, p. 277). Without awareness, a health care professional is incapable of providing culturally sensitive services. Secondly, cultural knowledge requires learning about cultures throughout one’s practice (Campinha-Bacote, 2002; Wall-Bassett et al., 2018). Thirdly, cultural skill implies “conducting an assessment of cultural data of the patient” to provide relevant care with respect to their values (Wall-Bassett et al., 2018, p. 277). Fourthly, cultural encounters are the interactions, conversations, and meetings with patients who represent different cultural backgrounds. Finally, cultural desire stands for the “process of wanting to be more culturally competent” (Wall-Bassett et al., 2018, p. 278). Thus, each of the concepts is pivotal in the process of delivery of culturally competent health care.
The existence and meticulous definition of each of the concepts is essential in understanding their place in the overall framework of cultural competence since, without even one of the elements, the model would be incomplete. The model is both concise and thorough, with each element in its place and performing its connecting role with other elements (Sharifi et al., 2019). The intertwined relationships between the elements of the framework are visually represented in Figure 1. Each circle represents one of the concepts; their overlapping demonstrates their impact of them on one another and on the overall process of cultural competence, which is at the center of the model.
As shown in Figure 1, all five circles representing the constructs of the model are overlapping, meaning that there is a five-fold connection between them, forming a complete cultural competence system. The interplay between the codependent elements implies that “no matter when the health care provider enters into the process, all five constructs must be addressed and/or experienced” (Campinha-Bacote, 2002, p. 183). Such a close connection in the relationships means that any deterioration or improvement in any of the concepts will lead to consecutive change in the rest of the elements of the system. For example, if a health care provider seeks to improve their cultural knowledge, it will inevitably improve their skill, awareness, encounters, and desire, ultimately raising the level of cultural competence. The larger are the circles, the larger is the areas of their intersection in the center, meaning that each concept’s enhancement contributes to the competence in the long-term perspective (Campinha-Bacote, 2002). Thus, the framework is complete and demonstrative of the importance of constructs in the overall system.
The framework has significant importance to the health care delivery setting due to its support of the necessity for the continuous investment of knowledge and skill into building a culturally competent medical field. Nurses and physicians, as well as other personnel in the health care environment, are encouraged to review and apply the Model of Cultural Competence in the Delivery of Healthcare Services to increase the level of their cultural competence by developing their cultural skills, cultural awareness, cultural knowledge, cultural encounters, and cultural desire. Such a path will allow for eliminating inequalities in the field of health care and strive for a system where justice and patient benefits prevail.
Conclusion
In summation, the examination of Campinha-Bacote’s framework has demonstrated that the use of cultural competency is essential for the health care setting and medical service delivery. It allows for prioritizing patient outcomes and experiences through the techniques that help meet patient needs in relation to their cultural background. The developed conceptual framework shows the interdependence between the elements of the model. In particular, the increase in either cultural awareness, cultural knowledge, cultural skill, cultural encounters, or cultural desire will ultimately increase the level of cultural competence. As the result, the development in this area will make the sphere of health care delivery a more just and quality-oriented system.
References
Campinha-Bacote, J. (2002). The process of cultural competence in the delivery of healthcare services: A model of care. Journal of Transcultural Nursing, 13(3), 181–184
Sharifi, N., Adib-Hajbaghery, M., & Najafi, M. (2019). Cultural competence in nursing: A concept analysis. International Journal of Nursing Studies, 99(103386), 1-8.
Wall-Bassett, E. D., Hegde, A. V., Craft, K., & Oberlin, A. L. (2018). Using Campinha-Bacote’s Framework to examine cultural competence from an interdisciplinary, international service learning program. Journal of International Students, 8(1), 274-283.