Cultural Competence as a Process
There is widespread agreement within the literature that the development of cultural competence is a continuous process, not a single event. As Campinha-Bacote (2005:1) notes: 'Competence is a process, not an event; a journey, not a destination; dynamic, not static; and involves the paradox of knowing'.
Marcia Wells (2000:192) developed a model based on Cross et al.'s (1989) conception of cultural competence as a continuum. Her model places the elements of cultural competence (knowledge, attitudes and skills) in a developmental framework with the following sequence of stages along a continuum from cultural incompetence to cultural proficiency:
- Cultural incompetence: Lack of knowledge of the cultural implications of health behaviour
- Cultural knowledge: Learning the elements of culture and their role in shaping and defining health behaviour
- Cultural awareness: Recognizing and understanding the cultural implications of behaviour
- Cultural sensitivity: The integration of cultural knowledge and awareness into individual and institutional behaviour
- Cultural competence: The routine application of culturally appropriate health care interventions and practices.
- Cultural proficiency: The integration of cultural competence into one's repertoire for scholarship (e.g., practice, teaching, and research). At the organizational level, cultural proficiency is an extension of cultural competence into the organizational culture. For the individual and the institution, it is mastery of the [five preceding] phases of cultural competence development."