Full Answer Section

• Madeleine Leininger (1970s-1980s): A nurse theorist, Leininger developed the “Transcultural Nursing” theory, which, while not using the exact term “cultural competence,” laid foundational groundwork by emphasizing the importance of understanding cultural beliefs, values, and practices in providing nursing care. Her work highlighted the need for culturally congruent care.
• African-American psychologists and social workers: Many scholars and practitioners from marginalized groups were advocating for culturally relevant approaches to address the historical inadequacy and cultural insensitivity of mainstream services for ethnic minorities.

The term arose from a recognition that simply being “culturally aware” or “sensitive” was insufficient; practitioners and systems needed to develop concrete skills and capacities to effectively serve diverse populations. It was a call for a more active, measurable, and systemic approach to diversity in professional practice.

2. What are the alternative definitions?

The definition of cultural competence has evolved and been debated, leading to several alternative or nuanced interpretations. Some key alternatives include:

• Early/Basic Definitions (Focus on knowledge and skills): These often defined cultural competence as “a set of congruent behaviors, attitudes, and policies that come together in a system, agency, or among professionals and enable that system, agency, or those professionals to work effectively in cross-cultural situations” (Cross et al., 1989). This definition emphasized acquisition of knowledge and specific skills.
• Emphasis on Specific Groups: Some definitions narrowly focused on competence with specific racial or ethnic groups, rather than a broader understanding of culture.
• Critiques Leading to Broader Concepts: Critics argued that “competence” implies a finite endpoint, a mastery that can be achieved, which is problematic given the vastness and fluidity of culture. This led to alternative or expanded concepts:
  • Cultural Humility: Introduced by Melanie Tervalon and Jann Murray-Garcia (1998), this concept emphasizes a lifelong commitment to self-reflection and critique, recognizing power imbalances, and developing mutually beneficial partnerships with communities. It prioritizes openness, respect, and a continuous learning process over a fixed state of “competence.”
  • Cultural Responsiveness/Proficiency: These terms are often used interchangeably with cultural competence but can sometimes imply a more active, dynamic, and adaptable engagement with diverse cultural contexts, rather than a static skill set. “Responsiveness” emphasizes the ability to adapt to the needs of diverse individuals and communities.
  • Intercultural Competence: This term, often used in education and international relations, tends to focus more broadly on effective and appropriate interaction and communication across various cultural differences, moving beyond just ethnic or racial groups to include differences in gender, class, sexual orientation, disability, etc.

3. What is the preferred definition and why?

While “cultural competence” remains widely used, the preferred understanding in modern cross-cultural education and counseling increasingly leans towards a dynamic, ongoing process that incorporates elements of both cultural competence and cultural humility, often emphasizing the latter’s philosophical stance.

My preferred definition, incorporating this evolution, is:

“Cultural competence is a dynamic, ongoing developmental process by which individuals and organizations acquire and integrate knowledge, awareness, and skills to effectively respond to the unique needs of diverse populations. It is underpinned by a commitment to cultural humility—a lifelong process of critical self-reflection, an openness to learning from others, a recognition of power imbalances, and the willingness to redress them, thereby fostering respectful and effective cross-cultural engagement and practice.“

Why this is preferred:

• Process, Not Endpoint: It explicitly defines cultural competence as an “ongoing developmental process,” addressing the critique that “competence” implies a fixed mastery. This acknowledges the fluid and multifaceted nature of culture and the continuous learning required.
• Integration of Knowledge, Awareness, and Skills: It retains the essential components of traditional definitions (knowledge, awareness, skills) as crucial elements for effective practice.
• Incorporation of Cultural Humility: By stating it is “underpinned by a commitment to cultural humility,” it integrates the crucial attitudinal and ethical stance that addresses power dynamics, self-reflection, and continuous learning. This moves beyond mere skill acquisition to a deeper ethical framework for interaction.
• Focus on Effective Response: It emphasizes the practical outcome – “to effectively respond to the unique needs” – highlighting the goal of equitable and high-quality service delivery.
• Applicability to Individuals and Organizations: It acknowledges that cultural competence is a responsibility of both individual practitioners and the systems within which they operate.

This definition provides a comprehensive and nuanced understanding, capturing the historical intent of the term while integrating critical advancements in thinking that emphasize continuous learning, ethical engagement, and systemic change.

4. What one or two primary sources can one go to find out more about the term?

1. Cross, T. L., Bazron, B. J., Dennis, K., & Isaacs, M. R. (1989). Towards a Culturally Competent System of Care (Vol. 1). Georgetown University Child Development Center, CASSP Technical Assistance Center.

   • Why: This is the foundational text that introduced one of the most influential early frameworks for cultural competence. It provides the initial definition and practical framework that shaped much of the subsequent discussion and development in the field. It’s essential for understanding the origins and initial conceptualization.

2. Tervalon, M., & Murray-Garcia, J. (1998). Cultural humility versus cultural competence: A critical distinction in defining physician training outcomes in multicultural education. Journal of Health Care for the Poor and Underserved, 9(2), 117-125.

   • Why: This article is pivotal for introducing the concept of “cultural humility” and directly contrasting it with “cultural competence.” It highlights the limitations of solely focusing on “competence” and advocates for a continuous, self-reflective, and power-aware approach. This piece is crucial for understanding the evolution of the term and the ongoing debate and refinement of best practices in cross-cultural engagement.