Page 129 - Cultural Competence in Health Education

Health Education Theoretical Models and Multicultural Populations 107

MODELS FOR ASSESSING CULTURAL COMPETENCE
The Purnell Model for Cultural Competence
The Purnell model for cultural competence provides a comprehensive, systematic, and
organized framework with specific questions and a format for learning and assessing

the concepts and characteristics of culture (see Figure 6.1 ) (Purnell & Paulanka, 2003;
Purnell, 2005). With this model, health professionals across disciplines and settings
can analyze the cultural data that will facilitate the development of culturally compe-
tent health promotion and illness and disease prevention programs.
The Purnell model for cultural competence is organized in a circle, with four outly-
ing rims representing the global society, the community, the family, and the person. The
interior part of the circle is divided into twelve pie - shaped sections representing cul-
tural domains and their concepts (Purnell & Paulanka, 2003; Purnell, 2005). In the cen-
ter of the model is an empty circle representing the unknown phenomena: the practices
and characteristics of the individual or group of interest. This circle will expand or con-
tract, depending on the individual user ’ s (in this case the health educator ’ s) level of cul-
tural competence. The model is based on several explicit assumptions and purposes. In
addition the Purnell model displays a jagged line that illustrates the nonlinear process
of acquiring cultural competence. Purnell (2005) explains that an individual progresses
from unconscious incompetence (not being aware of lacking knowledge about other
cultures), to conscious incompetence (being aware of lacking knowledge), to conscious
competence (learning and providing culturally appropriate interventions), and fi nally to
unconscious competence (automatically providing culturally competent services). Pur-

nell warns that it is difficult and potentially dangerous to work from unconscious com-
petence because differences among individuals exist in every racial and ethnic group.
Thus health educators must understand that cultural competence is a process and not an
end point.
As stated earlier, the outside rims, or macro aspect, of this model identify global
society, community, family, and person. In thinking about the global society, users of

this model consider world politics and communication, conflict and welfare, natural
disaster and famine, and international exchanges, among other things, and also the
expanding opportunity for people to travel around the world and interact with diverse
societies. World events are broadly disseminated through television, radio, the Inter-
net, and newsprint and thus affect all societies. As a result of such events, people are
forced to alter, consciously and unconsciously, their lifeways, worldviews, and accul-
turation patterns (Purnell & Paulanka, 2003; Purnell, 2005).
Community in this model is defined as a group of people having a common inter-

est or identity and living in specific vicinity. Community also includes physical, social,
and symbolic characteristics, such as mountains, economics, and history, that cause
people to connect with one another. For example, people may define their community

by their rural or urban environment or by social concepts such as politics and religion
or by symbolic characteristics such as art, music, and language. Family, in contrast, is

7/1/08 2:53:59 PM
c06.indd 107 7/1/08 2:53:59 PM
c06.indd 107