Page 69 - Cultural Competence in Health Education

Cultural Competence and Health Education 47

the dimensions of cultural competence are more than a list of descriptors; rather, they
represent the interaction and integration of an individual ’ s or group ’ s health beliefs, val-
ues, preferences, and practices with knowledge of the race and ethnic group. Likewise,
from a universal perspective, the dimensions of cultural competence are more than a list
of elements of the health service system. From this expansive perspective they represent
an organizational, structural, and clinical framework that entails an understanding of the
importance of social and cultural infl uences on clients ’ health beliefs and behaviors and
the integration and interaction of these factors with those who provide the product, ser-
vice, or health education. Dumas, Rollock, Prinz, Hops, and Blechman (1999) argue that
all such dimensions are legitimate aspects of cultural competence, but also advocate the
reorganization of the dimensions into a unified concept that provides a useful sense of

direction for practice, education and training, and research. A look at selected models,
frameworks, and constructs provides a structural view of how the many dimensions can
be reorganized.

Models, Frameworks, and Constructs
Although models, frameworks, and constructs provide guidance and direction in
explaining complex and abstract ideas, understanding cultural competence is a challenge

magnified by that competence ’ s own diversity. Cultural competence draws from the
knowledge base of many disciplines in an attempt to establish a theoretical orientation
for translating the many sociodemographic variables of a given group. Addressing the
ways the term multiculturalism obscures the reality that race and culture present many
different aspects, Helms and Richardson (1997) suggest a philosophical theoretical con-
struct that is responsive to the dynamics of diverse demographic groups. They also
acknowledge that a philosophical approach allows a focus on the strengths, competen-
cies, and skills of a demographic group, rather than an emphasis on group defi ciencies
and a group ’ s need for remediation based on a standard of the majority group.
The multiple dimensions of cultural competence (MDCC) model proposed by Sue
(2001) is both comprehensive and inclusive. This three - dimensional model addresses
the attributes of competence from a race - and culture - specific dimension; focuses on

culture at individual, professional, organizational, and societal levels; and builds
on knowledge, awareness of attitudes and beliefs, and skills as the components of cul-
tural competence. The model is expansive because each of its elements involves a con-

fluence of these three major dimensions.
The MDCC model ’ s three - dimensional concept can be helpful to health profes-
sionals in defining cultural competence. There are three points of interest here. First,

the model moves the defi nition of cultural competence beyond mere racial identifi ca-
tion and allows a comfortable dialogue in order to address cultural competence with
multicultural understanding and sensitivity. This comprehensive and inclusive approach
is one of the model ’ s strengths. Further, the MDCC model allows analysis to focus
on the individual (a single or micro unit of measure) or on other units all the way up
to the full society (a composite or macro unit of measure). In this way the model

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