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By the year 2050, the Asian population is expected to increase from 3% to 11%, the Black population from 12% to 16%, and the Hispanic population from 9% to 21% (Norbeck, 1995). Health care providers and health care organizations are responding to these changing statistics. Several models of service care delivery have emerged to meet the challenges of providing health care to a multicultural world (Devore & Schlesinger, 1985; Green, 1982; Leininger, 1978; Lum, 1986; Purnell, 1998). Warren's (1999) "Cultural Competence: An Interlocking Paradigm" proposes a model of cultural competence that goes beyond practice issues and incorporates implications for education and research in cultural competence.
The Interlocking Paradigm of Cultural Competence is a model that uses specific theoretical, philosophical, process, and assessment factors to develop and implement cultural competence within areas of practice, as well as education and research (Warren, 1999). The five factors include nurse-client interaction, theory, philosophy, process, and assessment which are visually represented in a circular, interrelated, overlapping style. Warren (1999) uses the works of Peplau (1952), Leininger (1995), Nichols (1987), Purnell (1998), and Campinha-Bacote (1994) in describing the factors needed to develop and implement cultural competence. This article discusses the "process" factor of cultural competence by presenting a model of cultural competence that health care providers and health care organizations can use as a framework for developing and implementing culturally responsive health care services. This article also proposes an instrument, based on this model of cultural competence, that will assist in the measurement and evaluation of cultural competence among health care professionals.
A CULTUKALLY competent model of HEALTHCARE
In reviewing several training programs on cultural competence, Chrisman and Schultz (1997) noted there was an incomplete conceptualization regarding the nature of cultural competence. Chrisman and Schultz (1997) recommend
scholars develop consensus on the conceptualization of cultural competence and to create a variety of theoretical frameworks to concretely guide nursing actions (p. 77).
The Process of Cultural Competence in the Delivery of Healthcare Services (Campinha-Bacote, 1998a) is one conceptual model of cultural competence that can concretely guide nursing actions. This model is based on Campinha-Bacote's (1994) earlier model of cultural competence.
The Process of Cultural Competence in the Delivery of Healthcare Services (Campinha-Bacote, 1998a) model defines cultural competence as:
the process in which...