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Cultural Competemility: A Paradigm

Shift in the Cultural Competence
versus Cultural Humility Debate –
Part I

Josepha Campinha-Bacote, PhD, MAR, PMHCNS-BC, CTN-A, FAAN

Abstract

For over 30 decades, cultural competence has commanded significant attention, being viewed as the
cornerstone of fostering cross-cultural communication, reducing health disparities, improving access
to better care, increasing health literacy and promoting health equity. However, a medley of
definitions and conceptualizations has created intense debate, questioning its true ability to address
cross-cultural problems in healthcare delivery. One ongoing debate centers around the relationship
between cultural competence and cultural humility. Part I of this two-part series on cultural
competemility will revisit this debate by discussing competing views of this relationship. A new
paradigm of thought regarding the relationship between cultural competence and cultural humility
will be proposed, one necessitating that cultural humility and cultural competence enter into a
synergistic relationship. This synergistic relationship is embodied in a term coined "cultural
competemility.” This article presents the debate regarding cultural competence verses cultural
humility, defines the term cultural competemility, explains the relationship between cultural humility
and cultural competence, describes the process of permeation and concludes by proposing a
synergistic relationship between cultural competence and cultural humility to create the process of
cultural competemility. Part II of this series will apply an intersectionality approach to the process of
cultural competemility and offer strategies for nurses to actively challenge and address inequalities.

Citation: Campinha-Bacote, J., (December 4, 2018) "Cultural Competemility: A Paradigm Shift in the Cultural
Competence versus Cultural Humility Debate – Part I" OJIN: The Online Journal of Issues in Nursing Vol. 24, No. 1.

DOI: 10.3912/OJIN.Vol24No01PPT20

Key Words: Cultural competence, cultural diversity, ethnically diverse, cultural humility, transcultural healthcare,
transcultural nursing, healthcare equity, healthcare disparities, social justice, cultural awareness, cultural
knowledge, cultural skill, cultural encounters, cultural desire, cultural competemility

For over 30 decades, cultural competence has commanded significant attention

and has become ubiquitous in human services' language and settings (Danso,
2016; Gallegos, Tindall, & Gallegos, 2008). Cultural competence has a history of The notion of
being viewed as the cornerstone of fostering cross-cultural communication, cultural competence
reducing health disparities, improving access to better care, increasing health is rooted in the
literacy and promoting health equity (Powell, 2016; Wong, LaVeist, & Sharfstein, social and political
2015; Yancu & Farmer, 2017). The notion of cultural competence is rooted in the climate of the
social and political climate of the 1960s and 1970s, where civil rights movements 1960s and 1970s...
demanded respect for cultural diversity and attention to racial and ethnic
inequalities in society (Chiarenza, 2012).

The concept first appeared in the social work literature and was referred to as ‘ethnic competence’ (Gallegos,
Tindall, & Gallegos, 2008). Chiarenza (2012) has asserted that existing concepts of cultural competence share two
basic assumptions, namely that cultural competence is a necessary and sufficient condition for working effectively
with differences, and that cultural competence can be taught, learned, trained, and achieved. He added that the
underlying assumption of this approach is that the greater the knowledge about another culture, the greater the
competence in practice.

A medley of definitions and conceptualizations has created intense discussion around the construct of cultural

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competence, questioning its true ability to address cross-cultural problems in

healthcare delivery (Danso, 2016; Harrison & Turner, 2010). One ongoing debate
A medley of centers around the relationship between cultural competence and cultural humility,
definitions and a term coined by Melanie Tervalon and Jann Murray-Garcia in 1998 (Tervalon &
conceptualizations Murray-Garcia, 1998). This article will revisit this debate and discuss the
has created intense competing views, maintaining that cultural competence should be either redefined,
discussion around replaced, augmented, and/or distinguished from cultural humility. The purpose of
the construct of this article is to introduce a new paradigm of thought regarding the relationship
cultural between cultural competence and cultural humility, one that will address the
competence... limitations of previous competing views and have a positive impact on the delivery
of culturally conscious healthcare services and experiences to the patient, the
family, and the community.

The Debate

Those opposing the concept of cultural competence assert that it is an endpoint and assumes that nurses and
other healthcare professionals (HCPs) can learn a quantifiable set of attitudes and skills that will allow them to
work effectively within the cultural context of the patient (Prasad et al., 2016). Other criticisms of cultural
competence include its strong focus on knowledge acquisition; a lack of social justice issues; its understanding as
a technical and communication technique; its potential to stereotype cultural groups; and its use of the concept of
culture as merely a substitution for minority racial/ethnic group identity. This discussion has led for calls to replace
cultural competence with the concept of cultural humility (Fisher-Borne, Cain & Martin, 2015; Tervalon & Murray-
Garcia, 1998).

Cultural humility is often seen as an alternative approach to cultural competence.

Cultural humility (Tervalon & Murray-Garcia, 1998) is a dynamic and lifelong
process focusing on self-reflection and personal critique. These authors call for Cultural humility is
healthcare professionals (HCPs) to clearly differentiate cultural humility from often seen as an
cultural competence. The literature reveals many articles that differentiate cultural alternative
humility from cultural competence. Specifically, cultural humility requires less approach to cultural
emphasis on knowledge and competency; places a greater emphasis on a life-long competence.
commitment; encourages nurturing of self-evaluation and critique; addresses
power imbalances; promotes interpersonal sensitivity; requires an attitude of
openness and egolessness; involves supportive interaction; entails maintaining an
interpersonal stance that is other-oriented; necessitates learning from differences (Foronda, Baptiste, Reinhold, &
Ousman, 2016; Hook, Davis, Owen, Worthington, & Utsey, 2013; Isaacson, 2014; Shaw, 2016; Tervalon & Murray-
Garcia, 1998). However, in a critical reflection on cultural competence and cultural humility, Danso (2016) offered
critiques about cultural humility replacing cultural competence. His analysis suggested that semantic appeal does
not necessarily give cultural humility a useful edge over the construct it seeks to displace and appears not to add
more value to practice than cultural competence.

In lieu of replacing the concept of cultural competence with cultural humility, other authors have taken the position
that cultural competence and cultural humility must be viewed as being in apposition (i.e., side-by-side), rather
than in opposition, of each other (Alsharif, 2012; Ortega & Faller, 2011; Yancu & Farmer, 2017). Yancu and Farmer
(2017) maintained that cultural humility may complement, rather than replace, cultural competence. These
authors added that if HCPs desire to interact effectively with a culturally diverse population, they need both
process (cultural humility) and product (cultural competence).

Still other authors suggest a redefinition of cultural competence (Chiarenza, 2012; Koehn & Swick, 2006).
Chiarenza urged HCPs to modify the way the concept of culture is used in healthcare to include not only ethnicity
and race, but also intersections of ethnicity, race, gender, age, class, education, religion, sexual orientation, and
physical ability, along with the unequal distribution of power and the existence of social inequities. Furthermore,
Koehn and Swick (2016) proposed to redefine cultural competence by expanding it to include a transnational
perspective. This broadens the scope of cultural competence by offering five skill domains. These domains are
derived from the fields of international relations, specifically, cross-cultural psychology, and intercultural
communication, namely analytic, emotional, creative, communicative, and functional.

A paradigm shift that challenges the aforementioned literature and suggests that cultural competence be
redefined, replaced with cultural humility, or viewed in apposition to cultural humility, must be explored in an
attempt to foster more effective cross-cultural communication, reduce health disparities, improve access to quality
care, increase health literacy and promote health equity. This shift necessitates that cultural humility and cultural
competence enter into a synergistic relationship, resulting in a combined effect greater than the sum of their
separate effects.

I have coined the term 'cultural competemility' to describe this synergistic

relationship. The origin of cultural competemility is the deliberate blending of the
The origin of cultural terms cultural competence (compete) and cultural humility (mility). It is my
assertion that the coined term 'cultural competemility' has the potential to

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competemility is the contribute to positively impacting the delivery of culturally conscious healthcare
deliberate blending services and experiences to all patients, families, and the community.
of the terms
cultural competence Defining Cultural Competemility
(compete) and
cultural humility
(mility).

Cultural competemility is a conceptual framework that I have derived from two models of cultural competence:
The Process of Cultural Competence in the Delivery of Healthcare Services (Campinha-Bacote, 2011), and A
Biblically Based Model of Cultural Competence in the Delivery of Healthcare Services (Campinha-Bacote, 2013).
The process model of cultural competence views cultural awareness, cultural knowledge, cultural skill, cultural
encounters, and cultural desire as the five constructs of cultural competence. In this model, 'cultural encounters’ is
the pivotal construct of cultural competence that provides the energy source and foundation for one’s journey
towards cultural competence.

The biblically based model (Campinha-Bacote, 2013) of cultural competence in the delivery of healthcare services
adds biblical components, such as humility, compassion, social justice, Imago Dei (image of God), and
teachableness in defining the process of cultural competence. Specifically, this model views the process of cultural
competence as the interdependent relationship among the following six constructs of cultural competence: imago
Dei, cultural desire, cultural awareness, cultural knowledge, cultural skill and cultural encounters. The model also
integrates specific intellectual and moral virtues: love, caring, social justice, humility, love of truth, teachableness,
intellectual honesty, wisdom, discernment, prudence, attentiveness, studiousness, practical wisdom,
understanding, temperance, patience, and compassion into these six constructs. These two frameworks provide
the foundation for the synergistic process between cultural humility and cultural competence.

Cultural competemility is defined as the synergistic process between cultural

humility and cultural competence in which cultural humility permeates each of the
five components of cultural competence: cultural awareness, cultural knowledge, Cultural
cultural skill, cultural desire, and cultural encounters. From this perspective, competemility is
cultural competemility can be viewed as simultaneously being both a process of defined as the
becoming and the process of being. Individuals must engage in the process of synergistic process
becoming culturally competent while synchronously being engaged in the process between cultural
of cultural humility. Cultural competemility requires HCPs to maintain both an humility and cultural
attitude and a lens of cultural competence and cultural humility as they engage in competence in
cultural encounters, obtain cultural knowledge, demonstrate the cultural skill of which cultural
conducting a culturally sensitive cultural assessment, and become culturally aware humility permeates
of both their own biases and the presence of “isms” (e.g., racism, sexism, each of the five
ableism, classism, ageism, anti-Semitism, heterosexism, colorism, components of
ethnocentrism). cultural
competence...

To fully comprehend the concept of cultural competemility, HCPs must reframe

previous extant views of cultural competence and cultural humility. This reframing
To fully comprehend process necessitates that they step back from what is being said and done in this
the concept of field of study and consider the alternative lens of a synergistic relationship by
cultural which cultural competence and cultural humility become the process of cultural
competemility, competemility.
HCPs must reframe
previous extant
views of cultural
competence and
cultural humility.

As HCPs enter into the process, it is necessary to reframe the concept of humility. While the literature suggests
that HCPs operate from a demeanor of humility, there is said to be a paradox in possessing humility. Scholars have
asserted that when we become aware of our humility and openly acknowledge it, we’ve lost it (Campinha-Bacote,
2013; Robinson & Alfano 2016). Furthermore, Robinson and Alfano (2016) maintain that humility is fraught with
contradiction because one cannot truthfully claim to be humble. Theses authors maintain that by consciously
striving to become humble, one might become less so, since humility supposedly is an asset that one can have
only by not paying attention to it. From this perspective it begs the question: “Is it possible to seek or learn
cultural humility?“ From a cultural competemility framework, it is conceivable.

Drawing from the field of theology, Ells (n.d.) and Campinha-Bacote (2013) argue that there are theological ways

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to humble oneself. Ells (n.d.) provides examples which include accepting a lowly
place; receiving correction and feedback from others graciously; choosing to serve
others; being quick to forgive; cultivating a grateful heart; purposely speaking ...by consciously
well of others; and acknowledging wrongdoings to others. Therefore, cultural striving to become
humility is an attitude of relating to patients; it has more to do with the HCPs' humble, one might
actions and the ends to which they are directed. As eloquently stated by author become less so,
Rick Warren (2012), “This is true humility: not thinking less of ourselves but since humility
thinking of ourselves less” (p. 265). supposedly is an
asset that one can
have only by not
paying attention to
it.

As HCPs enter into the process of cultural competemility, it is also necessary to

reframe the interpretations found in the literature regarding the meaning of
Reframing cultural cultural competence. Contrary to the existing literature, cultural competence does
competence as an not view competence as an endpoint or product; nor does it assume that nurses
ongoing process is and other healthcare professionals can learn a quantifiable set of attitudes and
critical in pursuing skills that will allow them to work effectively within the cultural context of the
cultural patient. Reframing cultural competence as an ongoing process is critical in
competemility. pursuing cultural competemility. Once the HCP has reframed traditional views on
competence and humility, it is important to understand the synergistic relationship
between these two concepts.

Synergistic Relationship Between Cultural Humility and Cultural Competence

The process of cultural competemility involves the total permeation of cultural humility into the five components of
cultural competence. The result of this permeation can be symbolically represented in a rotating ambigram. An
ambigram is a word, art form, or other symbolic representation whose elements retain meaning when viewed or
interpreted from a different direction, perspective, or orientation. Figure 1 displays an ambigram in which the word
competence, when flipped or rotated, spells the word humility (Figure 2). Thus, humility is found in competence
and competence is found is humility. To further illuminate the relationship between cultural humility and cultural
competence, the permeation and synergistic process of cultural humility into cultural competence will be
discussed.

Figure 1: Competence/Humility Ambigram

Figure 2. Humility/Competence Ambigram

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The total permeation of cultural humility into cultural awareness, cultural

encounters, cultural skill, cultural desire, and cultural knowledge can be viewed as
a process that exists along a continuum ranging from unconscious impermeability Unconscious
to unconscious permeability. Unconscious impermeability is being totally unaware impermeability is
that cultural humility is required during the process of becoming culturally aware being totally
and culturally knowledgeable, obtaining cultural skill and cultural desire, as well as unaware that
entering into cultural encounters. In this stage, the HCP is totally unaware and cultural humility is
unconcerned regarding the power imbalances that exist during the clinical required during the
encounters, or the social inequities that culturally and ethnically diverse patients process of
experience. becoming culturally
aware and culturally
knowledgeable...

In contrast, conscious impermeability is the awareness that cultural humility must be exhibited during the clinical
encounter; however, the HCP is unable to successfully display the cultural lens and demeanor of culturally humility.
Here, the HCP becomes keenly aware of the need for cultural humility by attending a workshop, reading an article
or book on the topic, or discussing the topic with colleagues, but is not able to grasp the concept of how to
personally demonstrate cultural humility. Conscious permeability, however, is the mindful act of learning how to
become culturally humble and to let this cultural lens pervade the entire cultural encounter with the patient.

Finally, unconscious permeability is the ability of the HCP to spontaneously

operate from a place of cultural humility when pursuing cultural awareness,
Conscious cultural knowledge, and obtaining cultural skill and cultural desire, as well as
permeability... is the entering into cultural encounters. In other words, the healthcare professional does
mindful act of not rely on specific rules to maintain a humble attitude, but rather has developed
learning how to an intuitive grasp of needed interactions and behaviors that demonstrate cultural
become culturally humility to the patient. From a continuum perspective, cultural competemility can
humble... be regarded as the ongoing process of moving from a position of unconscious
impermeability to unconscious permeability when cultural awareness, cultural
knowledge, cultural skill, cultural encounters, and cultural desire are being
pursued. Below, each of these five components of cultural competence will be
defined and strategies on how to allow cultural humility to permeate each component will be discussed.

The Process of Permeation

Cultural awareness involves the process of conducting a self-examination and

critical reflection of one’s own biases towards other cultures and also an in-depth
exploration of one’s cultural background (Campinha-Bacote, 2011). Cultural The conscious
awareness also involves being aware of the existence of documented racism and infusion of cultural
other “isms” in healthcare delivery. The HCP can allow cultural humility to humility into the
permeate cultural awareness by intentionally and mindfully acknowledging the construct of cultural
privilege and power inherent in their clinician role. The conscious infusion of awareness involves
cultural humility into the construct of cultural awareness involves the commitment the commitment of
of personal sacrifice. Sacrifice is an expression of biblical kindness, for it involves personal sacrifice.
denying ourselves something (Campinha-Bacote, 2013). Healthcare professionals
must be willing to sacrifice their prejudices and biases toward culturally different
patients in order to develop cultural competemility. Howard (2003) states that we
must sacrifice our “proprietary assumptions of our own rightness and our unreflective grip on our own certainty”
(p. 2). This type of sacrifice involves the moral commitment to serve all patients, regardless of their cultural
values, beliefs, or practices.

Cultural knowledge is defined as the process in which the HCP seeks and obtains a sound educational base
about culturally diverse groups (Campinha-Bacote, 2011). Additionally, cultural knowledge includes the integration
of three areas: a) health-related beliefs, practices, and cultural values of culturally and ethnically diverse

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populations; b) disease incidence and prevalence among culturally and ethnically diverse populations; and c)
treatment efficacy among culturally and ethnically diverse populations (Lavizzo-Mourey, 1996). The most serious
barrier to cultural competemility is not a lack of knowledge of the details of any given cultural orientation, but
rather the potential to stereotype individuals. The concept of intra-cultural variation is critical to remember when
gaining cultural knowledge to prevent the stereotyping of patients from different cultural groups.

Intra-cultural variation refers to the variation that is noted within cultural groups,
as well as the expected variation that exists across cultural groups. No individual
The most serious is a stereotype of one’s culture of origin, but rather a unique blend of the diversity
barrier to cultural found within each culture, an accumulation of life experiences, and the process of
competemility is acculturation to other cultures.
not a lack of
knowledge of the
details of any given
cultural orientation,
but rather the
potential to
stereotype
individuals.

The infusion of cultural humility into cultural knowledge allows meaningful and deliberate cultural encounters to
connect with the patient as a unique, individual person, and not a stereotype of the patient’s cultural group.
Cultural competemility necessitates a consciousness of the limits of one's knowledge, including sensitivity to
circumstances in which one's native egocentrism is likely to function self-deceptively and limit one's viewpoint
(Foundation for Critical Thinking, 1996).

The attribute of teachableness is necessary as cultural humility enters the

component of cultural knowledge (Campinha-Bacote, 2013). Teachableness is the
intellectual virtue that exudes the quality of being capable of receiving instruction Healthcare
and a willingness or readiness to be informed and instructed. Healthcare professionals must
professionals must be willing to be informed/taught by their patients and others, be willing to be
for a teachable spirit allows HCP to recognize that they can learn not only from informed/taught by
their colleagues, but also from their patients and other people (cultural their patients and
informants), regardless of the person’s status or achievement. others...

Cultural skill is the ability to conduct a cultural assessment to collect relevant cultural data regarding the patients
whom one serves (Campinha-Bacote, 2011). Cultural humility is infused into this construct by conducting a
cultural assessment that requires more than selecting a tool and asking the patient questions listed. The
healthcare professional’s approach must be done in a culturally sensitive manner. To infuse cultural humility into
cultural skill, it is suggested that HCPs listen with interest and remain non-judgmental about what they hear.
Boesen (2012) offers the following acronym as a guide to ‘ASSESS’ how to develop consistent cultural humility:
Ask questions in a humble, safe manner; Seek self-awareness; Suspend judgment; Express kindness and
compassion; Support a safe and welcoming environment; and Start where the patient is at.

Another approach to gain insight and understand another’s culture is the process
of ‘passing over and coming back’ (Dunne, 1972). ‘Passing over’ refers to shifting
...it is suggested to the standpoint of another culture, another way of life, another way of seeing an
that HCPs listen issue. It is followed by an equal and opposite process of ‘coming back’ with new
with interest and insight. We enter (pass over) into the feelings of our patients by allowing them to
remain non- share their cultural traditions. We then come back to the world of our own cultural
judgmental about traditions with new insight into the patient’s worldview, thus allowing us to
what they hear. formulate a mutually acceptable and culturally relevant treatment regimen. Dunne
(1972) noted that the process of passing over rests on the recognition that no
matter what one already knows, there is always more to know, for no standpoint
can be the endpoint. Thus, passing over to another world is possible for us
because we share common experiences of being humans.

Cultural encounters encourage the HCP to directly engage in face-to-face interactions and other types of
encounters with patients from culturally diverse backgrounds to modify existing beliefs about a cultural group and
prevent possible stereotyping (Campinha-Bacote, 2011). Continuous cultural encounters are needed to acquire
cultural awareness, cultural knowledge, cultural skill, and cultural desire. Cultural humility permeates the cultural
encounter as the HCP becomes mindful both that every encounter is an opportunity for inquisitiveness, self-
reflection, critique, and life-long learning, and also that maintaining an open heart and mind are necessary
(Fahlberg, Foronda, & Baptiste, 2016).

Key aspects of cultural humility during the cultural encounter are availability and presence, with the realization

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that presence is more than the physical presence of the HCP with patients, but
rather a matter of being available or open to patients (Marsden, 1990; Paterson &
Zderad, 1976). Thus, infusion of cultural humility into the component of cultural ...infusion of cultural
encounters is more about “being” than about “doing” and flows from a quality of humility into the
presence that we then extend to others. We must meet patients where they are component of
and take the time to listen and learn who they are, what they need, and what cultural encounters
they bring to the clinical encounter. In this encounter, we must ‘hold space’ for is more about
patients. Holding space means that the HCP is willing to walk alongside patients “being” than about
without judging them and requires the HCP to be totally present, attentive to what “doing” and flows
is said and not said, and what is happening and not happening (Hauka, 2017). from a quality of
With the HCP holding the space, patients are more free to participate in planning presence that we
their care. then extend to
others.

Cultural desire is the motivation of the HCP to ‘want to’ (as opposted to 'have to') engage in the process both of
becoming culturally aware, culturally knowledgeable, culturally skillful, and also seeking cultural encounters
(Campinha-Bacote, 2011). This form of motivation requires passion. Wilkerson (2002) asserted that true passion
is born of anguish and added that “Anguish means extreme pain and distress; The emotions so stirred that it
becomes painful, acute deeply felt inner pain, because of conditions about you, in you, or around you” (p. 7).
Healthcare professionals must become anguished at the social justice issues facing our growing culturally diverse
world and the severe inequalities that exist in healthcare. We must not forget the Institute of Medicine’s landmark
report (Smedley, Stith, & Nelson, 2002) which revealed that ethnic minorities in the United States are less likely to
receive medical care and experience lower quality of healthcare services .

Similarly, in 2001, the Surgeon General’s report on race, culture and ethnicity and mental health documented
racial and ethnic disparities in mental healthcare surrounding issues of misdiagnosis, underutilization,
overrepresentation, and improper treatment (U.S. Department of Health and Human Services, 2001). Explanations
are multifaceted; however, there is evidence to support (Beach, Rosner, Cooper, Duggan, & Shatzer, 2007;
Betancourt, Corbett, & Bondaryk, 2014) that these racial and ethnic disparities are related to the lack of cultural
competemility among HCPs. These landmark reports must evoke in us enough passion to ‘want to’ engage in the
process of cultural competemility. However, passion must be tempered with a cultural humility lens. Passion drives
us forward, and a lens of cultural humility will keep us focused.

A cultural humility lens of cultural desire dictates an understanding of social inequalities and how they affect
individuals. When cultural humility saturates the cultural desire of HCPs, there becomes a profound commitment to
social justice actions. Healthcare professionals will then realize that views they hold about patients and their
everyday interactions with patients and with one another can either contribute to socially just actions or reproduce
social injustices (Anderson et al., 2009). Research continues to demonstrate a direct correlation between inequality
and negative health outcomes. It is because of this link that healthcare professionals must consciously connect
cultural competemility with social justice.

Conclusion

The literature has argued that a focus on developing a culturally competent healthcare workforce, though well
intended, has resulted in an unintentional over-emphasis on shared group characteristics; an undervaluing of
unique differences of individuals; a failure to address the privilege and power imbalances between providers and
clients; an unbalanced focus on knowledge acquisition; and a misuse of the concept of culture as a substitution for
minority and/or racial/ethnic group identity(Fisher-Borne et al., 2015; Prasad et al, 2016; Tervalon & Murray-
Garcia, 1998). Strategies to address these issues have revolved around introducing the concept of cultural humility
and its various relationships with cultural competence. This article offers new insight into this relationship by
proposing a synergistic relationship between cultural competence and cultural humility to create the process of
cultural competemility. This approach has the potential to further contribute to this body of literature.

To advance the concept of cultural competemility, an application of this conceptual framework is needed. In an
upcoming article in this journal, authors Elizabeth Fitzgerald and Josepha Campinha-Bacote will utilize cultural
competemility as the framework for becoming culturally competent at both the individual and organizational level.
Utilizing an intersectionality approach to cultural competemility, this article will offer salient strategies in which
nurses in practice, education, research and/or administrative positions can engage to actively challenge and
address inequalities as they journey towards cultural competemility. Additional studies are needed, however, to
determine valid methods to assess the development of cultural competemility, to assess client perceptions of
providers who practice it, and to evaluate whether cultural competemility affects client outcomes (Davis,
Worthington, & Hook, 2010; Davis et al. 2011; Worthington, Davis, & Hook, 2017).

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Author

Josepha Campinha-Bacote, PhD, MAR, PMHCNS-BC, CTN-A, FAAN

Email: meddir@aol.com

Dr. Campinha-Bacote is President of Transcultural C.A.R.E. Associates. She has published extensively on issues
concerning transcultural healthcare. Dr. Campinha-Bacote is certified by the Transcultural Nursing Society (TCNS)
as an Advanced Certified Transcultural Nurse and has been inducted into the TCNS as a Transcultural Nursing
Scholar. She been the recipient of several national and international honors and awards, including the Transcultural
Nursing Society Leadership Award, the Ethnic/Racial Minority Fellowship Award from the National Institute of
Mental Health, the Lifetime Achievement Diversity Award from the University of Rhode Island, and the Minority
Health Knowledge Award from the Ohio Commission on Minority. Dr. Campinha-Bacote, a Fellow of the American
Academy of Nursing, has served on the National Advisory Committee to the United States Department of Health
and Human Services Office of Minority Health to develop standards for Culturally and Linguistically Appropriate
Services in Health Care.

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