This is a summary of The Purnell Model for Cultural Competence
Author: Larry Purnell, PhD, RN, FAAN
Publisher: Journal of Multicultural Nursing & Health (Riley Publications)
Click here for the original article
This article presents the Purnell Model for Cultural Competence, a framework designed to help healthcare workers understand and respond to cultural differences among patients, families, and communities. Purnell built the model in 1991 while teaching undergraduate nursing students. He noticed that students and staff lacked a consistent framework for thinking about their own culture and the cultures of the people they served. The model grew out of that gap.
Culture: the sum of behaviors, beliefs, values, and customs
Purnell opens by defining culture as the sum of behaviors, beliefs, values, and customs that a group learns and passes down, mostly through family, school, and community. He stresses that culture is largely unconscious and shapes how people think about health and illness without them realizing it.
He distinguishes between related terms that often get confused. Cultural awareness means noticing outward signs of diversity, like art, music, or dress. Cultural sensitivity means avoiding language or behavior that might offend someone from a different background. Cultural competence goes further. It requires providers to actively learn about a client’s culture, respect differences, avoid assuming their own beliefs match the client’s, and adjust care to fit the client’s worldview.
Interesting is also a study by Junco, Merson, and Salter about the effects of gender, ethnicity, and income on college student use of communication technologies. They studied usage patterns, which is measured in continuous units, or number of texts. They studied practices in relation to ethnicity, gender, and income.
Organizational Cultural Competence
The article also covers organizational cultural competence. Purnell lists concrete steps a healthcare institution should take, such as building diversity into its mission statement, training all new staff on culture, offering interpretation services, posting signs in multiple languages, and recruiting staff who reflect the populations they serve.
Purnell addresses the sensitive topic of race directly. He notes that human beings share over 99 percent of the same genetic code, per the Human Genome Project, yet race remains a relevant factor in health assessments because of hereditary and genetic disease patterns. He separates race from culture, pointing out that people can share physical traits without sharing the same cultural identity.
Cultural Competence, a four-stage process
A key section explains cultural competence as a four-stage process rather than a fixed endpoint. A person starts at unconscious incompetence, unaware of what they don’t know about another culture. They move to conscious incompetence, where they recognize the gap in their knowledge.
Next comes conscious competence, where they actively learn about a client’s culture and apply that knowledge. The final stage, unconscious competence, means culturally congruent care happens automatically. Purnell warns that this last stage carries risk, since individual differences within any cultural group mean that automatic assumptions can still lead to poor care.
Stereotyping and generalization
The article also draws a sharp line between stereotyping and generalization. Stereotyping treats a belief about a group as a fixed conclusion applied to every member. Generalization treats a belief as a starting point, something the provider should verify against the actual person in front of them.
Purnell gives the example of collectivist Asian cultures, where ingroup harmony often matters strongly. Assuming this trait applies to every individual is stereotyping. Using it as a prompt to ask further questions is generalization, and that’s the more useful skill for providers to build.
The Purnell Model
The heart of the article describes the Purnell Model itself. It’s shown as a circle with four nested rings: global society on the outside, then community, then family, then person at the center. Inside this circle sit twelve pie-shaped wedges, each representing a domain of culture.
These domains include overview and heritage, communication, family roles and organization, workforce issues, biocultural ecology, nutrition, high-risk behaviors, spirituality, pregnancy and childbearing, death rituals, healthcare practitioners, and healthcare practices. The very center of the circle is left dark, representing unknown phenomena, since no provider can fully know every detail about a client’s culture. A jagged line along the bottom of the diagram represents the nonlinear nature of cultural consciousness.
Underlying assumptions
Purnell lists the model’s underlying assumptions. No culture is better than another, cultures share core similarities, cultures change slowly, and clients who participate in their own care tend to have better outcomes. He also defines primary and secondary characteristics of culture.
Primary characteristics, which are hard to change, include nationality, race, color, gender, age, and religion. Secondary characteristics, which carry more flexibility, include education, socioeconomic status, occupation, marital status, sexual orientation, and immigration status. He notes that people who immigrate voluntarily tend to acculturate more readily than those who arrive as refugees or sojourners planning to return home.
Cultural Competence, a continuous process
The article closes by reinforcing that cultural competence is a continuous process, not a credential someone earns once. Purnell argues that no provider can master every world culture, so the model’s real value lies in giving providers a consistent set of questions to ask about any client, regardless of background. He frames this general-plus-specific approach as the path toward more individualized, respectful, and effective care across all healthcare disciplines.