Madeline Leininger’s Theory of Culture Care Diversity and Universality

Subject: Nursing
Pages: 2
Words: 661
Reading time:
3 min

History and Purpose of the Theory

  • Madeline Leininger developed the theory in 1978;
  • It is also called Culture Care Theory (CCT);
  • The Sunrise model was added in 1997;
  • The theory explains interdependence between care and culture;
  • It discovers culture-related meanings, patterns, and practices.

The theory was first introduced by Madeline Leininger in 1978 in her work titled Transcultural Nursing: Concepts, Theories, and Practices (Alligood, 2017). The second name of the Theory of Culture Care Diversity and Universality is Culture Care Theory (CCT). In 1997, the Sunrise Enable model was added to the theory, which was an essential concept map that guided nurses to culture-sensitive care (Alligood, 2017). The purpose of the theory was to help researchers explain the interdependence between nursing care and the culture of the patients (McFarland & Wehbe-Alamah, 2019). The theory can help researchers discover new meanings, patterns, expressions, and practices related to cultural care.

Tenets of the Theory

  • Tenets are central beliefs of a theory;
  • Care diversities and universalities exist among cultures;
  • Worldview and social factors influence care meanings;
  • Generic and professional factors influence health outcomes;
  • Cultural care decisions and action modes help.

Every theory has tenets or central beliefs that serve as the basis for the theory. The first tenet of the theory is that care diversities and universalities exist among cultures around the world (McFarland & Wehbe-Alamah, 2019). The second belief is that worldview, and social structure factors affect the understanding and the meaning of care (McFarland & Wehbe-Alamah, 2019). The third tenet is that both generic and professional health factors affect illness outcomes (McFarland & Wehbe-Alamah, 2019). Finally, the theory presupposes that cultural care decisions and action modes help to plan culturally congruent care for clients (McFarland & Wehbe-Alamah, 2019).

Central Constructs of the Theory

  • Care: assistive, supportive, and enabling experiences towards others;
  • Culture: shared values, beliefs, and norms;
  • Culture care: care based on cultural peculiarities;
  • Emic: local, indigenous, or insider’s cultural knowledge;
  • Etic: outside or stranger cultural knowledge.

CCT utilizes several central constructs, including care, culture, culture care, emic, and etic. Care is defined as assistive, supportive, and enabling experiences and ideas toward others (McFarland & Wehbe-Alamah, 2019). Culture is defined as “learned, shared, and transmitted values, beliefs, norms, and lifeways of a particular culture that guide thinking, decisions, and actions in patterned ways” (McFarland & Wehbe-Alamah, 2019, p. 547). Culture care is seen as care sensitive to cultural background. Leininger (1997) also sets emic against etic, which are insider and outsider knowledge about the culture.

Other Constructs of the Theory

  • Integrative care: appropriate and meaningful practices;
  • Health: culturally-defined well-being of individuals;
  • Culture care diversity: differences among cultures;
  • Culture care universality: a common understanding of phenomena;
  • Modes of decisions and actions: strategies of culture care.

The theory also focuses on the concepts of integrative care, health, culture care diversity and universality, and culture care modes of decisions and actions. Integrative care is viewed as the desired result of cultural care, which is appropriate and meaningful medical practice (McFarland & Wehbe-Alamah, 2019). Health is seen as the culturally-defined well-being of individuals (McFarland & Wehbe-Alamah, 2019). Culture care diversity and universalities are seen as common and differing understandings of phenomena (McFarland & Wehbe-Alamah, 2019). Finally, three cultural care modes of decisions and actions are understood as strategies for providing cultural care.

Cultural and Social Structure Dimensions

  • Cultural values, beliefs, and lifeways; Religious, spiritual, and philosophical factors;
  • Family, professional, and social factors;
  • Economic, political, and legal factors;
  • Biological, educational, and technological factors.

Leininger (1997) sees cultural care as a complicated matter, as it requires attention to numerous factors. It is generally accepted that culture is associated with values, beliefs, and lifeways. Moreover, religious, spiritual, philosophical, kinship, and social factors are also vital dimensions of cultural care. Culture also includes patterns of relationships in families, at work, and in society in general, and outside factors, such as political, economic, and legal environments. Leininger (1997) also sees biological, educational, and technological factors as crucial constituencies of culture care.


Alligood, M. (2017). Nursing theorists and their work. Elsevier.

Leininger, M. (1997). Overview of the theory of culture care with the ethnonursing research method. Journal of Transcultural Nursing, 8(2), 32–52. Web.

McFarland, M. R., & Wehbe-Alamah, H. B. (2019). Leininger’s theory of culture care diversity and universality: An overview with a historical retrospective and a view toward the future. Journal of Transcultural Nursing, 30(6), 540-557.