Midwives' experiences of providing care after cultural competency training: A longitudinal qualitative study in Iceland

INTRODUCTION: Cultural competency contributes to high-quality maternal care because it reduces disparities in perinatal experiences and outcomes, especially for marginalized, ethnic minority and immigrant women. However, less is known about the process of developing cultural competency skills over time. MAIN OBJECTIVE: To study the experiences of midwives who provide care for immigrant women after completing cultural competency training in a hospital setting in Iceland. METHODS: This longitudinal qualitative study used semi-structured interviews with eight midwives over a 6-month period in 2024 after completion of a training program. Interviews were analysed using reflexive thematic analysis. Three conceptual frameworks guided the study: The Practical Framework of Cultural Competence Interventions by Betancourt and colleagues; The Process of Cultural Competence in the Delivery of Healthcare Services by Campinha-Bacote; and The Activate-Connect-Transform Cultural Model by Li and colleagues. RESULTS: The results revealed an overarching theme of "Between ideals and reality: Midwives' journeys towards culturally competent care" with four subthemes that emerged: 1) Tension between commitment to quality care and systemic constraints; 2) Empathy and effective communication as foundations of trust; 3) Confidence in navigating cultural diversity; and 4) Adopting a problem-solving approach to overcome challenges. CONCLUSION: These results have important implications for practice, education and policy. Training in cultural competency and communication had a lasting impact on the way this group of midwives provided care. Creating a supportive environment that acknowledges and lessens the emotional and job-related stress on midwives who care for a diverse population is essential for compassionate care.