Adaptation and efficacy of a cultural competency training program for Icelandic midwives: A mixed-methods pilot study

OBJECTIVE: Cultural competency training programs have been taught in many countries to ensure safe, high-quality maternity care for migrant women. This study describes the adaptation and efficacy of the Operational Refugee and Migrant Maternal Approach (ORAMMA) cultural competency program to the Icelandic context. METHODS: Adaptation of the training program involved translation of material and critical review of the ORAMMA teaching material by Icelandic midwives with experience in caring for migrant women. Changes were made to incorporate Icelandic laws, healthcare services, social support and research. To assess efficacy, an explanatory sequential mixed-methods design was implemented consisting of a quasi-experimental design and focus group interviews. Through convenience sampling, 12 midwives and 15 midwifery students participated. First, cultural competency of 27 participants was evaluated with a one group pretest-posttest design. Wilcoxon and McNemar tests were used to compare scores. Then, semi-structured focus group interviews with 12 midwives were conducted one month after training and analysed through qualitative descriptive analysis. RESULTS: Pretest and posttest scores showed that participants had statistically significantly higher median scores (p < 0.05) on items measuring self-perceived cultural competency (Median = 24 vs. 25), skills (Median = 5 vs. 6), attitude (Median = 7 vs. 9) and knowledge (Median = 18 vs 22). Qualitative descriptive analysis revealed themes of "practical and useful information", "more understanding and empathy" and "increased confidence". CONCLUSION: Findings show that the program can be successfully adapted to a Nordic context and improve midwives' cultural competency. They may inform policy and practice regarding implementation of training programs.