title: Cultural Competence among Maternal Healthcare Providers in Bahir Dar City Administration, Northwest Ethiopia: Cross sectional Study.
abstract: BACKGROUND
  Cultural competency is now a core requirement for maternal health providers working in multicultural society. However, it has not yet received due attention in Ethiopia. This study aimed to determine the level of cultural competence and its associated factors among maternal health care providers in Bahir Dar City Administration, Northwest Ethiopia.
  
  
  METHODS
  Institution based cross-sectional study was carried out using both quantitative and qualitative methods. Maternal health care providers from all health facilities were our study participants. Structured Questionnaire with some modification of Campinha Bacote's tool was used to collect quantitative data from health workers and semi structured guide line was used for qualitative data among women. While quantitative data analysis was done using SPSS, qualitative data was analyzed using open code software. P-value of less than 0.05 was taken to determine statistical significance. Cronbach's alpha was used to test internal reliability and a factor loading of 0.3 or greater was the criterion used to retain items.
  
  
  RESULTS
  Two hundred seventy four health workers and seven women were involved in the study. The overall competency level was 57.3 % thought vary in different subscales or stages. Of the cultural competent health workers near to three fourth (73.0 %) were in awareness stage which is the earliest stage of competence in which individuals were aware only their own culture but not the world view of their clients. The voices of mothers in the qualitative assessment also showed discordance in cultural competence with their healthcare providers. Female health workers almost six times [AOR,5.5; 2.71, 11.30] more competent than male providers and those who got in-service training related to maternal care provided services more culturally competent than their counter parts with [AOR,3.5; 1.4, 8.64]. Reliability Cronbach's α coefficient value of cultural competence subscales showed 0.672,0 .719, 0.658, 0.714, and 0.631 for cultural awareness, knowledge, skill, encounter and desire, respectively.
  
  
  CONCLUSIONS
  The overall competence level of health workers was low and the mean competence level falls in awareness stage in the continuum of culturally incompetent, culturally aware, culturally competent, and culturally proficient indicated that the providers were aware of only their own culture but not the world view of their clients. The voices of mothers also showed that they were dissatisfied for the services they got and the interactions they had with health care providers. Hence, we recommend on job training of health workers and incorporation of cultural components in the curriculum of health workers as it would be the key to provide culturally acceptable services.
authors.affiliation: Department of Reproductive health, College of Medicine and Health sciences, Bahir Dar University, Bahir Dar city, Ethiopia. aragawamanu@yahoo.com.
authors.forename: Amanu
authors.initials: A
authors.lastname: Aragaw
authors.affiliation: Jhpiego- Ethiopia, Addis Ababa, Ethiopia. tyigzaw@jhpiego.net.
authors.forename: Tegbar
authors.initials: T
authors.lastname: Yigzaw
authors.affiliation: College of Health Sciences, Aksum University, Aksum, Ethiopia. meladesu@gmail.com.
authors.forename: Desalegn
authors.initials: D
authors.lastname: Tetemke
authors.affiliation: Department of Nursing and Midwifery, Bahir Dar Health Science College, Bahir Dar, Ethiopia. Wubie2001@gmail.com.
authors.forename: Wubalem
authors.initials: W
authors.lastname: G/Amlak
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D054521:Cultural Competency / Q000523:psychology*; D018864:Cultural Diversity; D065246:Culturally Competent Care / Q000706:statistics & numerical data*; D005002:Ethiopia; D005260:Female; D006268:Health Facilities / Q000706:statistics & numerical data; D007722:Health Knowledge, Attitudes, Practice; D006282:Health Personnel / Q000523:psychology*; D006801:Humans; D008297:Male; D008427:Maternal Health Services / Q000706:statistics & numerical data*; D008875:Middle Aged; D009035:Mothers / Q000523:psychology; D017060:Patient Satisfaction; D011247:Pregnancy; D036301:Qualitative Research; D011795:Surveys and Questionnaires; D055815:Young Adult