Disease and Health Research: Recent Developments Vol. 1

Cultural competency is increasingly recognised as an important component of respectful and person-centred maternity care, particularly in culturally diverse health systems. This chapter examines the role of cultural competency in shaping maternal satisfaction with childbirth services in Kenya, It presents the Cultural Competency–Maternal Satisfaction and Health Systems Performance (CCMS-HSP) Framework. The study employed a cluster randomised controlled trial (cRCT) design, with a total of 758 women receiving maternity services recruited from intervention and control facilities at baseline and endline, alongside healthcare workers from multiple professional cadres who received the structured training intervention. Quantitative data assessed changes in women’s perceptions of maternity care before and after the intervention, while qualitative interviews and focus group discussions explored women’s experiences, expectations, and perceived determinants of satisfactory childbirth care. The findings indicate that cultural competency training was associated with improvements in provider–patient communication, respect for women’s cultural beliefs and preferences, emotional support, trust in healthcare providers, and perceived quality of childbirth services. Statistically significant improvements were recorded across multiple dimensions of maternal satisfaction in intervention compared to control facilities, with the largest effect observed in staff friendliness and respect (F = 79.002, p < 0.001), followed by satisfaction with information provided (F = 11.493, p < 0.001), prompt provision of maternity services (F = 10.142, p = 0.001), and trust in healthcare providers (F = 6.395, p = 0.012). Mean satisfaction scores for consideration of cultural childbirth beliefs also improved, though the magnitude of change in this domain was more modest, suggesting that deeply embedded cultural practices require sustained engagement beyond a single training cycle. Women emphasised the importance of respectful treatment, clear information, continuous labour support, cultural responsiveness, autonomy in decision-making, and reassurance during childbirth. These findings informed the development of the CCMS-HSP Framework, which links cultural competency interventions to provider competencies, respectful maternity care processes, maternal satisfaction, healthcare utilisation, and broader health system performance. The chapter argues that cultural competency can support more responsive, respectful, and patient-centred childbirth services when integrated into health worker training, service delivery, supervision, and quality improvement systems. The framework provides a practical model for policymakers, educators, managers, and practitioners seeking to strengthen maternity care experiences in culturally diverse settings.