Health services, migration and diversity. Perspectives on the implementation of cultural competence

Evidence of inequities in migrants' health has demanded for the reorientation of health policies to provide diversity responsive, cultural competent and equitable health services. Cultural competence, defined as a strategy to promote equity for "diverse" populations, requires interventions at individual, organizational and system levels. Organizational practices of cultural competence remain heterogeneously implemented in Italian health services. This study aims to explore managers' perspectives on cultural competence in the healthcare system, considering how cultural competence is integrated in managerial practices and in service provision, and examining facilitators and barriers in the implementation of culturally competent interventions. We conducted a qualitative study based on the case study methodology. Data were collected in three health organizations of three Italian Regions. Individual and group interviews were conducted with managers or staff who had the lead responsibility for culturally competent programs (n = 15). Interviews were analysed through a thematic analysis. Findings show different concepts of cultural competence to promote equity for migrants' health, and the role of contextual factors in affecting its organizational implementation. Data show the presence of practices to promote access and quality of care. However, further work is needed to embed cultural competence principles and practices at all levels of the organisation and promote participatory practices involving migrants and stakeholders.