Integrating between cultural competence and humility: a qualitative study of Israeli pediatric cardiologists

Background: Working with culturally diverse populations in pediatric cardiology settings requires cultural competence and cultural humility. However, little is known about how physicians integrate these approaches. In this study we examined how pediatric cardiology providers describe the incorporation of cultural competence and humility into healthcare services provided to families of children with congenital heart disease (CHD) in pediatric settings in Israel, a country characterized by significant cultural, ethnic, and religious diversity. Methods: Semi-structured interviews were conducted with 17 pediatric cardiologists (12 men, five women; age 45–71 years) from various regions in Israel. Participants had between eight and 33 years of experience in the field. Interviews explored physicians’ perspectives on cultural competence and humility in their daily work with children and families affected by CHD. Data were analyzed using thematic content analysis with an interpretive phenomenological approach. Results: Three main themes were identified: (1) Cultural awareness, or physicians’ examination of their own cultural and professional values, particularly evident among those from minority backgrounds; (2) Cultural knowledge, or the understanding of families’ health-related beliefs and cultural values, acquired primarily through direct clinical experience rather than formal training; and (3) Cultural skills, including the use of culture-specific expressions, integration of spiritual leaders, and navigation of language barriers. The findings revealed an interplay between cultural competence and cultural humility, with physicians demonstrating varying levels of self-awareness and adaptation to diverse cultural needs. Conclusions: Whereas participants demonstrated substantial cultural knowledge and skills, they faced challenges related to self-awareness and a lack of systematic approaches to cultural practices. The study highlights the need for structured support and training in cultural competence and humility within pediatric cardiology settings, particularly in culturally diverse contexts. Future interventions should focus on developing and implementing effective healthcare delivery models specifically designed to address the needs of vulnerable populations in pediatric settings.