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Fieldwork is often a crucial part of community-based public health studies. However, few researchers write about this, often challenging, process. This paper highlights various occasions where fieldwork in the area of public health, health promotion or community health was more difficult than expected or did not go as planned. Our reflections on working in the field will help less experienced health researchers, or those new to conducting research in Nepal, in their research development. Moreover, this paper is also calling upon health promotion researchers to share more details about the process of doing fieldwork and its trials and tribulations. Our key advice is to be inquisitive and openminded around fieldwork, followed by: be prepared for your fieldwork, conduct a risk assessment of what might go wrong and consider your options to overcome such trials and tribulations. Fieldwork is unpredictable; therefore, it is important to share practical lessons from the field which helps other to better understand these tribulations, and learn from them. Moreover, sharing such information may guide new researchers and help them identify strategies that can address those issues and challenges in their future health promotion studies.

Getting a PhD is the highest possible education qualification which only a small proportion of all students achieve. As a consequence, examining PhD research in the form of a doctoral thesis is specialist work. This paper highlights the different options that are available for PhD examiners. There are four general options: (1) pass, (2) rewrite and resubmit; (3) lower degree, with or without resubmission; and (4) fail the PhD. However, from our experience, of both being examined for our own PhDs and examining others at a range of different universities, we have noted a considerable variety in detail within these common options. This paper outlines a variety of outcomes of a PhD examination, followed by four short case studies, each reflecting on a particular aspect /differences we experienced as examinees or as examiners. This paper further aims to alert PhD candidates and examiners to study the examination rules set by the awarding university, as the details of the PhD examination outcome, and hence the options available to both examiners and the students may differ more than one might expect.

Purpose Mental health disparities exist among Black, Asian and Minority Ethnics (BAME) populations. This paper aims to provide an overview of mental health services designed for the BAME population in the UK, both established BAME communities and refugee/asylum-seekers. Design/methodology/approach A range of electronic databases were searched for peer-reviewed studies conducted within the past decade in the UK. Using the Arksey and O’Malley methodology, data were extracted, analysed and summarised. Findings A total of 13 papers were identified, mostly non-randomised community-based. Studies were very heterogeneous in terms of their sample and service provided. After the initial appraisal, the authors presented a narrative synthesis. Overall, all studies reported positive mental health outcomes and beneficial effects. Research limitations/implications Because of the time limitations and quality of the papers, the authors only included peer-reviewed journal papers. Practical implications Mental health services provided for BAME people, both established and refugee/asylum-seekers are feasible and improve engagement with the services and mental health outcomes. Initiatives are required to facilitate the integration of these targeted services within mental health and community services for BAME in the UK. Originality/value This scoping review is a snapshot of the mental health services designed for BAME people in the UK, either established or refugee/asylum-seekers in the past 10 years and adds to the evidence-based knowledge from these studies.

Mental health in Black Asian and Minority Ethnic (BAME) communities is a rising public health concern in the UK, with key challenges around accessing mental health services. Our understanding of mental health issues in the growing Nepali and Iranian communities in the UK is very limited. Therefore, this study aims to explore the major factors affecting access to, and engagement with NHS mental health services. This study used a qualitative approach comprising in-depth interviews with seven Nepali, eight Iranians and six community mental health workers in the south of England. The data were analysed using a thematic approach. Six themes were identified: (1) stigma and fear; (2) gender; (3) language; (4) tradition and culture; (5) family involvement; and (6) lack of cultural awareness in health workers, all appearing to be major issues. This study contributes to a shared understanding of mental illness within two given cultural contexts to promote early interventions in UK mental health services. Developing cross-cultural perspectives in health care should be a priority in practice.

Background: People who are homeless experience poorer health outcomes and challenges accessing healthcare contribute to the experienced health inequality. There has been an expansion in using technology to promote health and wellbeing and technology has the potential to enable people who are socially excluded, including those who are homeless, to be able to access health services. However, little research has been undertaken to explore how technology is used to promote health and wellbeing for those who are homeless. This review aims to address the questions: ‘what mobile health (mHealth) related technology is used by homeless populations’ and ‘what is the health impact of mobile technology for homeless populations’? Methods: An integrative review methodology was employed. A systematic search of electronic databases was carried out between 4 January 2021 and 30 April 2021, searching for papers published between 2015 and 2021, which yielded 2113 hits, relevant papers were selected using specified inclusion and exclusion criteria reported using the Preferred Reporting Items for Systematic reviews and Meta-Analysis. The quality assessment of each paper included in the review was undertaken using the Mixed Methods Appraisal Tool. Results: Seventeen papers were selected for review and thematic analysis identified four themes: technology ownership, barriers to use, connectivity and health benefits. Conclusion: It is evident that technology has the potential to support the health and wellbeing of individuals who are homeless; however, there are challenges regarding connectivity to the internet, as well as issues of trust in who has access to personal data and how they are used. Further research is needed to explore the use of health technology with people who are homeless to address these challenges.

With the growing UK Nepali community, understanding their health and social care needs is an essential to reduce health and social care inequalities. However, very little is known about the health, wellbeing and utilisation of health and social care services among the Nepali population in the UK. Therefore, this study set out to identify health and social care needs of Nepali community. The mixed-methods study was conducted with the Nepali population living in London. It consists of a semi-structured survey (N = 345); three focus group discussions and three key informant interviews. The mean age of the participants was 40.6 (± 17.6). About 28% of our sample reported having chronic health problems. About 60% currently consume alcohol and 21% were smokers. Male participants (35%) more likely to be physically active than females (21%). Registration with a family doctor/general practitioner (GP) was high (96%). However, uptake of disease screening was very low (28%). In the preceding year, 17% had experienced poor mental or emotional health. The findings also suggest language is a key barrier to utilise health and social care among UK Nepali. We suggest removing the language barrier is essential step to improve access to available health and social care services. A culturally sensitive educational initiative creating awareness about the structure of UK health and social care services is required to offer to this community.

Patient and public involvement/engagement (PPI/E) in public health research and health technology assessment (HTA) in high-income countries (HICs) have significantly increased over the past decade. PPI/E helps to improve research and HTA, ultimately benefitting patients and service users. PPI/E is a very new concept in many low- and middle-income countries (LMICs). This paper considers the importance of PPI in public health research and HTA in the development and implementation of technology in the health sector in South Asia. Currently, in this region, health technology is frequently adopted from HICs without local research and HTA. It also discusses the importance of local co-creation of technology to reflect the needs of users within a culturally appropriate setting. It is important for LMIC-based researchers to understand the potential of PPI/E and how it can contribute to it to improve health care and research, especially perhaps in the era of COVID-19.

Background: There are significant numbers of people experiencing homelessness both in the UK and internationally. People who are homeless are much more likely to die prematurely and, therefore, need strong access to ongoing health and social care support if we hope to address the health disparity they face. Objectives: The aim of the research was to explore how people who are homeless identify and locate appropriate health and social care services. Design: A mixed methods research study was applied on people who are currently homeless or had previously experienced homelessness. Settings: The research study was based in an urban area in the southwest of England. The area was chosen as it was identified to be in the top 24 local authorities for the number of homeless individuals. Participants: A hundred individuals participated in the survey, of those 32% were living on the streets whilst 68% were living in temporary accommodation such as a charity home, shelter or a hotel paid for by the local authority. In addition, 16 participated in either a focus group or one-to-one interview Methods: The quantitative component consisted of a paper-based questionnaire whilst the qualitative aspect was focus groups/one-to-one interviews. The COREQ criteria were used in the report of the qualitative aspects of the study. Results: Quantitative data identified poor health in 90% of the sample. Access to both healthcare and wider wellbeing services (housing and food) was problematic and support for this was largely through third sector charity organisations. Qualitative data identified numerous systemic, individual and cultural obstacles, leaving difficulty for people in terms of knowing who to contact and how to access services, largely relying on word of mouth of other people who are homeless. Conclusions: In order to address health inequities experienced by people who are homeless, there is a need to review how information regarding local health and wider wellbeing services is provided in local communities.

The promulgation of constitution of Nepal in 2015 has shifted the unitary government of Nepal towards federalism with significant devolution of power to seven newly created provinces, each with their own unicameral legislature. The major challenges during the transition phase in health sector are spillover effects, unclear roles and responsibilities of local authorities, human resource management and strengthening capacity at local level as per local need. Despite these challenges, federalism brings fertile ground for the local government to work more closely with their people; with more effective financing and planning based on evidences and their need. Keywords: Federalism; health sector; Nepal; challenges; opportunities.

Edited byMichelle Cleary, PhD, RNSchool of Health Sciences, University of Tasmania, Sydney, NSW, AustraliaDementia is a long-term medical condition, which affects not only the person with dementia ...

The health system in Nepal is currently undergoing some very interesting radical reforms. The new Constitution in 2015 brought a complete restructuring of the country’s political system, creating a Federal Republic with seven Provinces. This change involves a significant devolution of power and resources from central to local level in many sectors including the health sector. This editorial warns of the risk of moving away the political focus from Public Health in a centralised political system

The notion that health professionals should be accountable to people and the society they serve is not a\ud new concept (1). Globally, health professionals are being nudged to demonstrate their commitment with\ud continuing professional development (CPD) in order to maintain competence in light of evidence-based\ud practice and ever changing technology in health service provision. CPD provides an important strategy\ud to improve the knowledge and skills of health practitioners as well as the quality of service (2). The World\ud Health Organization also stresses the need to capacity enhancement of nurses and midwives through education,\ud training and career development in Southeast Asia (3). The member states in the Region have agreed\ud on a Decade for Strengthening Human Resources for Health in South-East Asia, 2015–2024, and country\ud action plans have been developed to strengthen physicians, nurses and midwives with the focus on transforming\ud education and retention (4). This editorial highlights the importance of CPD and existing lack of such provision in the field of nursing in Nepal.

BACKGROUND AND OBJECTIVES: Mental illness is increasingly recognized as a global health problem. However, in many countries, including Nepal, it is difficult to talk about mental health problems due to the stigma associated with it. Hence a training programme was developed to train auxiliary nurse midwives, who otherwise are not trained in mental health as part of their pre-registration training in rural Nepal, on issues related to maternal mental health. After the training programme a selection of auxiliary nurse midwives were interviewed to establish their views on the training, its usefulness and ways to improve it. METHODS: This qualitative study reports on the analysis of interviews conducted with auxiliary nurse midwives who participated in the training programme. The interviews addressed issues associated with the training programme as well as perceptions around mental health in rural Nepal. Transcripts were thematically analysed. RESULTS: Three themes emerged from analysis: (1) issues related to training; (2) societal attitudes; and (3) support for women. The 'training' theme describes the benefits and limitations of training sessions. 'Societal attitudes' describes society's attitude towards mental health which is largely negative. 'Support' describes the positive behaviour and attitude towards pregnant women and new mothers. CONCLUSION: The study supports the need for continued training for auxiliary nurse midwives who are based in the community. This gives them the opportunity to reach the whole community group and potentially have influence over reduction of stigma; offer support and diagnosis of mental ill-health. There is still stigma around giving birth to a female child which can lead to mental health problems. It is imperative to increase awareness and educate the general public regarding mental health illnesses especially involving family members of those who are affected.

Purpose – The purpose of this paper is to analyse cost as a barrier to the uptake of antenatal care (ANC) in rural Nepal amidst a variety of barriers and facilitators. Design/methodology/approach – A qualitative study with face-to-face interviews were conducted with 50 ANC users and non-users participants. The setting is rural Nepal, some 20 kilometres outside the capital Kathmandu. Interviews were audiotaped, transcribed and translated into English and results were presented thematically. Findings – Cost was sometimes a barrier to seeking ANC for poor rural women. It included transport costs, opportunity costs of not being able to work in the household and service-related costs (such as blood or urine tests). The effect of cost as a barrier varied between women of different socio-economic status. Cost was a barrier to accessing ANC partly due to the women's lack of control over household resources. Social implications – It is important to consider cost in the wider socio-economic context of rural people's lives as financial costs alone do not explain the level of uptake of ANC. Originality/value – This study provides an original insight of women's experiences on financial issues relating to the use of ANC services in Nepal. Another important aspect of this study was approached with the multiple respondents (i.e. women, their husbands and their mothers-in-law) regarding the use of ANC and financial impact in the use of services. The findings of this study have important implications in health policy formation by providing clear picture of women's financial situation in access to ANC.

DOI: http://dx.doi.org/10.3126/hren.v10i3.7141 Health Renaissance; September-December 2012; Vol 10 (No.3);229-235

Systematic reviewing involves a structured, rigorous, and objective approach to provide a critical synthesis of the available evidence in a particular field. This paper provides a guide to the key steps to undertake a systematic review. It describes the steps to search for relevant literature, provides advice on how to extract data, synthesize and then interpret data during the review process. It also provides the key references and guidelines which are commonly used for systematic review. It is important that researchers conduct and publish systematic reviews to help generate appropriate evidence to interventions and identify gaps in ‘local’ research. The authors argue that there is a place for systematic reviews in health services research in Nepal. Finally, this paper acknowledges that evidence should be considered within the local health situation and context.http://dx.doi.org/10.3126/nje.v1i4.5498 Nepal Journal of Epidemiology 2011;1(4):114-118

Title. Factors affecting the utilization of antenatal care in developing countries: systematic review of the literature. Aim. This paper is a report of a systematic review to identify and analyse the main factors affecting the utilization of antenatal care in developing countries. Background. Antenatal care is a key strategy for reducing maternal mortality, but millions of women in developing countries do not receive it. Data sources. A range of electronic databases was searched for studies conducted in developing countries and published between 1990 and 2006. English-language publications were searched using relevant keywords, and reference lists were hand-searched. Review methods. A systematic review was carried out and both quantitative and qualitative studies were included. Results. Twenty-eight papers were included in the review. Studies most commonly identified the following factors affecting antenatal care uptake: maternal education, husband’s education, marital status, availability, cost, household income, women’s employment, media exposure and having a history of obstetric complications. Cultural beliefs and ideas about pregnancy also had an influence on antenatal care use. Parity had a statistically significant negative effect on adequate attendance. Whilst women of higher parity tend to use antenatal care less, there is interaction with women’s age and religion. Only one study examined the effect of the quality of antenatal services on utilization. None identified an association between the utilization of such services and satisfaction with them. Conclusion. More qualitative research is required to explore the effect of women’s satisfaction, autonomy and gender role in the decision-making process. Adequate utilization of antenatal care cannot be achieved merely by establishing health centres; women’s overall (social, political and economic) status needs to be considered.

Mental health of pregnant women and new mothers is a growing area of concern in both low- and high-income countries. Maternity services in the UK, for example, have focused more attention on maternal mental health. We recognise that pregnancy, birth and the postnatal period is a time of major psychological and social change for women.

It is clear that academic dissemination has a system of checks and balances which authors may experience as barriers. We all want to be sure that scientific information disseminated in academic journals is based on solid data, ethically collected and correctly interpreted. The process of peer reviewing helps to prevent bad science and/or poor scientific papers being published. Many published scientific papers differ from the original submitted manuscript since papers go through a process of peer-review, editing and rewriting. However, there are other potential obstacles in the field of academic publishing. This paper is a case-study of one methods paper which stumbled upon a number of barriers related to the viability and continued existence of a number of academic journals in Nepal. Finally, we offer some advice to help health journals to survive when their editors leave.DOI: http://dx.doi.org/10.3126/nje.v2i4.7093Nepal Journal of Epidemiology Vol.2(4) 2012 pp.213-215

Nepal is one of the poorest countries of the world and its people suffer from many health problems associated with poverty. Maternity care is underdeveloped, women do not always seek maternity care or the help of a skilled birth attendant, even if the service is available. One key underlying problem is that Nepal lacks proper midwifery, as defined by international standards. There have been some very positive developments towards recognition of the distinct skills required for midwifery. In this paper, we describe a maternal health promotion intervention funded by a London-based Buddhist organisation. The intervention is community-based and works with women's groups in rural areas.

Background Antenatal care (ANC) has been recognised as a way to improve health outcomes for pregnant women and their babies. However, only 29% of pregnant women receive the recommended four antenatal visits in Nepal but reasons for such low utilisation are poorly understood. As in many countries of South Asia, mothers-in-law play a crucial role in the decisions around accessing health care facilities and providers. This paper aims to explore the mother-in-law's role in (a) her daughter-in-law's ANC uptake; and (b) the decision-making process about using ANC services in Nepal. Methods In-depth interviews were conducted with 30 purposively selected antenatal or postnatal mothers (half users, half non-users of ANC), 10 husbands and 10 mothers-in-law in two different (urban and rural) communities. Results Our findings suggest that mothers-in-law sometime have a positive influence, for example when encouraging women to seek ANC, but more often it is negative. Like many rural women of their generation, all mothers-in-law in this study were illiterate and most had not used ANC themselves. The main factors leading mothers-in-law not to support/encourage ANC check ups were expectations regarding pregnant women fulfilling their household duties, perceptions that ANC was not beneficial based largely on their own past experiences, the scarcity of resources under their control and power relations between mothers-in-law and daughters-in-law. Individual knowledge and social class of the mothers-in-law of users and non-users differed significantly, which is likely to have had an effect on their perceptions of the benefits of ANC. Conclusion Mothers-in-law have a strong influence on the uptake of ANC in Nepal. Understanding their role is important if we are to design and target effective community-based health promotion interventions. Health promotion and educational interventions to improve the use of ANC should target women, husbands and family members, particularly mothers-in-law where they control access to family resources.

This paper is a report of a systematic review to identify and analyse the main factors affecting the utilization of antenatal care in developing countries.Antenatal care is a key strategy for reducing maternal mortality, but millions of women in developing countries do not receive it.A range of electronic databases was searched for studies conducted in developing countries and published between 1990 and 2006. English-language publications were searched using relevant keywords, and reference lists were hand-searched.A systematic review was carried out and both quantitative and qualitative studies were included.Twenty-eight papers were included in the review. Studies most commonly identified the following factors affecting antenatal care uptake: maternal education, husband's education, marital status, availability, cost, household income, women's employment, media exposure and having a history of obstetric complications. Cultural beliefs and ideas about pregnancy also had an influence on antenatal care use. Parity had a statistically significant negative effect on adequate attendance. Whilst women of higher parity tend to use antenatal care less, there is interaction with women's age and religion. Only one study examined the effect of the quality of antenatal services on utilization. None identified an association between the utilization of such services and satisfaction with them.More qualitative research is required to explore the effect of women's satisfaction, autonomy and gender role in the decision-making process. Adequate utilization of antenatal care cannot be achieved merely by establishing health centres; women's overall (social, political and economic) status needs to be considered.

There has been a steady growth in recent decades in Nepal in health and health services research, much of it based on quantitative research methods. Over the same period international medical journals such as The Lancet, the British Medical Journal (BMJ), The Journal of the American Medical Association (JAMA) and the Journal of Family Planning & Reproductive Health Care and many more have published methods papers outlining and promoting qualitative methods. This paper argues in favour of more high-quality qualitative research in Nepal, either on its own or as part of a mixed-methods approach, to help strengthen the country’s research capacity. After outlining the reasons for using qualitative methods, we discuss the strengths and weaknesses of the three main approaches: (a) observation; (b) in-depth interviews; and (c) focus groups. We also discuss issues around sampling, analysis, presentation of findings, reflexivity of the qualitative researcher and theory building, and highlight some misconceptions about qualitative research and mistakes commonly made.DOI: http://dx.doi.org/10.3126/kumj.v9i4.6350 Kathmandu Univ Med J 2011;9(4):301-5

For most students and junior researchers, writing an abstract for a poster or oral presentation at a conference is the first piece they may write for an audience other than their university tutors or examiners. Since some researchers struggle with this process we have put together some advice on issues to consider when writing a conference abstract. We highlight a number of issues to bear in mind when constructing one’s abstract. DOI: http://dx.doi.org/10.3126/kumj.v11i3.12518 Kathmandu Univ Med J 2013; 43(3):262-265

Mental health in pregnant women and new mothers is increasing recognised on the global health agenda. In Nepal mental health is generally a difficult to topic to discuss. THET, a London-based organisation, funded Bournemouth University, and Liverpool John Moores University in the UK and Tribhuvan University in Nepal to train community-based maternity workers on issues around mental health.This paper reports on a quantitative survey with nearly all Auxiliary Nurse Midwives in Nawalparasi (southern part of Nepal). The findings illustrate the lack of training on mental health issues related to pregnancy and childbirth in this group of health workers. Thus the paper’s conclusions stress the need for dedicated training in this field.Journal of Manmohan Memorial Institute of Health Sciences Vol. 2 2016 p.20-26