Eimear Gibbons
Country: Ireland
Background:
Research Project: A study of the relationships between female patients and health practitioners in Kathmandu, Nepal and their effects on the health seeking behaviour of women
BACKGROUND: The overall aim of this study was to determine the attitudes of health practitioners in Kathmandu towards the involvement and competency of their female patients and to see if there was a correlation between how health practitioners viewed their relationship and how the women felt about the relationship. Another aim was to gauge whether there exists a difference in the level of satisfaction with care provided between rural Nepali women who travel to Kathmandu for care, and those already living in Kathmandu. Through group discussions and personal observations the primary researcher wanted to develop a greater understanding of the maternal health concerns of the women of this area and to understand the specific barriers affecting their accessing quality maternal care. It was anticipated that the results of this study would help propose programmes and initiatives that will help improve the health status and health seeking behaviour of women in Nepal.
METHOD: Qualitative and quantitative methods were used to gather data. A survey questionnaire was distributed among health professionals working in a variety of health clinics and hospitals in Kathmandu. The survey garnered demographic information about the practitioners. The established Patient-Practitioner Orientation Scale (Krupat 1996) was used to assess their attitudes and approaches to the care of their patients. The surveys were translated into Nepali to increase the rate of response and accuracy of answers. Three focus group discussions were carried out. The first was carried out in Gurje, Nuwakot with members of grassroots women’s groups. The second was carried out in Ghyamrang, two hours outside of the town of Pokhara, with four women from the village. The final discussion was carried out with female patients from the female ward in Bir Hospital, Kathmandu. They were asked how they feel about the treatment they receive from the practitioners and whether they feel intimidated or welcomed by them. Nepali research assistants were hired for each discussion. The discussions were carried out in Nepali.
CONCLUSION: This study showed an awareness and appreciation among health professionals of the importance of patient-centred care. However, a large percentage of health professionals surveyed agree that it is they who should decide what gets talked about in consultations, that patients do not always need a full explanation of their illness and that good diagnostic skills usurp the need for the development of bedside manner. These conclusions differ from the attitudes revealed by the women of the group discussions who valued being fully informed and involved in the consultation process. The issues disclosed in the group discussions were similar to those in the literature reviewed. Women’s concerns in Nepal are the same as those throughout Africa, Asia and the developing world, those of, costs, quality of care and accessibility.