Service user and healthcare provider perspectives on barriers for men using sexually transmitted infection services in public hospital of Nepal: a qualitative study

ABSTRACT

Background

In a time of rapid modernization in Nepal, most Nepalese men are engaging in more risky sexual health behaviours. As most of these Nepali men have little factual information or guidance about sexual health or access to health care, it is imperative to explore how and if there remain particular barriers to sexual health service use for sexually transmitted infection (STI) prevention, screening and treatment. Our study explored the perspectives of healthcare providers and Nepalese men as service users who access public hospital in Nepal, regarding the barriers to STI service use.

Methods

18 semi-structured interviews were conducted through purposive sampling for healthcare service providers while Nepali male service users between age 25–49 years were interviewed following a convenience sampling. Qualitative thematic analysis, separately for providers and service users was conducted in order to identify varying perspectives regarding barriers to STI service use.

Results

The main barriers by healthcare providers include low health literacy, poor user-provider interaction, overcrowding in service delivery, and in maintaining confidentiality. Service users mentioned about poor sexual health knowledge and confidentiality remain a concern, while both groups mentioned about fear of infection with STI as a facilitator factor in availing sexual health service screening and treatment.

Conclusion

Our data identify complexities of delivering sexual health services to Nepali men and barriers to service use. The data suggest that there is a need for greater education regarding STIs and related services, and also consideration of the various cultural factors that influence service use in Nepal.

KEYWORDS:

• Sexually transmitted infections
• health seeking behaviour
• Nepalese men
• health literacy
• healthcare providers

Acknowledgement

The authors acknowledge the authorities of TUTH for their enormous support during the field work of this research.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Notes on contributors

Yamin Tauseef Jahangir

Yamin Tauseef Jahangir, MPH, B.Pharm is a Doctoral Candidate at the School of Public Health & Health Systems, University of Waterloo, Ontario, Canada and a Lecturer at the Department of Public Health, School of Health and Life Sciences, North South University, Dhaka, Bangladesh. He is a public health researcher with a focus on sexual healthcare services, cultural competence in medicine and cultural safety, gender and health, and has worked in World Health Organization and European Union consortium projects on sexual health service access and utilization in resource limited settings in Asia and Africa.

Amul Shrestha

Amul Shrestha, MPH, BPH, is a Program and Research Officer, Ipas Nepal, in Kathmandu, Nepal. He was a Faculty Member at Valley College of Technical Sciences, Sitapaila, Kathmandu and Secretary, Innovative Foundation for Health and Research-IFHR, Kathmandu, Nepal. Amul Shrestha completed his MPH degree from the Department of Public Health, School of Health and Life Sciences, North South University, Dhaka, Bangladesh.

Fatima Alhaan

Fatima Alhaan, MES, BSc., is a Doctoral Candidate at School of Public Health & Health Systems, University of Waterloo, Ontario, Canada.

Samantha B. Meyer

Samantha B. Meyer, PhD, is an Associate Professor at School of Public Health & Health Systems, University of Waterloo, Ontario, Canada.