Gender and caste inequalities in primary healthcare usage by under-5 children in rural Nepal: an iterative qualitative study into provider perspectives and the potential role of implicit bias

Saugat Joshi; Alisha Karki; Simon Rushton; Bikash Koirala; Srijana Basnet; Barsha Rijal; Jiban Karki; Gerda Pohl; Manish Baidya; Tim Chater; Dan Green; Andrew Lee

doi:10.1136/bmjopen-2022-069060

Gender and caste inequalities in primary healthcare usage by under-5 children in rural Nepal: an iterative qualitative study into provider perspectives and the potential role of implicit bias

Saugat Joshi, Alisha Karki, Simon Rushton, Bikash Koirala, Srijana Basnet, Barsha Rijal, Jiban Karki, Gerda Pohl, Manish Baidya, Tim Chater, Dan Green, Andrew Lee

Research output: Contribution to journal › Article › peer-review

Abstract

OBJECTIVE: This study explored provider perspectives on: (1) why inequalities in health service usage persist; and (2) their knowledge and understanding of the role of patient experience and implicit bias (also referred to as unconscious bias).

DESIGN: A three stage, iterative qualitative study was conducted involving two rounds of in-depth interviews and a training session with healthcare staff. Interview transcripts were analysed using a reflexive thematic approach in relation to the study's aims.

SETTING: Participants were recruited from rural hill districts (Mugu, Humla, Bajura, Gorkha and Sindhupalchok) of Nepal.

PARTICIPANTS: Clinical staff from 22 rural health posts.

RESULTS: Healthcare providers had high levels of understanding of the cultural, educational and socioeconomic factors behind inequalities in healthcare usage in their communities. However, there was less knowledge and understanding of the role of patient experience-and no recognition at all of the concept of implicit bias.

CONCLUSION: It is highly likely that implicit bias affects provider behaviours in Nepal, just as it does in other countries. However, there is currently not a culture of thinking about the patient experience and how that might impact on future usage of health services. Implicit bias training for health students and workers would help create greater awareness of unintended discriminatory behaviours. This in turn may play a part in improving patient experience and future healthcare usage, particularly among disadvantaged groups.

Original language	English
Article number	e069060
Number of pages	8
Journal	BMJ Open
Volume	13
Issue number	6
Early online date	26 Jun 2023
DOIs	https://doi.org/10.1136/bmjopen-2022-069060
Publication status	Published - 26 Jun 2023

Bibliographical note

Copyright © Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY. Published by BMJ. https://creativecommons.org/licenses/by/4.0/
This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/. Funding Information: This research was supported by the UK Economic and Social Research Council’s GCRF NGO Secondary Data Analysis Initiative, Grant Ref: ES/T010436/1.

Keywords

Humans
Child
Bias, Implicit
Nepal
Social Class
Qualitative Research
Primary Health Care

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10.1136/bmjopen-2022-069060Licence: CC BY 4.0

Joshietal_2023_VoR
Copyright © Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY. Published by BMJ. https://creativecommons.org/licenses/by/4.0/ This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.
Final published version, 348 KBLicence: CC BY 4.0

Cite this

Joshi, S., Karki, A., Rushton, S., Koirala, B., Basnet, S., Rijal, B., Karki, J., Pohl, G., Baidya, M., Chater, T., Green, D., & Lee, A. (2023). Gender and caste inequalities in primary healthcare usage by under-5 children in rural Nepal: an iterative qualitative study into provider perspectives and the potential role of implicit bias. BMJ Open, 13(6), Article e069060. https://doi.org/10.1136/bmjopen-2022-069060

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abstract = "OBJECTIVE: This study explored provider perspectives on: (1) why inequalities in health service usage persist; and (2) their knowledge and understanding of the role of patient experience and implicit bias (also referred to as unconscious bias).DESIGN: A three stage, iterative qualitative study was conducted involving two rounds of in-depth interviews and a training session with healthcare staff. Interview transcripts were analysed using a reflexive thematic approach in relation to the study's aims.SETTING: Participants were recruited from rural hill districts (Mugu, Humla, Bajura, Gorkha and Sindhupalchok) of Nepal.PARTICIPANTS: Clinical staff from 22 rural health posts.RESULTS: Healthcare providers had high levels of understanding of the cultural, educational and socioeconomic factors behind inequalities in healthcare usage in their communities. However, there was less knowledge and understanding of the role of patient experience-and no recognition at all of the concept of implicit bias.CONCLUSION: It is highly likely that implicit bias affects provider behaviours in Nepal, just as it does in other countries. However, there is currently not a culture of thinking about the patient experience and how that might impact on future usage of health services. Implicit bias training for health students and workers would help create greater awareness of unintended discriminatory behaviours. This in turn may play a part in improving patient experience and future healthcare usage, particularly among disadvantaged groups.",

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Joshi, S, Karki, A, Rushton, S, Koirala, B, Basnet, S, Rijal, B, Karki, J, Pohl, G, Baidya, M, Chater, T, Green, D & Lee, A 2023, 'Gender and caste inequalities in primary healthcare usage by under-5 children in rural Nepal: an iterative qualitative study into provider perspectives and the potential role of implicit bias', BMJ Open, vol. 13, no. 6, e069060. https://doi.org/10.1136/bmjopen-2022-069060

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T2 - an iterative qualitative study into provider perspectives and the potential role of implicit bias

AU - Joshi, Saugat

AU - Karki, Alisha

AU - Rushton, Simon

AU - Koirala, Bikash

AU - Basnet, Srijana

AU - Rijal, Barsha

AU - Karki, Jiban

AU - Pohl, Gerda

AU - Baidya, Manish

AU - Chater, Tim

AU - Green, Dan

AU - Lee, Andrew

N1 - Copyright © Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY. Published by BMJ. https://creativecommons.org/licenses/by/4.0/ This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/. Funding Information: This research was supported by the UK Economic and Social Research Council’s GCRF NGO Secondary Data Analysis Initiative, Grant Ref: ES/T010436/1.

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N2 - OBJECTIVE: This study explored provider perspectives on: (1) why inequalities in health service usage persist; and (2) their knowledge and understanding of the role of patient experience and implicit bias (also referred to as unconscious bias).DESIGN: A three stage, iterative qualitative study was conducted involving two rounds of in-depth interviews and a training session with healthcare staff. Interview transcripts were analysed using a reflexive thematic approach in relation to the study's aims.SETTING: Participants were recruited from rural hill districts (Mugu, Humla, Bajura, Gorkha and Sindhupalchok) of Nepal.PARTICIPANTS: Clinical staff from 22 rural health posts.RESULTS: Healthcare providers had high levels of understanding of the cultural, educational and socioeconomic factors behind inequalities in healthcare usage in their communities. However, there was less knowledge and understanding of the role of patient experience-and no recognition at all of the concept of implicit bias.CONCLUSION: It is highly likely that implicit bias affects provider behaviours in Nepal, just as it does in other countries. However, there is currently not a culture of thinking about the patient experience and how that might impact on future usage of health services. Implicit bias training for health students and workers would help create greater awareness of unintended discriminatory behaviours. This in turn may play a part in improving patient experience and future healthcare usage, particularly among disadvantaged groups.

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KW - Child

KW - Bias, Implicit

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KW - Social Class

KW - Qualitative Research

KW - Primary Health Care

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DO - 10.1136/bmjopen-2022-069060

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SN - 2044-6055

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JO - BMJ Open

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ER -

Gender and caste inequalities in primary healthcare usage by under-5 children in rural Nepal: an iterative qualitative study into provider perspectives and the potential role of implicit bias

Abstract

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Keywords

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