Barriers and Facilitators to Patient Utilization of Non-Communicable Disease Services in Primary Healthcare Facilities in Nepal: A Qualitative Study.

Background: The Nepalese government endorsed and implemented the Package of Essential Non-Communicable Disease Interventions (PEN) by the World Health Organization (WHO) to prevent and manage four major non-communicable diseases (NCDs): cardiovascular disease (CVD), diabetes, cancers, and chronic respiratory diseases. This study explored barriers and facilitators to patient utilization of NCD services at primary healthcare facilities in Nepal.

Methodology: We conducted a qualitative study with a 35 purposive sample of patients living with one or more NCDs (hypertension, diabetes, chronic obstructive pulmonary disease (COPD/ asthma) who sought healthcare at primary healthcare facilities in 14 randomly selected districts in seven provinces in Nepal that implemented PEN. Trained qualitative researchers conducted in-depth interviews in-person in a private setting using a semi-structured interview guide developed based on the Health Belief Model in the local language. The interviews were audio-recorded, transcribed verbatim, coded inductively and deductively, and analyzed by a framework approach using Dedoose software.

Results: From the perspectives of patients, key facilitators of service utilization encompassed free medicines, low-cost services, geographical and financial accessibility, less waiting time, positive interactions with health service providers, experiencing improvements in their health conditions, and support from family and peers. Barriers to utilizing services included inadequate health services (e.g., lack of medications and equipment), inaccessibility and affordability, inadequate health-related information from health service providers, low knowledge of NCD care, and lack of reminders or follow ups.

Conclusion: Enhancing NCD service utilization is potentially attainable through interventions that address patients' knowledge, self-motivation, and misconceptions. Furthermore, strengthening the availability and accessibility of crucial services such as laboratory investigations, medications, equipment, and the patient-provider relationship is crucial for sustainable implementation of PEN.