DIYASU Community Development Centre, Biratnagar, Nepal.
Massey University, Wellington, New Zealand.
Glob Health Promot. 2022 Jun;29(2):41-49. doi: 10.1177/17579759211001718. Epub 2021 Apr 12.
Non-communicable diseases (NCDs) are a rapidly emerging global health challenge with multi-level determinants popularly known as social determinants. The objective of this paper is to describe the individual and community experiences of NCDs in the two case districts of Nepal from a social determinants of health perspective.
This study adopted qualitative study design to identify the experiences of NCDs. Sixty-three interviews were conducted with key informants from different sectors pertinent to NCD prevention at two case districts and at the policy level in Nepal. Twelve focus group discussions were conducted in the selected communities within those case districts. Data collection and analysis were informed by the adapted Social Determinants of Health Framework. The research team utilised the framework approach to carry out the thematic analysis. The study also involved three sense-making workshops with policy level and local stakeholders.
Three key themes emerged during the analysis. The first theme highlighted that individuals and communities were experiencing the rising burden of NCDs and metabolic risks in both urban and rural areas. The other two themes elaborated on the participant's experiences based on their socio-economic background and gender. Disadvantaged populations were more vulnerable to the risk of NCDs. Further, being female put one into an even more disadvantaged position in experiencing NCD risks and accessing health services.
The findings indicated that key social determinants such as age, geographical location, socio-economic status and gender were driving the NCD epidemic. There is an urgent need to take action on social determinants of health through multi-sectoral action, thus also translating the spirit of the recommendations made a decade ago by the Commission on Social Determinants of Health in addressing a complex challenge like NCDs in Nepal.
非传染性疾病（NCDs）是一个迅速出现的全球性健康挑战，其具有多层次的决定因素，通常被称为社会决定因素。本文的目的是从健康的社会决定因素角度描述尼泊尔两个案例地区的 NCD 个体和社区经验。
本研究采用定性研究设计来确定 NCD 的经验。在尼泊尔的两个案例地区和政策层面，与 NCD 预防相关的不同部门的 63 名关键知情者进行了访谈。在这些案例地区的选定社区进行了 12 次焦点小组讨论。数据收集和分析以适应的健康的社会决定因素框架为指导。研究小组利用框架方法进行主题分析。该研究还涉及与政策层面和当地利益相关者进行的三次意义构建研讨会。
分析过程中出现了三个关键主题。第一个主题强调，个人和社区都在城市和农村地区经历着 NCD 和代谢风险的负担增加。另外两个主题根据参与者的社会经济背景和性别详细阐述了他们的经验。弱势群体更容易受到 NCD 风险的影响。此外，作为女性，在体验 NCD 风险和获得卫生服务方面，她们处于更加不利的地位。
研究结果表明，年龄、地理位置、社会经济地位和性别等关键社会决定因素正在推动 NCD 流行。迫切需要通过多部门行动来解决健康的社会决定因素，从而也将十年前卫生保健社会决定因素委员会提出的建议的精神转化为尼泊尔这样一个复杂挑战的 NCD 应对措施。
