Neupane Pabitra, Adhikari Suyasha, Khanal Sushma, Devkota Sulochana, Sharma Manasi, Shrestha Anisha, Timilsina Amit
Master of Arts in Gender Studies, Tribhuwan University, Kathmandu, Bagmati Province, Nepal.
Central Department of Public Health, Bachelor in Public Health, Tribhuvan University, Kathmandu, Bagmati Province, Nepal.
PLoS One. 2024 Dec 13;19(12):e0311944. doi: 10.1371/journal.pone.0311944. eCollection 2024.
Women with disabilities in rural Nepal face many challenges in accessing sexual and reproductive health services including harassment and unpleasant behavior by the healthcare providers. Though National Guideline for Disability Inclusive Health Service in Nepal is in place, there are gaps in providing the sexual and reproductive health needs of women with disabilities. There has been limited research exploring the competency and capacity of health care providers on providing sexual and reproductive health services and information for women living with disabilities. Thus, this study aims to explore the competencies of rural healthcare providers in delivering disability inclusive sexual and reproductive health services for women with disabilities.
The study used qualitative research methodology using thematic research design. Key informant interviews and focus group discussions were conducted using semi-structured interview guidelines to obtain information. Data collection was carried out till the data saturation was reached. Inductive coding was done using Dedoose software. The codebook was developed, sub-themes and themes were developed and presented as result of this study.
Knowledge gaps in disability management, procedural skills and biased perception towards sexual and reproductive health need of women with disabilities, were evident among healthcare providers. Additionally, an inadequate skill among health care providers to communicate with women with disabilities for service provision was evident. To address these challenges and enhance the competency of the health care providers there is need for disability management trainings for them. Other important measures such as inclusion of disability and sexual and reproductive health in medical education curriculum, provision of sign language interpreter and disability inclusive information system, decision-making abilities and authority for disability inclusive infrastructure and tool is necessary.
To address the existing challenges for disability inclusive health services, it is essential to strengthen the competency and agency of the healthcare providers, and improve the ecosystem of health institution. For this, it is important for health institutions to be disability inclusive, improved behavior and attitude of health care providers, enhanced clinical knowledge on disability management and procedural skills of healthcare providers. Additionally, improving interpersonal communication skills and decision-making autonomy of health care providers is important for disability inclusive SRH services.
尼泊尔农村地区的残疾妇女在获得性健康和生殖健康服务方面面临诸多挑战，包括医疗服务提供者的骚扰和不良行为。尽管尼泊尔有《包容性残疾健康服务国家指南》，但在满足残疾妇女的性健康和生殖健康需求方面仍存在差距。关于医疗服务提供者为残疾妇女提供性健康和生殖健康服务及信息的能力和资质的研究有限。因此，本研究旨在探讨农村医疗服务提供者为残疾妇女提供包容性残疾性健康和生殖健康服务的能力。
本研究采用定性研究方法，采用主题研究设计。使用半结构化访谈指南进行关键信息人访谈和焦点小组讨论以获取信息。数据收集持续到达到数据饱和。使用Dedoose软件进行归纳编码。编制了编码手册，形成了子主题和主题，并作为本研究的结果呈现。
医疗服务提供者在残疾管理知识差距、程序技能以及对残疾妇女性健康和生殖健康需求的偏见认知方面表现明显。此外，医疗服务提供者在与残疾妇女沟通以提供服务方面的技能不足也很明显。为应对这些挑战并提高医疗服务提供者的能力，需要为他们提供残疾管理培训。其他重要措施包括将残疾及性健康和生殖健康纳入医学教育课程、提供手语翻译和包容性残疾信息系统、为包容性残疾基础设施和工具提供决策能力和权力。
为应对包容性残疾健康服务的现有挑战，加强医疗服务提供者的能力和能动性以及改善医疗机构的生态系统至关重要。为此，医疗机构实现残疾包容性、改善医疗服务提供者的行为和态度、增强医疗服务提供者在残疾管理方面的临床知识和程序技能非常重要。此外，提高医疗服务提供者的人际沟通技能和决策自主性对于包容性残疾性健康和生殖健康服务也很重要。
