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Table 2 Frequencies and percentages of themes across all participant types

From: Traditional and biomedical care pathways for mental well‐being in rural Nepal

  Endorsing Participants
Traditional Healer (%) Community Member (%) Physician (%) Total (%)
Personal explanatory models for disease
 1. Supernatural and scientific beliefs 36 (90) 40 (50.6) 2 (40.0) 78 (62.9)
  1a. Self-contradicting belief narratives 7 (17.5) 21 (26.6) 0 28 (22.6)
 2. Science alone 0 26 (32.9) 5 (100.0) 31 (13.7)
 3. Supernatural alone 1 (2.5) 2 (1.6) 1 (20.0) 4 (3.2)
Perceptions of traditional healers
 1. Origin stories for supernatural relationships and abilities 21 (52.5) 15 (19.0) 0 36 (29.0)
  1a. No fear or difficulty versus mental illness 1 (2.5) 6 (7.6) 0 7 (5.7)
 2. Healer-induced feelings of peace and satisfaction 6 (15.0) 21 (26.6) 2 (40.0) 29 (23.4)
  2a. Resultant desire to re-enter everyday life 5 (12.5) 12 (15.2) 2 (40.0) 18 (14.5)
 3. Patients prefer one healer based on healer-factors 3 (7.5) 16 (20.3) 0 19 (15.3)
  3a. Healer as community member 21 (52.5) 52 (65.8) 0 73 (58.9)
  3b. Healer as figurative or literal family 4 (10.0) 12 (15.2) 0 16 (12.9)
  3c. Sensitivity to local socioeconomic issues 10 (25.0) 45 (57.0) 0 55 (44.4)
  3d. Non-discriminatory 20(50.0) 33 (41.8) 0 53 (42.7)
  3e. Offers skills as a social service 14 (35.0) 36 (45.6) 0 50 (40.0)
   3e1. Realistic and familiar payment scheme 16 (15.0) 29 (72.5) 0 35 (28.2)
   3e2. Avoids growing wave of healer corruption 13 (32.5) 26 (29.1) 3 (60.0) 36 (29.0)
   3e3. Emotional availability 1 (2.5) 11 (13.9) 0 12 (9.7)
   3e4. Genuine appearance 0 51 (64.6) 8 (20.0) 59 (47.6)
    3e4a. No substance abuse 0 6 (7.6) 0 6 (4.8)
  3f. Quick response 3 (7.5) 18 (22.8) 0 21 (16.9)
  3g. Follow-up care 6 (15.0) 12 (15.2) 0 18 (14.5)
  3h. Allows for reinvestigation across several healers 0 15 (19.0) 0 15 (12.1)
  3h. Proven mastery over the supernatural 13 (32.5) 29 (36.7) 0 42 (33.9)
   3h1. Has wide repertoire of mantra 1 (2.5) 5 (6.3) 0 6 (4.8)
  3i. Can instill some but not too much fear 1 (2.5) 13 (16.5) 0 14 (11.3)
  3j. Lacks arrogance 12 (30.0) 41 (51.9) 0 53 (42.7)
Perceptions of clinicians
 1. Well-educated 24 (60.0) 64 (81.0) 1 (20.0) 89 (71.8)
 2. Dedicated to medicine 9 (22.5) 32 (40.5) 2 (40.0) 43 (34.7)
 3. Adverse prescription side effects 19 (47.5) 24 (30.4) 0 43 (34.7)
 4. Powerful and fast-acting medicines 11 (27.5) 56 (70.9) 0 67 (54.0)
 5. Financial barriers 12 (30.0) 32 (40.5) 0 44 (35.5)
 6. Geographic barriers 7 (17.5) 29 (36.7) 0 36 (29.0)
 7. Patient preference against discriminatory practices 5 (12.5) 8 (10.1) 0 14 (11.3)
Perceptions of care among healers and clinicians
 1. Healers alone for specific ailments 4 (10.0) 33 (41.8) 1 (20.0) 38 (30.6)
  1a. Subjective symptomatic improvement 0 19 (24.1) 0 19 (15.3)
  1b. Minor physical illnesses 8 (20.0) 21 (26.6) 0 29 (23.4)
  1c. Intractable physical illnesses 0 12 (15.2) 0 12 (9.7)
  1d. Odd behavior 7 (17.5) 15 (19.0) 0 22 (17.7)
  1e. Madness 9 (22.5) 5 (6.3) 0 14 (11.3)
  1f. Socio-environmental duress 5 (12.5) 14 (17.7) 0 19 (15.3)
   1fa. Taboo subjects 2 (5.0) 11 (13.9) 0 13 (10.5)
 2. Clinicians alone for specific ailments 11 (27.5) 39 (49.4) 3 (60.0) 53 (42.7)
  2a. Severe or emergency physical illnesses 20 (50.0) 26 (32.9) 0 46 (37.1)
  2b. “True” mental illness 11 (27.5) 4 (5.1) 0 15 (12.1)
 3. Both healers and clinicians for specific ailments 12 (30.0) 51 (64.6) 1 (20.0) 64 (51.6)
  3a. Healers as first-line 9 (22.5) 35 (44.3) 1 (20.0) 45 (36.3)
   3a1. Rule out supernatural issues 4 (10.0) 17 (21.5) 0 21 (16.9)
   3a2. Rule out must precede clinician’s 1 (2.5) 11 (13.9) 0 12 (9.7)
  3b. Clinician as first-line 5 (12.5) 35 (44.3) 1 (20.0) 41 (33.1)
   3b1. Concern for conflicting belief systems 4 (10.0) 28 (35.4) 0 32 (25.8)
    3b1a. Resultant unfulfilled expectations 1 (2.5) 22 (27.8) 1 (20.0) 24 (19.4)
   3b2. No concern for conflicting belief systems 0 8 (10.1) 1 (20.0) 9 (7.3)
    3b2a. Resultant unfulfilled expectations 0 2 (2.4) 0 1 (2.4)
   3b3. Unconventional medical care pathways 1 (2.5) 13 (16.5) 1(20.0) 15 (12.1)
    3b3a. Multiple, redundant clinicians 0 9 (11.4) 0 9 (7.3)
    3b3b. Bringing healers into the hospital 0 5 (6.3) 1 (20.0) 6 (4.8)
    3b3c. Early discharge to healer 1(2.5) 4 (5.1) 0 4 (3.2)
Desired pathways to care among healers and clinicians
 1. Care-seeking as it stands 1 (2.5) 19 (24.1) 4 (80.0) 23 (18.6)
  1a. Healers and clinicians too fundamentally different 1 (2.5) 9 (11.4) 1 (20.0) 10 (8.1)
  1b. Concern for harm from magical-medical mixing 3 (7.5) 10 (12.7) 0 13 (10.5)
 2. Improved collaboration 27 (67.5) 45 (57.0) 0 72 (58.1)
  2a. Legitimizes the healer’s role in society 2 (5.0) 4 (5.1) 0 6 (4.8)
  2b. Preserves Nepali culture 3 (7.5) 3 (3.8) 0 6 (4.80)
  2c. Medical training and referrals to clinicians 2 (5.0) 4 (5.1) 0 6 (4.8)
  2d. Two-way referrals 6 (15.0) 9 (11.4) 0 16 (12.9)
  2e. Mutual respect and recognition 17 (42.5) 9 (11.4) 0 26 (21.0)
   2e1. Learning and motivating one another 5 (12.5) 2 (2.5) 0 7 (5.7)
   2e2. Sharing skill sets 2 (5.0) 1 (1.3) 0 3 (2.4)