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) |