This paper illustrates the growing importance of mixed-methods research to a wide range of health disciplines ranging from nursing to epidemiology. Mixed-methods approaches requires not only the skills of the individual quantitative and qualitative methods but also a skill set to bring two methods/datasets/findings together in the most appropriate way. Health researchers need to pay careful attention to the ‘best’ approach to designing, implementing, analysing, integrating both quantitative (number) and qualitative (word) information and writing this up in a way that enhances its applicability and broadens the evidence-based practice. This paper highlights the strengths and weaknesses of mixed-methods approaches as well as some of the common mistakes made by researchers applying mixed-methods for the first time.

Introduction: Nepal’s move to a federal system was a major constitutional and political change, with significant devolution of power and resources from the central government to seven newly created provinces and 753 local governments. Nepal’s health system is in the process of adapting to federalism, which is a challenging, yet potentially rewarding, task. This research is a part of broader study that aims to explore the opportunities and challenges facing Nepal’s health system as it adapts to federalisation. Methods: This exploratory qualitative study was conducted across the three tiers of government (federal, provincial, and local) in Nepal. We employed two methods: key informant interviews and participatory policy analysis workshops, to offer an in-depth understanding of stakeholders’ practical learnings, experiences, and opinions. Participants included policymakers, health service providers, local elected members, and other local stakeholders. All interviews were audio-recorded, transcribed, translated into English, and analysed thematically using the six WHO (World Health Organization) health system building blocks as a theoretical framework. Results: Participants noted both opportunities and challenges around each building block. Identified opportunities were: (a) tailored local health policies and plans, (b) improved health governance at the municipality level, (c) improved health infrastructure and service capacity, (d) improved outreach services, (e) increased resources (health budgets, staffing, and supplies), and (f) improved real-time data reporting from health facilities. At the same time, several challenges were identified including: (a) poor coordination between the tiers of government, (b) delayed release of funds, (c) maldistribution of staff, (d) problems over procurement, and (e) limited monitoring and supervision of the quality of service delivery and data reporting. Conclusion: Our findings suggest that since federalisation, Nepal’s health system performance is improving, although much remains to be accomplished. For Nepal to succeed in its federalisation process, understanding the challenges and opportunities is vital to improving each level of the health system in terms of (a) leadership and governance, (b) service delivery, (c) health financing, (d) health workforce, (e) access to essential medicines and technologies and (f) health information system.

The paper explores how COVID-19-related moral panics have led to fear and othering practices among returnee Nepalese migrants from India and Muslims living in Nepal. This qualitative study included in-depth interviews with 15 returnee migrants, 15 Muslims from Kapilvastu and Banke districts of Nepal, and eight interviews with media and health professionals, and representatives from migration organisations. Four themes emerged from our data analysis: (1) rumours and mis/disinformation; (2) impact of rumours on marginalised groups (with three sub-themes: (i) perceived fear; (ii) othering practices; (iii) health and social impact); (3) resistance; and (4) institutional response against rumours. Findings suggest that rumours and misinformation were fuelled by various media platforms, especially social media (e.g., Facebook, YouTube) during the initial months of the lockdown. This created a moral panic which led to returnee migrants and Muslim populations experiencing fear and social isolation. Resistance and effective institutional responses to dispel rumours were limited. A key contribution of the paper is to highlight the lived experiences of COVID-19 related rumours on marginalised groups. The paper argues that there is a need for clear government action using health promotion messages to tackle rumours (health-related or otherwise), mis/disinformation and mitigating the consequences (hatred and tensions) at the community level.

Migrant workers support low- and middle-income economies through remittances, often bearing considerable health risks with long-term consequences. This study aims to understand the health and wellbeing issues of Nepalese migrant workers in Gulf Cooperation Council (GCC) countries, a major destination for low-skilled Nepalese workers. We conducted a mixed-methods study in Dhading district of Nepal. A pilot survey was carried out with returnee migrants from GCC countries to understand key health and wellbeing issues faced by workers. In addition, in-depth interviews were conducted with a subset of these returnee migrants and their families, and related stakeholders. These aimed to understand broader societal and policy implications in relation to labour migration. Quantitative data from the survey were analysed using descriptive statistics and thematic analysis was used for qualitative interviews. 60 returnee migrants (58 males, 2 females) took part in the survey (response rate, 100%). Median age of the survey participants was 34 (IQR, 9) years and 68% had completed school level education. Returnee migrants reported suffering from various physical and mental health issues during their stay in GCC countries including cold/fever (42%), mental health problems (25%) and verbal abuse (35%). 20 participants took part in the qualitative study:10 returnee migrants (8 males, 2 females), four family members (female spouses) and six key stakeholders working in organizations related to international migration. Interview participants reported severe weather conditions resulting in physical health problems (e.g. pneumonia, dehydration and kidney disease) as well as mental health issues (including anxiety, loneliness and depression). Participants raised concerns about the usefulness and appropriateness of pre-departure training, and the authenticity of medical tests and reports in Nepal. Female migrants reported facing stigma after returning home from abroad. Language difficulties, alongside issues related to payment, insurance and support at work were cited as barriers to accessing healthcare in destination countries. Our study shows that Nepalese migrant workers experience severe weather conditions and suffer from various physical and mental health issues, including workplace abuse and exploitation. The study highlights an urgent need for strategies to enforce compulsory relevant pre-departure orientation and appropriate medical screening in Nepal, and fair employment terms and full health insurance coverage in destination countries. Greater collaboration between the Nepalese government and GCC countries is needed to ensure necessary legislation and regulatory frameworks are in place to safeguard the health and wellbeing of migrant workers.

Vaccination saves lives and can be an effective strategy for preventing the spread of the COVID-19, but negative attitudes towards vaccines lead to vaccine hesitancy. This study aimed to explore the factors influencing the uptake of the COVID-19 vaccine in the Nepali community in the United Kingdom (UK). This qualitative study included in-depth interviews with 20 people from Nepal living in the UK. Interviews were conducted by a native-Nepali speaker and all interviews were audio-recorded, transcribed, and translated into English before being analysed thematically. Our study found that attitudes towards COVID-19 are generally positive. Nine overlapping themes around barriers to COVID-19 vaccination were identified: (a) rumours and mis/disinformation; (b) prefer home remedies and yoga; (c) religion restriction; (d) concern towards vaccine eligibility; (e) difficulty with online vaccine booking system; (f) doubts of vaccine effectiveness after changing the second dose timeline; (g) lack of confidence in the vaccine; (h) past bad experience with the influenza vaccine; and (i) worried about side-effects. Understanding barriers to the uptake of the COVID-19 vaccine can help in the design of better targeted interventions. Public health messages including favourable policy should be tailored to address those barriers and make this vaccination programme more viable and acceptable to the ethnic minority communities in the UK.

Perinatal mental health is a major public health issue that arises during pregnancy and/or after birth, with substantial implications for social, parental, and maternal functioning, as well as overall quality of life. The study aimed to determine the prevalence of perinatal depression and its associated risk factors among women who visited a maternity hospital in Kathmandu, Nepal. A cross-sectional study was conducted at the Paropakar Maternity and Women’s Hospital in Kathmandu. A total of 300 women in their perinatal period were interviewed. The Edinburgh Perinatal Depression Scale (EPDS) was used to measure perinatal depression. The Poisson regression model was used to determine risk factors associated with perinatal depression. The mean age of respondents was 25.5 (SD 4.5) years; average age during their first pregnancy was 23.5 (SD 3.7) years; and 53.7% of respondents were in the antenatal period. The prevalence of depressive symptoms (EPDS ≥ 10) was 40% (95% CI 31.4% to 45.8%). Unsupportive family members (adjusted prevalence ratio [aPR] 2.23; 95% CI 1.75–2.86), postnatal period (aPR 2.64; 95% CI 1.97–3.53), complications faced during delivery (aPR 1.76; 95%CI 1.30–2.39), history of intimate partner violence (aPR 0.48; 95% CI 0.36–0.64), and first pregnancy at the age of ≤25 years (aPR 0.61; 95% CI 0.42–0.88) were identified as key risk factors of perinatal depression. Strong family support and the active involvement of partners in counselling can contribute to alleviating perinatal depression symptoms. Targeted interventions in health and well-being services should be implemented to address mental health burden during both pregnancy and postpartum periods.