Role of Perceived Social Support in Adherence to Antihypertensives and Controlled Hypertension: Findings of a Community Survey from Urban Nepal.

Introduction: Social support is considered vital for effective management of chronic conditions, but its role in improving adherence to antihypertensive medication and control of hypertension in urban Nepal is unknown. We examined the role of social support in adherence to antihypertensives and controlled blood pressure to inform future interventions for hypertension management. Methods: We analyzed cross-sectional data collected at baseline of a cluster randomized trial of hypertension patients (n=1252) in the community between May and November 2022. Multidimensional scale of perceived social support was used to measure social support, adherence to antihypertensives was measured using the Morisky medication adherence scale -8, and individuals with systolic- and diastolic- blood pressure less than 140 and 90 mmHg respectively were considered to have controlled hypertension. Modified Poisson regression models were used to estimate the prevalence ratios and corresponding 95% confidence intervals. Results: We found that 914 (73%) individuals received moderate to high social support. Participants receiving high social support had a numerically lower proportion of controlled hypertension (51%) however not statistically significant. The proportion of good adherence to antihypertensives did not differ between the social support categories. There was no association in overall, family, friends, and significant other sub-scales of social support with controlled hypertension and adherence to antihypertensives. Discussion: Further studies to understand the quality and mechanisms through which social support contributes to blood pressure control are needed for the health system to include social support in designing and implementing community-based interventions for hypertension management.

Effects of a dietary intervention on cardiometabolic risk and food consumption in a workplace.

BACKGROUND: Worksite-based health programs have shown positive impacts on employee health and have led to significant improvements in cardiovascular risk factor profiles. We aimed to determine the effect of cafeteria intervention on cardio-metabolic risk factors diet in a worksite setting (Dhulikhel Hospital) in Nepal. METHODS: In this one-arm pre-post intervention study, we recruited 277 non-pregnant hospital employees aged 18-60 with prediabetes or pre-hypertension. The study was registered in clinicaltrials.gov (NCT03447340; 2018/02/27). All four cafeterias in the hospital premises received cafeteria intervention encouraging healthy foods and discouraging unhealthy foods for six months. We measured blood pressure, fasting glucose level, glycated hemoglobin, cholesterol in the laboratory, and diet intake (in servings per week) using 24-hour recall before and six months after the intervention. The before and after measures were compared using paired-t tests. RESULTS: After six months of cafeteria intervention, the median consumption of whole grains, mono/polyunsaturated fat, fruits, vegetable and nuts servings per week increased by 2.24(p<0.001), 2.88(p<0.001), 0.84(p<0.001) 2.25(p<0.001) and nuts 0.55 (p<0.001) servings per week respectively. The median consumption of refined grains decreased by 5.07 servings per week (p<0.001). Mean systolic and diastolic blood pressure decreased by 2 mmHg (SE = 0.6; p = 0.003) and 0.1 mmHg (SE = 0.6; p = 0.008), respectively. The low-density lipoprotein (LDL) was significantly reduced by 6 mg/dL (SE = 1.4; p<0.001). CONCLUSION: Overall, we found a decrease in consumption of refined grains and an increase in consumption of whole grains, unsaturated fats, fruits, and nuts observed a modest reduction in blood pressure and LDL cholesterol following a 6-month cafeteria-based worksite intervention incorporating access to healthy foods.

Digital health interventions for suicide prevention among LGBTQ: A narrative review.

Background: Suicidal thoughts and behaviors (STBs) are prevalent within the Lesbian, Gay, Bisexual, Transgender, and Queers (LGBTQ) community, often exacerbated by challenges in accessing care and the perceived stigma and discrimination tied to disclosing one's identity. Digital health interventions that offer psychosocial self-help present a promising platform to reach individuals at risk of STBs, especially those who may not engage with conventional health services. This review aimed to assess the role of digital-based intervention in reducing STBs among LGBTQ individuals. Methods: We conducted a systematic literature search from three databases, PsycINFO, PubMed, and CINHAL, from 1st Jan 1990 to 31st December 2023. The review encompassed studies investigating the feasibility, acceptability, and impact of digital interventions on STBs, employing randomized control trials (RCTs), pseudo-RCTs, observational pre-posttest designs, and qualitative studies. Potential bias was evaluated using the McGill Mixed Methods Appraisal Tool (MMAT). Results: Five non-overlapping studies were included, reporting data from 777 participants. The studies featured diverse types of digital interventions, including videos, online writing, and mobile applications. The studies included three RCTs, and two qualitative studies. Across most of these studies, notable enhancements or reductions in the proportion of participants reporting STBs were observed post-intervention, alongside improvements in help-seeking intentions. The findings underscored that the applications used in the studies were engaging, acceptable, and deemed feasible in effectively addressing suicide prevention among the LGBTQ community. Conclusion: Overall, digital interventions were found to be feasible and acceptable in suicide prevention among LGBTQ communities, demonstrating preliminary efficacy in increasing help-seeking behavior when experiencing suicidal thoughts and in reducing STBs. Therefore, advocating for widespread promotion and dissemination of digital health interventions is crucial, particularly in low- and middle-income countries (LMICs) with limited access to health services and heightened barriers to obtaining such services. Further research using fully powered RCT is imperative to assess the efficacy of these interventions.

Stable Dual miR-143 and miR-506 Upregulation Inhibits Proliferation and Cell Cycle Progression.

The mainstays of lung cancer pathogenesis are cell cycle progression dysregulation, impaired apoptosis, and unregulated cell proliferation. While individual microRNA (miR) targeting or delivering is a promising approach that has been extensively studied, combination of miR targeting can enhance therapeutic efficacy and overcome limitations present in individual miR regulations. We previously reported on the use of a miR-143 and miR-506 combination via transient transfections against lung cancer. In this study, we evaluated the effect of miR-143 and miR-506 under stable deregulations in A549 lung cancer cells. We used lentiviral transductions to either up- or downregulate the two miRs individually or in combination. The cells were sorted and analyzed for miR deregulation via qPCR. We determined the miR deregulations' effects on the cell cycle, cell proliferation, cancer cell morphology, and cell motility. Compared to the individual miR deregulations, the combined miR upregulation demonstrated a miR-expression-dependent G2 cell cycle arrest and a significant increase in the cell doubling time, whereas the miR-143/506 dual downregulation demonstrated increased cellular motility. Furthermore, the individual miR-143 and miR-506 up- and downregulations exhibited cellular responses lacking an apparent miR-expression-dependent response in the respective analyses. Our work here indicates that, unlike the individual miR upregulations, the combinatorial miR treatment remained advantageous, even under prolonged miR upregulation. Finally, our findings demonstrate potential advantages of miR combinations vs. individual miR treatments.

Barriers and Facilitators of Implementing a Healthy Lifestyle Intervention at Workplaces in South Africa.

Current evidence indicates that workplace health and wellness programmes provide numerous benefits concerning altering cardiovascular risk factor profiles. Implementing health programmes at workplaces provide an opportunity to engage adults towards positive and sustainable lifestyle choices. The first step in designing lifestyle interventions for the workplace is understanding the barriers and facilitators to implementing interventions in these settings. The barriers and facilitators to implementing lifestyle interventions in the workplace environment was qualitatively explored at two multinational consumer goods companies among seven workplaces in South Africa. Semi-structured in-depth interviews (IDIs) were conducted with ten workplace managers. Five focus group discussions (FGDs) were conducted among workplace employees. The IDI findings revealed that the main facilitators for participation in a lifestyle intervention programme were incentives and rewards, educational tools, workplace support, and engaging lessons. In contrast, the main facilitator of the FGDs was health and longevity. The main barriers from the IDIs included scheduling time for lifestyle interventions within production schedules at manufacturing sites, whereas time limitations, a lack of willpower and self-discipline were the main barriers identified from the FGDs. The findings of this study add to literature on the barriers and facilitators of implementing healthy lifestyle interventions at workplaces and suggest that there is a potential for successfully implementing intervention programmes to improve health outcomes, provided that such efforts are informed and guided through the engagement of workplace stakeholders, an assessment of the physical and food environment, and the availability of workplace resources.

Challenges in Effective Referral of Cardiovascular Diseases in Nepal: A Qualitative Study from Health Workers' and Patients' Perspective.

Background: Nepal, currently facing a high burden of noncommunicable diseases (NCDs), including cardiovascular diseases (CVDs), which poses the highest mortality rate in the country, does not seem to have a proper referral strategy. This study explored the wide range of factors and challenges that affect the referral system of CVD cases in Nepal. Methods: In this qualitative study, we conducted face-to-face and telephone interviews with purposely selected 57 key participants which included 35 healthcare professionals from tertiary, secondary, and primary levels from Bagmati Province and 22 CVD patients (myocardial infarction and stroke) from Bagmati and Madhesh Provinces. We interviewed them using an interview guide with open-ended questions for in-depth information in a local language and in a private space. The interviews were audio-recorded, transcribed verbatim, coded, and analyzed using the thematic approach. Results: The findings indicated that the referral system for CVD cases from primary- to secondary- to tertiary-level care is inadequate and malfunctioning. The major factors affecting referral of CVD cases are centralization of CVD-specific services in few urban areas, inadequate systematic communication between the centers, self-referential, lack of human resources for CVD care, and obstacles to patient transfer due to geographical and financial reasons. Conclusion: A referral system for CVD patients is absent in the context of Nepal. Understanding and addressing key factors that affect the referral system of CVD patients may help to improve cardiac outcomes and ultimately save lives.

Cyberbullying and cyber-victimisation among higher secondary school adolescents in an urban city of Nepal: a cross-sectional study.

OBJECTIVE: To assess the prevalence and factors associated with cyberbullying and cyber-victimisation among high school adolescents of Pokhara Metropolitan City, Nepal. DESIGN: A cross-sectional study. SETTING: Pokhara Metropolitan City, Nepal. PARTICIPANTS: We used convenient sampling to enrol 450 adolescents aged 16-19 years from four distinct higher secondary schools in Pokhara Metropolitan City. OUTCOME MEASURES: We administered the Cyberbullying and an Online Aggression Survey to determine the prevalence of cyberbullying and cyber-victimisation. Univariate and multivariate logistic regression analyses were performed to estimate the ORs and 95% CIs. Data were analysed using STATA V.13. RESULTS: The 30-day prevalence of cyberbullying and cyber-victimisation was 14.4% and 19.8%, and the over-the-lifetime prevalence was 24.2% and 42.2%, respectively. Posting mean or hurtful comments online was the most common form of both cyberbullying and cyber-victimisation. Compared with females, males were more likely to be involved in cyberbullying (adjusted OR (AOR)=13.52; 95% CI: 6.04 to 30.25; p value <0.001) and cyber-victimised (AOR=2.22; 95% CI: 1.33 to 3.73; p value <0.05). Using the internet almost every day was associated with cyberbullying (AOR=9.44; 95% CI: 1.17 to 75.79; p value <0.05) and cyber-victimisation (AOR=4.96; 95% CI: 1.06 to 23.18; p value <0.05). Students from urban place of residence were associated with both cyberbullying (AOR=2.45; 95% CI: 1.23 to 4.88; p value <0.05) and cyber-victimisation (AOR=1.77; 95% CI: 1.02 to 3.05; p value <0.05). CONCLUSION: The study recommends the implementation of cyber-safety educational programmes, and counselling services including the rational use of internet and periodic screening for cyberbullying in educational institutions. The enforcement of strong anti-bullying policies and regulations could be helpful to combat the health-related consequences of cyberbullying.

Designing and Developing a Mobile App for Management and Treatment of Gestational Diabetes in Nepal: User-Centered Design Study.

BACKGROUND: Mobile apps can aid with the management of gestational diabetes mellitus (GDM) by providing patient education, reinforcing regular blood glucose monitoring and diet/lifestyle modification, and facilitating clinical and social support. OBJECTIVE: This study aimed to describe our process of designing and developing a culturally tailored app, Garbhakalin Diabetes athawa Madhumeha-Dhulikhel Hospital (GDM-DH), to support GDM management among Nepalese patients by applying a user-centered design approach. METHODS: A multidisciplinary team of experts, as well as health care providers and patients in Dhulikhel Hospital (Dhulikhel, Nepal), contributed to the development of the GDM-DH app. After finalizing the app's content and features, we created the app's wireframe, which illustrated the app's proposed interface, navigation sequences, and features and function. Feedback was solicited on the wireframe via key informant interviews with health care providers (n=5) and a focus group and in-depth interviews with patients with GDM (n=12). Incorporating their input, we built a minimum viable product, which was then user-tested with 18 patients with GDM and further refined to obtain the final version of the GDM-DH app. RESULTS: Participants in the focus group and interviews unanimously concurred on the utility and relevance of the proposed mobile app for patients with GDM, offering additional insight into essential modifications and additions to the app's features and content (eg, inclusion of example meal plans and exercise videos).The mean age of patients in the usability testing (n=18) was 28.8 (SD 3.3) years, with a mean gestational age of 27.2 (SD 3.0) weeks. The mean usability score across the 10 tasks was 3.50 (SD 0.55; maximum score=5 for "very easy"); task completion rates ranged from 55.6% (n=10) to 94.4% (n=17). Findings from the usability testing were reviewed to further optimize the GDM-DH app (eg, improving data visualization). Consistent with social cognitive theory, the final version of the GDM-DH app supports GDM self-management by providing health education and allowing patients to record and self-monitor blood glucose, blood pressure, carbohydrate intake, physical activity, and gestational weight gain. The app uses innovative features to minimize the self-monitoring burden, as well as automatic feedback and data visualization. The app also includes a social network "follow" feature to add friends and family and give them permission to view logged data and a progress summary. Health care providers can use the web-based admin portal of the GDM-DH app to enter/review glucose levels and other clinical measures, track patient progress, and guide treatment and counseling accordingly. CONCLUSIONS: To the best of our knowledge, this is the first mobile health platform for GDM developed for a low-income country and the first one containing a social support feature. A pilot clinical trial is currently underway to explore the clinical utility of the GDM-DH app.

Exploring knowledge, perceptions, and practices of antimicrobials, and their resistance among medicine dispensers and community members in Kavrepalanchok District of Nepal.

BACKGROUND: Inappropriate use of antimicrobials is a global public health issue, particularly in developing countries, including Nepal, where over-the-counter sales and self-medication of antimicrobials are common. OBJECTIVES: To explore knowledge, perceptions, and practices of antimicrobials and their resistance among medicine dispensers and community members in Nepal. METHODS: The study was conducted in three rural and five urban municipalities of the Kavrepalanchok district from May 2021 to August 2021. Data were collected using two qualitative approaches: In-Depth Interviews (IDIs) and Focus Group Discussions (FGDs). Data were analyzed using thematic analysis that combined deductive and inductive approaches to identify codes under pre-specified themes. RESULTS: A total of 16 In-depth interviews with medicine dispensers and 3 focus group discussions with community members were conducted. Knowledge regarding antimicrobial resistance varied among dispensers. Those with a prior educational background in pharmacy often had good knowledge about the causes and consequences of antimicrobial resistance. Meanwhile, consumers were less aware of antimicrobial resistance. Community members perceived antimicrobials as effective medicines but not long-term solution for treating diseases. They reported that dispensing without a prescription was common and that both consumers and dispensers were responsible for the inappropriate use of antimicrobials. On the contrary, several dispensers said that self-medication was common among the consumers, especially among more educated groups. The medicine dispensers and consumers expressed concerns about the weak enforcement of policies regarding pharmacy drug use and dispensing practices. CONCLUSION: Promoting and strengthening the appropriate use of antimicrobials among medicine dispensers and community members is crucial. Bold policies and collective implementation of regulations could help combat antimicrobial resistance.

Facilitators and barriers to hypertension management in urban Nepal: findings from a qualitative study.

INTRODUCTION: In Nepal, one-fourth of the adult population has hypertension. Despite provision of comprehensive hypertension services through the primary healthcare system, huge gaps in treatment and control of hypertension exist. Our study explored the individual, interpersonal, health system and community-level barriers and facilitators affecting hypertension management in urban Nepal. METHODS: We used a qualitative methodology informed by Kaufman's socioecological model, conducting focus group discussions with hypertension patients and their family members. In-depth interviews with hypertension patients, healthcare providers and municipal officials were also conducted. RESULTS: We found that inadequate knowledge about hypertension and harmful cultural beliefs hindered effective treatment of hypertension. Interrupted medical supply and distrust in primary healthcare providers affected the poor's access to hypertension services. Poor communication between family members and gender norms affected adaptation of treatment measures. This study emphasised the role of family members in supporting patients in adhering to treatment measures and rebuilding community trust in primary healthcare providers for better access to hypertension services. The findings guided the development of a manual to be used by community health workers during home visits to support patients to control high blood pressure. CONCLUSION: The study highlights the importance of integrating various aspects of care to overcome the multiple barriers to hypertension management in urban settings in low-resource countries. Participatory home visits have the potential to empower individuals and families to develop and implement feasible and acceptable actions for home management of hypertension through improved adherence to antihypertensive medication, and behaviour change.

Community-based lifestyle intervention for diabetes (Co-LID study) management rural Nepal: study protocol for a clustered randomized controlled trial.

BACKGROUND: Type 2 diabetes mellitus (T2DM) has increased globally; with a disproportionate burden in South and Southeast Asian countries, including Nepal. There is an urgent need for clinically and cost-effective culturally adapted T2DM management programs. In this study, we aim to assess the effectiveness of community based culturally appropriate lifestyle intervention in improving the management and care of people with T2DM. METHODS: We will conduct a cluster randomized control trial to evaluate the effectiveness of community based culturally appropriate lifestyle intervention in improving T2DM outcomes. The trial will be conducted in 30 randomly selected healthcare facilities from two purposively selected districts (Kavrepalanchowk and Nuwakot districts) of Bagmati province, Nepal. The selected healthcare facilities are being randomized into 15 interventions (n = 15) and usual care (n = 15) groups. Those in the intervention will receive group-based 12 an hour-long fortnightly session delivered over 6 months period. The intervention package includes 12 planned modules related to diabetes care, ongoing support, supervision and monitoring, follow-up from the trained community health workers, and educational materials on diabetes self-management. The participants in the usual care groups will receive pictorial brochure on diabetes management and they will continue receiving the usual care available from the local health facilities. The primary outcome is HbA1c level, and the secondary outcomes include quality of life, health care utilization, and practice of self-care behaviour, depression, oral health quality of life, and economic assessment of the intervention. Two points measurements will be collected by the trained research assistants at baseline and at the end of the intervention. DISCUSSION: This study will provide tested approaches for culturally adapting T2DM interventions in the Nepalese context. The findings will also have practice and policy implications for T2DM prevention and management in Nepal. TRIAL REGISTRATION: Australia and New Zealand Clinical Trial Registry (ACTRN12621000531819). Registered on May 6, 2021.

A critical analysis of health system in Nepal; Perspective's based on COVID-19 response.

Background: Nepal moved from a unitary government to a federal system of government in 2015 under its constitution. Nepal is a federal democratic republic governed by three levels of government: a federal, provincial, and local level. The response to COVID-19 in Nepal has been majorly led and controlled by the federal government. All three levels of government are performing their responsibilities; however, they face various challenges in responding to COVID-19. This study aimed to critically analyze Nepal's health system in the context of the COVID-19 response. Methods: We conducted semi-structured in-depth interviews by telephone among the policymakers, health workers, and stakeholders at the federal, provincial, and local levels (n = 41) between January to July 2021. The interviews were audio recorded, transcribed into English, and coded using inductive-deductive approaches. Results: COVID-19 considerably impacted routine health care, mainly maternity services and immunization. Inadequate financial resources, inadequate human resources, and the lack of ventilators, ICUs, and X-ray services were the significant challenges in tackling and managing COVID-19 effectively. Conclusion: The study found that all three levels of government perform their roles and responsibilities and effectively manage the pandemic. The federal and provincial governments focused more on the plans and policy development, while the local government demonstrated greater accountability in implementing those plans and policies. Therefore, all three tiers of government need to coordinate together for preparing and communicating information in times of emergency. Besides, it is imperative to empower local governments to maintain Nepal's federal health system.

Association between cancer stigma and cervical cancer screening uptake among women of Dhulikhel and Banepa, Nepal.

BACKGROUND: Cervical cancer ranks as the most common cancer among Nepalese women with a high incidence and mortality. Despite evidence that effective screening programs reduce disease burden, screening services are under-utilized. Cancer stigma can be a major barrier to cervical cancer screening uptake among Nepalese women. OBJECTIVES: This study assessed the association between cancer stigma and cervical cancer screening uptake among women residing in semi-urban areas of Kavrepalanchok district (Dhulikhel and Banepa), Nepal. METHODS: We conducted a cross-sectional study among 426 women aged 30-60 years using telephone interview method from 15th June to 15th October 2021. A validated Cancer Stigma Scale (CASS) was used to measure cancer stigma and categorized women as presence of cancer stigma if the mean total score was greater than three. We obtained information on cervical cancer screening uptake through self-reported responses. Univariable and multivariable logistic regression were performed to assess the association between cancer stigma and cervical cancer screening uptake. We adjusted socio-demographic: age, ethnicity, occupation, religion and education, and reproductive health variables: parity, family planning user, age of menarche and age at first sexual intercourse during multivariable logistic regression. RESULTS: Twenty-three percent of women had cancer stigma and 27 percent reported that they had ever been screened for cervical cancer. The odds of being screened was 0.23 times lower among women who had stigma compared to those who had no stigma (95% CI: 0.11-0.49) after adjusting for confounders: age, ethnicity, occupation, religion, education, parity, contraceptive use, age of menarche and age at first sexual intercourse. CONCLUSION: Women residing in semi-urban areas of Nepal and had cancer stigma were less likely to have been screened for cervical cancer. De-stigmatizing interventions may alleviate cancer stigma and contribute to higher uptake of cervical cancer screening.

Cluster randomised trial to evaluate comprehensive approach to hypertension management in Nepal: a study protocol.

INTRODUCTION: Despite having effective approaches for hypertension management including use of antihypertensive medication, monitoring of blood pressure and lifestyle modification many people with hypertension in Nepal remain undetected and untreated. A comprehensive intervention which provides personalised counselling on lifestyle modification, medication adherence together with support for regular monitoring of blood pressure is expected to achieve well controlled blood pressure. METHODS AND ANALYSIS: This is a community-based, non-blinded, parallel group, two-arm cluster randomised controlled trial, with an allocation ratio of 1:1, conducted in Budhanilkantha municipality, Nepal. Ten health facilities and their catchment area are randomly allocated to either of the two arms. 1250 individuals aged 18 years and older with an established diagnosis of hypertension will be recruited. The intervention arm receives a comprehensive hypertension management package that includes blood pressure audit by health workers, home-based patient support by community health workers to engage patient and family members in providing tailored educational counselling on behavioural and lifestyle changes in addition to routine care. The control arm includes routine hypertension care. Trained enumerators will ensure consent and collect data. Outcome data on blood pressure, weight, waist and hip circumference will be measured and self-reported data on diet, lifestyle, medication adherence and hypertension knowledge will be registered at 11 months' follow-up. The change in outcome measures will be compared by intention to treat, using a generalised linear mixed model. A formative assessment will be conducted using semistructured interviews and focus group discussions to explore factors affecting hypertension management. A mix-method approach will be applied for process evaluation to explore acceptability, adoption, fidelity, feasibility and coverage. ETHICS AND DISSEMINATION: Ethics approval was obtained from Nepal Health Research Council (682/2021) and Regional Committee for Medical and Health Research Ethics, Norway (399479). The findings will be disseminated in peer-reviewed journal articles and with decision makers in Nepal.

Nutrition and food security in Nepal: a narrative review of policies.

In the past few decades, the Nepali government has endorsed several nutritional policies, strategies, and guidelines. Given the lack of a comprehensive review of such policy documents, this review aims to describe the nutrition and food security policies and understand the existing policy gaps in Nepal. Findings from this study can be used to develop policies and programs to address Nepal's current and future nutritional needs. Policies relevant to nutrition and food security were identified by searching government websites and directly approaching relevant government ministries. Thematic analysis was conducted using framework methods under 8 predetermined themes: nutrition intervention, food security, food system, capacity building of human resources, nutrition education, nutrition governance, research, and monitoring and evaluation. The contents of each document reviewed were manually extracted in a spreadsheet stratified by the themes, and the findings were summarized for the respective themes. A total of 30 policy documents were reviewed. Most policies have focused on undernutrition; only a few have addressed overnutrition and diet-related noncommunicable diseases. Food security through a sustainable food system has been considered a key policy area in Nepal. Other areas in the food and nutrition policy landscape are capacity building for human resources, behavior change practices, nutrition governance, monitoring, and evaluation. Policy gaps have been identified in the quality and sustainability of nutrition programs; access to health care services; competent human resources for nutrition; intersectoral coordination and commitment; and support for monitoring, evaluation, and research activities. Most policies have tried to address a wide range of components of food and nutrition security; however, strategies focused on overnutrition and diet-related noncommunicable diseases are lacking. Several gaps are identified in this policy review; the findings can guide the policymakers to address these gaps via further policy development.

How Did People with Prediabetes Who Attended the Diabetes Prevention Education Program (DiPEP) Experience Making Lifestyle Changes? A Qualitative Study in Nepal.

Diabetes can be prevented through lifestyle modification in the prediabetic phase. A group-based lifestyle intervention called 'Diabetes Prevention Education Program' (DiPEP) was tested recently in Nepal. The present study aimed to explore experiences of making lifestyle changes among people with prediabetes participating in the DiPEP. This qualitative study, with semi-structured interviews of 20 participants, was conducted 4-7 months following DiPEP intervention. Data analysis was performed by thematic analysis. The results included four themes, understanding that diabetes could be prevented, lifestyle changes made, hurdles to overcome, and experiencing benefits leading to sustained change. Some participants said they felt relieved to know that they had a chance to prevent diabetes. The participants talked mostly about making changes in diet (reducing carbohydrate intake) and physical activity (starting exercises). Obstacles mentioned included a lack of motivation and a lack of family support to implement changes. Experiencing benefits such as weight loss and reduced blood sugar levels were reported to lead them to maintain the changes they had made. Understanding that diabetes could be prevented was a key motivator for implementing changes. The benefits and hurdles experienced by the participants of the present study can be taken into consideration while designing lifestyle intervention programs in similar settings.

Reliability and validity of a Global Physical Activity Questionnaire adapted for use among pregnant women in Nepal.

BACKGROUND: Physical activity (PA) plays an important role in optimizing health outcomes throughout pregnancy. In many low-income countries, including Nepal, data on the associations between PA and pregnancy outcomes are scarce, likely due to the lack of validated questionnaires for assessing PA in this population. Here we aimed to evaluate the reliability and validity of an adapted version of Global Physical Activity Questionnaire (GPAQ) among a sample of pregnant women in Nepal. METHODS: A cohort of pregnant women (N=101; age 25.9±4.1 years) was recruited from a tertiary, peri-urban hospital in Nepal. An adapted Nepali version of GPAQ was administered to gather information about sedentary behavior (SB) as well as moderate and vigorous PA across work/domestic tasks, travel (walking/bicycling), and recreational activities, and was administered twice and a month apart in both the 2nd and 3rd trimesters. Responses on GPAQ were used to determine SB (min/day) and total moderate to vigorous PA (MVPA; min/week) across all domains. GPAQ was validated against PA data collected by a triaxial accelerometer (Axivity AX3; UK) worn by a subset of the subjects (n=21) for seven consecutive days in the 2nd trimester. Intra-class correlation coefficients (ICC) and Spearman's rho were used to assess the reliability and validity of GPAQ. RESULTS: Almost all of the PA in the sample was attributed to moderate activity during work/domestic tasks or travel. On average, total MVPA was higher by 50 minutes/week in the 2nd trimester as compared to the 3rd trimester. Based on the World Health Organization (WHO) guidelines, almost all of the participants were classified as having a low or moderate level of PA. PA scores for all domains showed moderate to good reliability across both the 2nd and 3rd trimesters, with ICCs ranging from 0.45 (95%CI: (0.17, 0.64)) for travel PA at 2nd trimester to 0.69 (95%CI: (0.51, 0.80)) for travel PA at 3rd trimester. Reliability for total MVPA was higher in the 3rd trimester compared to 2nd trimester [ICCs 0.62 (0.40, 0.75) vs. 0.55 (0.32, 0.70)], whereas the opposite was true for SB [ICCs 0.48 (0.19, 0.67) vs. 0.64 (0.46, 0.76)]. There was moderate agreement between the GPAQ and accelerometer for total MVPA (rho = 0.42; p value <0.05) while the agreement between the two was poor for SB (rho= 0.28; p value >0.05). CONCLUSIONS: The modified GPAQ appears to be a reliable and valid tool for assessing moderate PA, but not SB, among pregnant women in Nepal.

Effect of a social media-based health education program on postnatal care (PNC) knowledge among pregnant women using smartphones in Dhulikhel hospital: A randomized controlled trial.

INTRODUCTION: Postnatal care services helps in detecting and subsequently managing life threatening complications. With the ubiquitous use of the mobile phone in Nepal, social media based postpartum education has the potential to increase PNC knowledge among pregnant women. This study aimed to assess the effect of social media-based health education program on PNC knowledge among pregnant women attending Dhulikhel hospital, Nepal. MATERIALS AND METHODS: We conducted a two-arm open-label randomized controlled trial among literate pregnant women visiting Dhulikhel hospital for ANC check-up from May to August, 2021. A computer-based program allocated 229 pregnant women owning smartphones with internet connectivity in a 1:1 ratio to either intervention (n = 109) or usual care (n = 120). We assessed PNC knowledge in the participants by interviewing in-person or via phone. The intervention group received a 16 minutes video on PNC and the participants were reminded to view the video every week via telephone for a month. Control group received usual care. The primary outcome of the study was change in PNC knowledge score. We utilized intent-to-treat analysis and measured the effect of the intervention on PNC knowledge score using simple linear regression analysis. RESULTS AND DISCUSSION: The mean PNC knowledge score increased by additional 8.07 points among pregnant women in the intervention group compared to the control group (95% CI: 2.35: 13.80; p-value = 0.006). The maternal care attribute knowledge increased by 4.31 points (95% CI: 1.51-7.10, p-value = 0.03) and newborn care attribute knowledge increased by 3.39 points (95% CI: 0.41-6.37, p-value = 0.02) among pregnant women in the intervention compared to the control group. CONCLUSION: A social media-based health education is effective in improving PNC knowledge score among pregnant women. Further research is needed to evaluate if this increased knowledge is translated into the increased utilization of PNC care. TRIAL REGISTRATION: ClinicalTrials.gov ID: NCT05132608.

Prevalence and factors associated with depression, anxiety, and stress symptoms among home isolated COVID-19 patients in Western Nepal.

Introduction: Globally, COVID-19 pandemic has a significant impact on mental health. In Nepal, COVID-19 positive cases have to self-isolate at home in multi-generational and multi-family households. This could be strongly associated with depression, anxiety, and stress-related health outcomes. Additionally, COVID-19 related stigma and fear of transmission may intensify depression, anxiety, and stress symptoms. This study determined the prevalence of depression, anxiety, and stress symptoms and their association with presence of COVID-19 symptoms and comorbid conditions among home isolated COVID-19 positives in the Karnali province, Nepal. Methods: We conducted a cross-sectional study to assess depression, anxiety, and stress symptoms among 402 home isolated COVID-19 patients of Karnali province from January to May 2021 using "Depression, Anxiety and Stress Scale-21 (DASS-21)". We interviewed patients to collect socio-demographic, DASS-21, COVID-19 symptoms, comorbid conditions, and self-treatment. We conducted a telephonic interview using a standardized questionnaire using Kobotoolbox. We calculated the prevalence of depression, anxiety, and stress symptoms. We utilized univariate and multivariate logistic regression to determine their association with the presence of COVID-19 symptoms and comorbid conditions. In multivariate logistic regression, we adjusted sociodemographic factors (age, gender, ethnicity, marital status, monthly family income, education level), smoking status and history of self-treatment. We reported adjusted odds ratios (aOR) with 95% confidence intervals. All analyses were conducted in R (version: 4.0.3). Results: The prevalence of depression, anxiety and stress symptoms among home isolated COVID-19 patients were 8.0% (95% CI: 5.5 to 11.1), 11.2% (95% CI: 8.3 to 14.7), and 4.0% (95% CI: 2.3 to 6.4) respectively. Higher odds of depression symptoms (aOR: 2.86; 95% CI: 1.10-7.44, p = 0.03), anxiety symptoms (aOR: 3.81; 95% CI: 1.62 to 8.93; p = <0.01) and stress symptoms (aOR: 7.78; 95% CI: 1.43 to 42.28; p = 0.02) were associated significantly with presence of COVID-19 symptoms in past week. Higher odds of anxiety symptoms were associated with the presence of comorbid conditions (aOR = 2.92; 95% CI: 1.09 to 7.80; p = 0.03). Conclusion: Depression, anxiety, and stress symptoms were present in a significant proportion of home isolated COVID-19 patients in western Nepal and positively associated with the presence of COVID-19 symptoms. In this global COVID-19 pandemic, it is important to provide timely counseling to high-risk groups like those with comorbidities and COVID-19 symptoms to maintain a high level of mental health among home isolated COVID-19 patients.

Validation of the Cancer Stigma Scale in Nepalese Women.

BACKGROUND: Cancer stigma is known to have an adverse impact on cancer patients as well as vulnerable groups who are at risk of developing cancer. In Nepal, there is no validated instrument for assessing cancer stigma and there has been relatively little research examining the stigmatization of cancer among the Nepalese population. OBJECTIVE: We aimed to validate the Cancer Stigma Scale (CASS) among apparently healthy Nepali women. METHODS: We interviewed 426 Nepali women after the translation, back-translation, and cross-cultural adaptation of the CASS into Nepali. We assessed internal consistency using Cronbach's alpha and assessed model fit using confirmatory component analysis. RESULTS: The Nepali CASS had satisfactory internal reliability, Cronbach's alpha of the overall scale and six components was 0.88 and 0.70-0.89, respectively. Confirmatory factor analysis confirmed the six-factor structure (RMSEA = 0.074, GFI = 0.864, AGFI = 0.825, CFI = 0.901, NFI = 0.866, χ2/df=3.341). Having no formal education was associated with higher levels of stigma related to avoiding cancer patients and attributing cancer to personal responsibility. CONCLUSIONS: The Nepali CASS demonstrated sufficient internal consistency, reliability, and model fit indices, making it suitable for assessing cancer stigma among Nepali people.