Examining the association between perceived stigma, its correlates, and restrictions in participation among persons with disabilities in Nepal: a cross-sectional study.

BACKGROUND: Disability stigma in low- and middle-income countries is one of the most persistent and complex barriers limiting persons with disabilities (PwDs) from enjoying their rights and opportunities. Perceived stigma among PwDs and its impact on participation restriction is rarely assessed in Nepal. OBJECTIVE: This study aimed to measure the extent of perceived stigma by PwDs, identify its relationships with specific demographic factors, and assess the impact on social participation. METHODS: A cross-sectional survey was conducted between May and July 2022 among PwDs in Nepal, with a sample of 371. The Explanatory Model Interview Catalog (EMIC) stigma scale and P-scale suitable for people affected by stigmatized conditions were used, and the generated scores were analyzed. One-way ANOVA was performed to determine group differences for sociodemographic variables, and linear regression and correlational analysis were used to identify their association and measure the strength and direction of the relationship. RESULTS: The mean stigma score was 16.9 (SD 13.8). 42% of respondents scored higher than the mean. The scores differed significantly by disability type, caste and ethnicity, education, occupation, and household wealth. Over 56% reported participation restriction, and 38% had severe/extreme restriction. Approximately 65% of participants with intellectual disabilities, 53% with multiple disabilities, and 48.5% of persons with severe or profound disabilities experienced severe or extreme restrictions. Perceived stigma had a positive correlation with Disability type (r = 0.17, P < 0.01) and negative correlations with Severity of disability (r= -0.15, P < 0.05), and Household wealth (r= -0.15, P < 0.01). Education was inversely associated with both stigma (r= -0.24, P < 0.01), and participation restriction (ß= -9.34, P < 0.01). However, there was no association between stigma and participation restriction (ß= -0.10, P > 0.05). CONCLUSION: All participants exhibited stigma in general; however, the severity varied based on disability type, level of education, and sociocultural circumstances. A large proportion of participants reported facing a high degree of restrictions in participation; however, no association was detected between perceived stigma and participation restriction. A significant negative linear correlation was observed between education and participation restriction. Stigma reduction programs focusing on education and empowerment would be especially important for overcoming internalized stigma and increasing the participation of PwDs.

Female Clients Satisfaction towards Primary and Secondary Eye Health Facilities and Cost of Eye Care in Nepal.

INTRODUCTION: In Nepal, females suffer from disproportionately higher burden of blindness and vision impairment with low access to eye care. The available knowledge is inadequate to address the issues related to gender and generate information to reduce the gender disparity. The aim of this study was to determine female clients' satisfaction with services at eye facilities in Nepal and to estimate the cost of cataract surgery. MATERIALS AND METHODS: Exit interviews were conducted in 2018 with 308 female clients from eight facilities in five districts. Face to face interviews were conducted using a pretested semi-structured questionnaire adopted from the midterm review of Vision 2020. RESULTS: The mean age of participants was 54±17 years. Ninety seven percent (97%) of the participants reported that they received service as per their expectation and were satisfied with the service of the facilities. Major factors for satisfaction were: thorough eye examination (54%), behavior of health staff (40%), and cleanliness of health facility (39%). Another eighty percent (80%) of the participants mentioned that they would recommend or return to the same facility. Fifteen percent of the participants perceived that they faced problems at the eye facility because of their gender. Around three quarters (73%) paid health expenses from their pocket. Most (83%) of the participants rated user fees as either reasonable or inexpensive. CONCLUSION: The majority of participants reported receiving service as expected and willingness to return to the same eye health facility for future consultation. However, most participants had to pay the health care expenses out-of-pocket.

Translation and cross-cultural adaptation of a Nepali version of the Dutch Participation and Activity Inventory for Children and Youth (PAI - CY) with visual impairment.

BACKGROUND: Visual impairment is an important cause of disability in children. There is a lack of information on rehabilitation needs and low vision support services for children with visual impairment in Nepal. This is a pilot study designed to translate, culturally adapt and pre-test the Dutch version of the Participation and Activity Inventory for Children and Youth (PAI-CY) with visual impairment aged 7-17 years to develop a Nepali version. Questionnaires (PAI-CY versions for 7-12 and 13-17 years) were translated using standardized methods and were culturally adapted by a panel of experts. They were pretested to evaluate comprehensibility and relevance among six children with visual impairment and blindness. Finally, participants completed a questionnaire evaluation form. RESULTS: The translation and cultural adaptation process resulted in the adaptation of nine items to make them suitable for Nepali culture. Most children had comprehensibility problems with some specific items because of vocabulary, sentence structure and the composition of items. Most of the children were satisfied with the questionnaires. CONCLUSION: The study resulted in the development of a Nepali version of the PAI-CY. We worked with a small group of content experts and a small but representative sample of children which allowed us to use rigorous translation procedures to address language and cultural differences. A population based study has been planned to investigate the psychometric properties of these questionnaires.