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Cardiovascular diseases (CVDs) are a leading cause of global death and disability, affecting one-third of adult population. Often overlooked in school-going adolescents, behavioural risk factors are crucial contributors to CVD risk which begin early and accelerate during adolescent period. This study aims to assess the behavioural risk factors and their associated determinants among adolescents of Tulsipur Sub-Metropolitan City, Nepal. A school-based cross-sectional study was conducted among 361 adolescents aged 16-19 years studying in grade 11 and 12 from public and private schools. Schools were selected using a stratified proportionate sampling method. Data were collected through a self-administered, structured, and validated questionnaire covering socio-demographic characteristics, behavioural risk factors of CVDs, and parental information. Descriptive and analytical statistics were used to analyse the data. The most prevalent behavioural risk factor was the consumption of calorie drinks (99%), followed by sedentary behaviour (60%), insufficient fruit and vegetable intake (57%), physical inactivity (35%), and consumption of processed food high in salt (33%). The prevalence of current smoking, alcohol consumption, and smokeless tobacco use was 12%, 10%, and 9% respectively. Key factors associated with the behavioural risk include maternal education, ethnicity, and education system. Parental tobacco and alcohol use were also associated with adolescent smoking and alcohol consumption. The high prevalence of CVD risk factors among adolescents in Nepal highlights the urgent need for targeted interventions in both household and school settings. These interventions should aim to reduce behavioural risk factors to prevent the future burden of CVDs in resource-limited areas like Nepal.

Sexual and Reproductive Health and Rights (SRHR) have been promoted globally, yet sexual and reproductive health (SRH) interventions are seldom evaluated from the perspective of service users and service providers. Very little is known about whether and why various target groups including general women are (or are not) practicing SRH -related self-care practices. This study explored SRH self-care practices and facilitators and barriers to the adoption of SRH self-care among reproductive-age women of Nepal. In this descriptive qualitative study, we conducted in-depth interviews in June 2022 with ten married women of reproductive age (service users) and four SRHR service providers (program managers and health service providers) in Nepal. Thematic analysis was conducted for data analysis. We found that commonly practiced self-care practices were self-administration of contraceptives, self-management of pain, self-monitoring of pregnancy, self-awareness and seeking medical abortions (tele-abortion), self-medication for pre-exposure prophylaxis for HIV, and self-testing for HIV and pregnancy. The multi-level barriers to SRH self-care were poor knowledge and perceived lack of need for SRH self-care, limited access, and negative behaviors from the service providers. The program-related barriers included lack of evidence, limited financial resources, lack of accountability, and limited knowledge and skills among service providers on SRH self-care measures. Peer support, an increasing number of service sites, and access to and use of digital (health) tools emerged as the facilitators of SRH self-care. The findings of this study suggest that addressing barriers such as poor knowledge, limited access, and negative attitudes while leveraging facilitators such as peer support and digital tools is essential for promoting and enabling effective SRH self-care among women. Population-wide awareness programs supplemented by increasing service sites are essential for increasing SRH self-care practices.

Background Nepal has a high prevalence of hypertension which is a major risk factor for cardiovascular diseases globally. It is inadequately controlled even after its diagnosis despite the availability of effective treatment of hypertension. There is a need for an in-depth understanding of the barriers and facilitators using theory to inform interventions to improve the control of hypertension. This formative study was conducted to address this gap by exploring the perceived facilitators and barriers to treatment and control of hypertension in Nepal. Methods We conducted in-depth interviews (IDIs) among hypertensive patients, their family members, healthcare providers and key informants at primary (health posts and primary health care center) and tertiary level (Kathmandu Medical College) facilities in Kathmandu, Nepal. Additionally, data were collected using focus group discussions (FGDs) with hypertensive patients. Recordings of IDIs and FGDs were transcribed, coded both inductively and deductively, and subthemes generated. The emerging subthemes were mapped to the Capability, Opportunity, and Motivation-Behaviour (COM-B) model using a deductive approach. Results Major uncovered themes as capability barriers were misconceptions about hypertension, its treatment and difficulties in modifying behaviour. Faith in alternative medicine and fear of the consequences of established treatment were identified as motivation barriers. A lack of communication between patients and providers, stigma related to hypertension and fear of its disclosure, and socio-cultural factors shaping health behaviour were identified as opportunity barriers in the COM-B model. The perceived threat of the disease, a reflective motivator, was a facilitator in adhering to treatment. Conclusions This formative study, using the COM-B model of behaviour change identified several known and unknown barriers and facilitators that influence poor control of blood pressure among people diagnosed with hypertension in Kathmandu, Nepal. These findings need to be considered when developing targeted interventions to improve treatment adherence and blood pressure control of hypertensive patients.

Health literacy (HL) is crucial in achieving the Sustainable Development Goal of reducing one-third of premature mortality by 2030 from Non-Communicable Diseases (NCDs) and improving Universal Health Coverage. Low health literacy is linked to poor health outcomes, and evidence shows that levels of limited HL are high, even among highly educated individuals. This study aims to assess HL levels and related factors among patients with NCDs at Tribhuvan University Teaching Hospital (TUTH) in Nepal. A cross-sectional survey was conducted at TUTH among 303 patients with NCDs with Cardiovascular Diseases, Chronic Obstructive Pulmonary Disease, Diabetes Mellitus, Hypertension, Epilepsy, Asthma and Cancer who came for follow-up from December 2022 to February 2023. Data was collected via face-to-face interviews by the trained enumerators using a structured Health Literacy Questionnaire (HLQ) containing 44 items (divided into nine domains). Multivariate logistic regression analysis was performed using SPSS version 26, with statistical significance at 0.05, to determine the associated factors of HL. The mean ±SD age of the respondents was 47.4±16.18 years. More than half of the respondents were female (56.1%). The patients had higher HL in all HL domains except ‘Navigating the healthcare system’. Educational status was significantly associated with six out of nine HL domains. Co-morbidity, attendance at health-related seminars, regular physical activity, and social connectedness were associated with at least one of the domains of HL. This study identified the important factors of HL, such as socio-demographic and medical factors among patients with NCDs. This highlights the need for a comprehensive approach to address identified gaps in HL, considering its multifaceted and composite nature and promoting interventions to improve HL in high-risk populations.

Hypertension is a significant risk factor for cardiovascular diseases (CVDs), which remains the leading causes of morbidity and mortality globally, with a disproportionate impact on low and middle income countries. While hypertension is prevalent across various populations, government employees are particularly susceptible due to high stress levels, sedentary lifestyles, and work-related pressures. Therefore, this study was undertaken to assess the prevalence of hypertension and its associated risk factors among government employees in the Doti district of Nepal. A cross-sectional study was carried out among 195 government employees in Dipayal Silgadhi Municipality of Doti district of Sudurpashchim province of Nepal. The data was collected through face-to-face interviews using Simple Random Sampling (SRS) technique and analysed using SPSS v25. The structured questionnaire adopted from the WHO STEPS survey tool was used for data collection. Bivariate and multivariate logistic regression model was used to assess the factors associated with hypertension. The prevalence of hypertension among government employee was 36.4%% ± 5.6%. Participants with age group 30-40 years [Adjusted Odd's Ratio (AOR) 14.4, 95% Confidence Interval (CI) (1.6, 127.7)], 40-50 years [AOR 13.7, 95% CI (1.04, 180.3)] and work experience (20-30 years) [AOR 6.67, 95% CI(1.23, 35.9), and drinking alcohol [AOR 0.35, 95% CI (0.17, 0.72)] were found to be statistically significant with hypertension. The study revealed the high prevalence of hypertension among government employees; significantly associated with risk factors like age group 30-50 years, work experience and alcohol consumption, indicating an alarming public health concern. These results highlight the pressing need for focused interventions to reduce the risk of hypertension and its related problems among government employees, such as lifestyle changes, workplace health programs, and routine health screenings.

Osteoporosis is a major public health problem that can lead to physical disability, working performance limitations, decreased self-sufficiency, and increased hospitalization and mortality rates. People are unaware of osteoporosis, and it is often undiagnosed until fractures occur. Limited studies have been conducted to determine the knowledge, attitude, and practice regarding osteoporosis among middle-aged women in Nepal. This study aimed to determine existing knowledge, attitude, and practice towards osteoporosis among middle and old-aged women in Nepal. A cross-sectional study was conducted among the selected wards of Kirtipur Municipality to recruit 405 participants. Participants were selected using a stratified random sampling technique. Face-to-face interviews using a structured questionnaire were performed to collect the data. Frequencies, percentages, mean, and standard deviation were used to describe the characteristics of participants. Multivariate logistic regression was used to determine the factors associated with knowledge, attitude, and practice regarding osteoporosis. Pearson’s correlation coefficient was used to determine the correlation between knowledge, attitude, and practice regarding osteoporosis. The mean ± SD age of the participants was 46.2 ±9.1 years. Nearly half of the participants (48.8%) had good knowledge, while 57.7% and 51.8% had positive attitudes and good practices regarding osteoporosis, respectively. The occupation and income of the participants were statistically significant and associated with the knowledge level. Meanwhile, age, ethnicity, education, occupation, and monthly household income were associated with attitude level. With a good practice level, ethnicity, family type, and education were statistically significant. The knowledge-attitude (r ka = 0.093, p < 0.05), attitude-practice (r ap = 0.171, p < 0.001), and knowledge-practice (r kp = 0.274, p < 0.001) for osteoporosis were positively correlated. The study found that still around half of the middle and old-aged women had poor knowledge, negative attitudes, and poor practices regarding osteoporosis. Moreover, it highlighted inadequate dietary practices, such as low consumption of milk, vegetables, fruits, and calcium supplements among women, indicates are at greater risk of osteoporosis. The study emphasized the need for community-based awareness programs for the target population such as housemakers, and lower-income groups, to prevent osteoporosis among women.

IntroductionMisinformation about cardiovascular health has the potential to negatively impact public health outcomes. Understanding the nature and spread of such misinformation is crucial for developing effective interventions to mitigate this potential risk. However, despite the critical importance of this issue, there is a gap in comprehensive reviews mapping the existing literature on cardiovascular health misinformation. This scoping review aims to map the existing literature on cardiovascular health misinformation, identifying its spread, prevalence, impact and strategies for correction across diverse populations and settings.MethodsThis review will follow the Joanna Briggs Institute guidelines for conducting a scoping review. A comprehensive search will be conducted across multiple databases, including MEDLINE, EMBASE, SCOPUS and Web of Science, along with grey literature sources. The last date of search was January 2025. The review will include studies without date that involve individuals affected by cardiovascular disease (CVD) misinformation, examine the spread, prevalence, impact or correction of misinformation related to cardiovascular health, and capture various cultural, geographic or setting-specific factors. The exclusion criteria include studies that do not directly address misinformation related to CVD. All identified records will be imported into Covidence systematic review software. Two reviewers will independently screen titles and abstracts, followed by full-text reviews of potentially relevant studies. Discrepancies will be resolved through discussion or by consulting a third reviewer. Data extraction will be conducted by two reviewers using a pre-piloted tool, and a descriptive presentation of the findings will be done. Both inductive and deductive content analysis methods will be employed for objectives related to the impact and strategies to combat misinformation.Ethics and disseminationGiven that the study involves synthesising data from existing published literature, ethical approval is not required. The findings will be disseminated through international conference presentations, published in a peer-reviewed journal and shared with public health organisations and policymakers.

BackgroundUnderstanding contextual needs and preferences is important for a successful design and effective outcome of a mHealth strategy.ObjectivesThis formative study aimed to explore the perspectives of patients and providers on the acceptability of a mHealth (text message) strategy and elicit preferred features of a mHealth strategy for hypertension management.DesignA qualitative study was conducted using in-depth interviews and focus group discussions guided by the technology acceptance model.SettingThe study was conducted at primary healthcare facilities and at a tertiary level referral hospital in Kathmandu, Nepal.ParticipantsA total of 61 participants, patients with hypertension (n=41), their family members (n=5), healthcare workers (n=11) and key informants (n=4) were included. We purposively recruited patients with hypertension aged 30–70 who attended the selected healthcare facilities to obtain maximum variation based on their age, sex and literacy.ResultsThe respondents perceived the mHealth strategy to be useful as it would reinforce medication compliance and behaviour change. Participants valued the trustworthiness of information from health authorities that could be delivered privately. Some implementation challenges were identified including a lack of technical manpower, resources for software development, gaps in recording a patient’s essential information and digital illiteracy. Solutions proposed were having system-level preparedness for recording the patient’s details, establishing a separate technical department in the hospital and involving a family member to assist illiterate/elderly patients. In addition, participants preferred text messages in the local language, containing comprehensive contextual content (disease, treatment, cultural foods and misconceptions) delivered at regular intervals (2–3 times/week) preferably in the morning or evening.ConclusionsWe found that a simple text messaging strategy was acceptable for hypertension management in this low/middle-income country setting. However, meticulous planning must address the needs of a diverse range of participants to ensure the mHealth strategy is acceptable to wider groups.

IntroductionThe rise of antimicrobial resistance represents a critical threat to global health, exacerbated by the excessive and inappropriate dispensing and use of antimicrobial drugs, notably antibiotics, which specifically target bacterial infections. The surge in antibiotic consumption globally is particularly concerning in low-income and middle-income countries (LMICs), where informal healthcare providers (IPs) play a vital role in the healthcare landscape. Often the initial point of contact for healthcare-seeking individuals, IPs play a crucial role in delivering primary care services in these regions. Despite the prevalent dispensing of antibiotics by IPs in many LMICs, as highlighted by existing research, there remains a gap in the comprehensive synthesis of antibiotic dispensing practices and the influencing factors among IPs. Hence, this scoping review seeks to map and consolidate the literature regarding antibiotic dispensing and its drivers among IPs in LMICs.Methods and analysisThis review will follow the Joanna Briggs Institute guideline for scoping review. A comprehensive search across nine electronic databases (MEDLINE, EMBASE, SCOPUS, Global Health, CINAHL, Web of Science, LILACS, AJOL and IMSEAR) will be performed, supplemented by manual searches of reference lists of eligible publications. The search strategy will impose no constraints on study design, methodology, publication date or language. The study selection process will be reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. The findings on antibiotic dispensing and its patterns will be synthesised and reported descriptively using tables, visuals and a narrative summary. Additionally, factors influencing antibiotic dispensing will be elucidated through both inductive and deductive content analysis methods.Ethics and disseminationEthical approval is not required for scoping reviews. The findings will be disseminated through peer-reviewed publications and presentations at relevant conferences.

IntroductionUncontrolled blood pressure is one of the main risk factors for cardiovascular disease and death in Low-income and middle-income countries. Improvements to medication adherence and lifestyle changes can be assisted by using mobile phone text messaging interventions. This study aims to test the feasibility and acceptability of a text messaging intervention for blood pressure control ‘(TEXT4BP)’, developed based on behavioural change theory to improve treatment adherence and lifestyle change among hypertensive patients in Nepal.Methods and analysisThe TEXT4BP intervention will be tested using a two-arm parallel-group, unblinded, individually randomised controlled trial. This feasibility study would recruit 200 clinically diagnosed hypertensive patients aged 18–69 years, currently receiving blood pressure-lowering medication for more than 3 months, visiting a tertiary healthcare facility in Kathmandu, Nepal. A nested qualitative study will assess the acceptability of the short message service intervention. The intervention group will receive text messages containing information on hypertension, diet, medication and physical activity three times a week for 3 months. The control group will receive standard care. At baseline and 3 months, measures of medication adherence, salt intake, physical activity and blood pressure will be collected. Feasibility measures, such as differential rates of recruitment and attrition rates, will be calculated. Acceptability of text message interventions will be studied using usability measures and in-depth interviews among intervention group participants. This pilot study is not funded.Ethics and disseminationThis study has received ethics approval from the University of New South Wales Human Research Ethics Committee B (HC190357), Nepal Health Research Council (302/2019) and Institutional Review Committee of Kathmandu Medical College and Teaching Hospital Kathmandu, Nepal (030520192). The findings of the study will be disseminated through peer-reviewed publications and conference presentations.Trial registration numberACTRN12619001213134.