Open access Original research BMJ Open: first published as 10.1136/bmjopen-2020-043312 on 12 December 2020. Downloaded from Perceptions and experiences of the public regarding the COVID-19 pandemic in Nepal: a qualitative study using phenomenological analysis Navin Bhatt ,1 Bandana Bhatt ,2 Soniya Gurung,3 Suresh Dahal,4 Amrit Raj Jaishi,4 Bandana Neupane,5 Shyam Sundar Budhathoki 6 To cite: Bhatt N, Bhatt B, ABSTRACT Strengths and limitations of this study Gurung S, et al. Perceptions Objectives Perceptions of people regarding COVID-19 and experiences of the public influences their health behaviour in terms of seeking regarding the COVID-19 ► Representation of participants from diverse public health services. This helps the government in pandemic in Nepal: a qualitative backgrounds. planning appropriate public health strategies. Therefore, study using phenomenological ► A large number of participants interviewed in a short analysis. BMJ Open this study intends to explore the perceptions of people period of time abiding preventive measures and 2020;10:e043312. doi:10.1136/ towards COVID-19 and their experiences during the safety guidelines. bmjopen-2020-043312 pandemic in Nepal. ► Use of the phenomenological approach has enriched Design, setting and participants This qualitative ► Prepublication history and the evidence generated from the lived experiences additional material for this study was conducted among the public in Kathmandu, of people. Kanchanpur, Bajura and Jhapa districts of Nepal. Eight paper are available online. To ► Children and the elderly population excluded from view these files, please visit focus group discussions and 40 in- depth interviews the study due to the possibility of increased risk of the journal online (http:// dx. doi. were conducted by using a maximum variation sampling COVID-19. org/ 10. 1136/ bmjopen- 2020- method. ► Hesitancy of participants to participate in the focus 043312). Results The findings were organised into the following group discussions due to different stages of lock- themes: General understanding of COVID-19, Disease Received 31 July 2020 down and disease outbreak in different parts of the prevention, Source of information and misconceptions, Revised 09 November 2020 country. Accepted 30 November 2020 Expectation and challenges; and Personal and societal consequences of COVID-19, social distancing and http://bmjopen.bmj.com/ lockdown. There was a good general understanding among respondents about COVID-19, personal INTRODUCTION preventive measures and population- level strategies. The COVID-19 is a newly discovered infec- They responded that the use of masks, sanitisers, tious disease, first seen in December 2019 at handwashing and proper lockdown would help to Wuhan city of Hubei province, Central China. prevent the disease. The respondents acknowledged the A rapid spread with a high transmission rate vital role of media in increasing awareness. Participants and substantial deaths have been observed also expressed concerns over the misleading news worldwide affecting 216 countries, areas or on September 23, 2021 by guest. Protected copyright. spread by some media. The lack of social interaction, territories already.1 2 The World Health Orga- isolation and loss of income were raised as pertinent nization (WHO) declared the COVID-19 issues by the participants as potentially leading to psychological consequences. Health workers and outbreak as a global pandemic on 11 March 2020.3 In Nepal, the first case was confirmed public both raised concerns over inadequate Personal 4 Protective Equipment, under- prepared health system, on 23rd of January 2020, in a person who had 5 unorganised public quarantine centres, and public returned from Wuhan. It was also the first 6 violation of lockdown recorded case of COVID-19 in South Asia. © Author(s) (or their Conclusions This study reports participants’ views The total cases in Nepal reached 188 883 as employer(s)) 2020. Re- use on disease prevention measures such as maintaining of 6 November 2020, with 1070 mortalities.4 permitted under CC BY-NC. No commercial re- use. See rights personal hygiene, adhering to physical distancing, and Countries around the world are imple- and permissions. Published by using personal protective equipments. Additionally, menting different measures, from local BMJ. it illuminates the confusion among public due to quarantines to travel restrictions, to prevent For numbered affiliations see conflicting public health messages from different wide spread of the virus.7 Nepal is a risk zone end of article. sources of information which was deemed as misleading for COVID-19 due to its weak health system by the participants. This research sheds light on and porous borders with India.8 The govern- Correspondence to people’s perspectives and experiences that can inform ment of Nepal adopted various preparedness Dr Navin Bhatt; population- targeted policies in the future. n. navin. bhatt@ gmail. com measures viz.: establishing and strengthening Bhatt N, et al. BMJ Open 2020;10:e043312. doi:10.1136/bmjopen-2020-043312 1 Open access BMJ Open: first published as 10.1136/bmjopen-2020-043312 on 12 December 2020. Downloaded from the health desk at International Airport, Nepal–China towards COVID-19 and their experiences about the social and Nepal–India borders; designating COVID-19 hospi- distancing measures applied by the government during tals—to prevent and control infection and provide critical the COVID-19 pandemic in Nepal. care where available; procuring and stockpiling Personal Protective Equipment (PPE), laboratory items and venti- lators; and allocating spaces for quarantine purposes METHODS throughout the country. Moreover, the risk communica- Study design tion protocol was developed, prevention and protection The phenomenological approach of qualitative research messages were disseminated in local languages, and case design was used due to lack of previous studies on the investigation and contact tracing were carried out. The topic for Nepal. The use of phenomenological approach surveillance systems, screening at point of entries, and helped explore and understand people’s own perspec- community level screening and testing were also strength- tives and description of the events from their lived 9 ened, and the Rapid Response Team was mobilised. experiences.19 This approach was also instrumental in On 20 March 2020, the government of Nepal enforced identifying key topic areas and interview guide for data a complete lockdown of the country that included the collection based on the preliminary interactions with the suspension of international and domestic flights, restric- research participants. This study was conducted from tions on movement and mass gathering, and closures of March to June 2020. the schools and colleges, businesses and services apart from those considered essential. People were urged to Researcher characteristics and reflexivity 10 stay at home maintaining social distance. The interviewer team comprised of experts from different The unintended effects among people at all levels are health fields that included two public health researchers, many, ranging from anxiety/stress to reduced freedom two medical doctors and one postgraduate resident on daily living, and from fear of the unknown to loss of who had the experience of conducting the qualitative 11 income sources. It has been reported that the strict and research design. Before the data collection, an online prolonged lockdown has various effects such as effects on video meeting was conducted for all the members of the maternity services and rise in maternal deaths, effects on research team on interviewing, facilitating, recording, mental health and rise in suicide cases, effects on chil- note-taking and transcribing. The research team and the dren and adolescents, rise in domestic violence, impact research participants were not familiar with each other, on routine health services like child health and immuni- personally and professionally. sation, impacts on logistics and supply management, and impacts on farming.12 A study conducted in Nepal showed Study sites that 41.9% of health workers had symptoms of anxiety, Based on proximity to greater risk factors of an outbreak 37.5% had depressive symptoms, 33.9% had symptoms of in Nepal and to include diverse population from different http://bmjopen.bmj.com/ insomnia and more than half of the health workers faced geographical regions of Nepal having heterogeneity of stigma.13 health facilities, culture, tradition, people’s behaviour A study in India reported that the knowledge and prac- and geographical access to the effective health services, tice towards COVID-19 pandemic among people is good Kathmandu, Kanchanpur, Bajura and Jhapa districts but still there was a gap in right perception.14 Similarly, were selected purposively. The population profile of the in the USA and the UK, people had important miscon- districts is described in online supplemental file 1. The ceptions about COVID-19 whereas, in Nepal, a study location of the study sites in different districts is listed reported that the overall knowledge of COVID-19 was in table 1. The municipalities in the district were conve- on September 23, 2021 by guest. Protected copyright. high and the majority of people had a positive perception niently selected and wards were selected randomly. towards universal safety measures.15 The future trajectory of the COVID-19 pandemic Study population and sampling technique largely depends on the behaviour