Facilitators and barriers to participation in health mothers’ groups in improving maternal and child health and nutrition in Nepal : A mixed-methods study

BACKGROUND: In Nepal, Health Mother’s Groups (HMG) are women’s group-based programmes for improving maternal and child health. However, they remain underutilised with only 27% of reproductive-aged women participating in an HMG meeting in 2016. This study aimed to understand the facilitators and barriers to HMG meeting participation. METHODS: We conducted a convergent mixed-methods study using cross-sectional quantitative data from the 2016 Nepal Demographic and Health Survey and primary data collected via 35 in-depth interviews and eight focus group discussions with 1000-day women and their family members, female community health volunteers (FCHVs) and health facility staff in two geographies of Nepal, Kaligandaki and Chapakot. Quantitative data were analysed using logistic regression and qualitative data using deductive coding. The results were triangulated and thematically organised according to the socio-ecological model (SEM). RESULTS: Facilitators and barriers emerged across individual, interpersonal and community levels of the SEM. In the survey, women with more children under five years of age, living in a male-headed household, or in rural areas had increased odds of HMG participation (p < 0.05) while belonging to the Janajati caste was associated with lower odds of participation (p < 0.05). Qualitative data helped to explain the findings. For instance, the quantitative analysis found women’s education level associated with HMG participation (p < 0.05) while the qualitative analysis showed different ways women’s education level could facilitate or hinder participation. Qualitative interviews further revealed that participation was facilitated by women’s interest in acquiring new knowledge, having advanced awareness of the meeting schedule and venue, and engagement with health workers or non-government organisation staff. Participation was hindered by the lack of meeting structure and work obligations during the agricultural season. CONCLUSIONS: To improve women’s participation in HMGs in Nepal, it is necessary to address factors at the SEM’s individual, interpersonal, and community levels, such as enhancing FCHV literacy, providing advance notice of the meeting schedule, upgrading the meeting venues and reducing women’s workload through family support, particularly during agricultural season. These improvements are essential for strengthening effective implementation of HMG meetings and similar women’s group-based platforms, and for ultimately improving maternal and child health in Nepal.