Table 1 Factors influencing healthcare service utilisation in Nepal

1

(Acharya 2010) [52]

To establish the most important socio-background characteristics associated with women’s decision-making power

Cross sectional

8257 married women

Women with high education level have greater autonomy in the decision making for their own healthcare.

2

(Allendorf 2007a) [37]

To comparing spouses’ reports of women’s autonomy with health outcomes in Nepal.

Cross sectional

1858 currently married couples

Women with higher autonomy for household decisions have more access to healthcare.

3

(Allendorf 2007b) [42]

To explore the connections among women’s land rights, women’s empowerment, and child health in Nepal

Cross sectional

4884 women

Children of women with decision making power in the family were less undernourished.

4

Atteraya 2010 [41]

To examine the relationship between women’s autonomy and ability to negotiate safer sex practices among married women.

Cross sectional

8896 married women

Women with higher autonomy in household decision making could also negotiate safe sex.

5

Baral 2010 [63]

To identify the issues associated with women’s role and choices regarding use of Skilled Birth Attendants and to explore factors affecting utilisation of maternal health services in Nepal.

Review

Number of papers not mentioned

Availability of transportation and distance to the health facility, lack of infrastructure and services, availability and accessibility of the services, healthcare cost; inadequate staff, women’s status in the society; women’s involvement in decision making; contribute to utilisation of Skilled Birth Attendance for delivery.

6

Baral 2012 [33]

To identify the range and pattern of maternal health service utilisation in Nepal over

Review

Number of papers not mentioned

Women with higher education and living in urban areas are more likely to use maternal health services.

7

Bhatta 2015 [30]

To assess associated paternal factors and degree of inequity in access to maternal healthcare service utilization.

Cross sectional

2200 men

Husbands with higher education and higher income facilitate their wives to make ANC visits and institutional delivery.

8

Bhattarai 2015 [47]

To explore health seeking behavior and utilization of healthcare services in the rural places in VDCs of Ilam district

Cross sectional

300 men and women

People seek healthcare from traditional healers due to perception of high cost in modern medicine. Private institutions are preferred compared to the public.

9

Bhusal 2011 [48]

To find out the effectiveness and efficiency of Aama Surakshya Karyakram to address barrier in accessing maternal health services in Nepal.

Cross Sectional

47 women

Pregnant mothers were not aware of the provision of incentive for institutional delivery. Of those who were aware, did not know what the incentive was for. Financial incentives are seen to increase the utilisation of maternal health services.

Methods:

10

Budhathoki 2014 [60]

To find the factors associated with awareness of occupational hazards and protective measures and the use of protective measures, and the possible relationship between awareness and actual use of PPE.

Cross sectional

300 welders

Welders with higher education are more aware of the hazards and utilise more protective measures.

11

Brunson 2010 [55]

To identify impediments to receiving obstetric care in a context where the infrastructure and services were in place. This

Qualitative

30 women

Women are not aware about the general danger signs of pregnancy, which in turn hinders timely seeking of pregnancy care.

12

Byrne 2013 [65]

To identify demand-side barriers to the utiliza- tion of formal RMNCH services in the Mountains ecological region of Nepal

Review

23 papers

Low status of women, caste discrimination, less knowledge of healthcare, less active mothers groups, dissatisfaction quality of care, health worker attitudes and cultural/spiritual traditions affect healthcare utilisation.

13

Chapagain 2006 [39]

To appraise conjugal power relations and explore the nexus between such relations and couples’ participation in reproductive health (RH) decision-making.

Cross sectional

223 married couples

Gender power relations, traditional gender roles and cost associated with service affects reproductive healthcare decision making.

14

Choulagain 2013 [56]

To examine the characteristics associated with utilization of SBA services in mid- and far-western Nepal

Cross Sectional

2,481 women

Women’s awareness of danger signs of pregnancy, distance from health facilities and inadequate transportation pose major barriers to the utilisation of skill birth attendants’ services.

15

Furuta 2006 [36]

To examine the influence of four indica- tors of women’s household position on the receipt of skilled antenatal and delivery care: their involvement in decision making about their own healthcare and about large household purchases, their employment and control over their own earnings, and their discussion of family planning with their husbands.

Cross sectional

4,695 currently married women

Women supported by husbands, women with higher education were more likely to seek maternal healthcare.

16

Ghimire 2009 [64]

To identify the barriers of access to sexual health services by FSWs in Nepal

Mixed-method

425 female sex workers (FSWs) for quantitative survey and 15 FSWs for in-depth interview

Lack of confidentiality, discriminatory attitudes by healthcare providers, communication gap with service providers and fear of public identification as a sex worker were barriers in seeking sexual health services by the female sex workers.

17

Gubhaju 2009 [54]

To provide indepth examination of the link between husbands’ and wives’ education levels and method of choice of family planning.

Cross Sectional

21,057 women

Level of education of husband and wives affects the choice of family planning method adopted by women.

18

Halim 2011 [51]

To examine the correlates and consequences of antenatal care utilization in Nepal

Cross sectional

3,549 mothers and 2,460 children (0–36 months)

Maternal & paternal education play important role in the utilisation of routine antenatal care.

19

Hotchkiss 2001 [25]

To assess the impact of this investment on the use of maternal healthcare services.

Cross Sectional

1,434 women of reproductive age

Physical access to a healthcare facility affects the utilisation of maternal health services.

20

Iriyama 2007 [59]

To examine the associations between two subscales, perceived severity and perceived susceptibility, and the abstinence intentions of male adolescent students in Nepal.

Cross sectional

297 male students

Knowledge of HIV AIDS among adolescents affected their sex behavior.

21

Jahn 2000 [66]

To assess the performance of maternity care and its specific service components (preventive interventions in antenatal care, antenatal screening, referral, obstetric care) in Banke District, Nepal

Cross Sectional

136 pregnant women, 146 postnatal women

Availability of comprehensive maternal healthcare was associated with higher utilisation of the services.

22

Mishra 2005 [29]

To analyse the contribution of socio- economic status to non-adherence to DOTS.

Case–control

50 cases of tuberculosis and 100 controls

High travel cost to reach the treatment facility, low socioeconomic status affects non-adherence to anti-tuberculosis treatment.

23

Mullany 2006 [44]

To understand the barriers to male involvement in maternal health and explore men’s, women’s, and providers’ attitudes towards the promotion of male involvement in antenatal care and maternal health.

Qualitative

31 couples and 9 women

Low levels of knowledge are associated with less involvement of males in maternal healthcare of their wives.

24

Mullany 2007 [40]

To test the impact of involving male partners in antenatal health education on maternal healthcare utili- zation and birth preparedness in urban Nepal

Randomised controlled trial

442 antenatal women

Women who received education with their husbands have better birth preparedness.

25

Mullany 2005 [45]

To investigate patterns of household decision-making and the context of male involvement behaviors in Katmandu, Nepal

Cross sectional

592 pregnant women

Good communication between husband and wife leads to increased involvement of husband in maternal healthcare.

26

Onta 2014 [57]

To explore the perceptions of service users and providers regarding barriers to skilled birth care

Qualitative

12 FGDs (7–10 women per group) & 12 FGDs (7–10 ANC service providers)

Inadequate knowledge of services, distance to health facilities, unavailability of transportation, and poor availability of skilled birth attendants, poor infrastructure, less service coverage, inadequate awareness about services/facilities, cultural practices and beliefs, and low prioritization of birth care are barriers to maternal healthcare.

27

Pokhrel 2004 [31]

To map out a hierarchical scale of household decision-making regarding child healthcare.

Cross sectional

8,112 adults

Household income and mother’s education is associated with healthcare seeking for children.

28

Poudel 2015 [50]

To find the existing knowledge gap about the economic burden of HIV/AIDS at the household level in Nepal

Review

7 papers

Lack of awareness of potential economic burden of HIV/AIDS upon household exists in the community.

29

Poudel 2004 [62]

To identify Nepali migrants’ vulnerability to HIV/STIs, and to explore the possible role of migration in causing the HIV/STI epidemic in far western Nepal.

Qualitative

60 migrants

Low knowledge on and low perceived vulnerability to HIV/STIs led to risky behaviour among migrants.

30

Powell-Jackson 2009 [49]

To explore early implementation of the programme at the district-level to understand the factors that have contributed to its low uptake

Qualitative

55 key informants from district health service

Bureaucratic delays in the disbursement of funds, gaps in policy communication to implementers and prople affects utilisation of safe delivery services.

31

Puri 2006 [61]

To analyze the sexual behavior, perceived risk of contracting STIs and HIV/AIDS, and protective behaviors of migrant workers

Cross sectional

1,050 factory workers

Migrant workers are not aware about the consequences of unsafe sex and transmission of HIV.

32

Regmi 2010 [76]

To explore the barriers to using sexual health services, including condom-use among young people in Nepal

Qualitative

50 youth for FGD and 31 in depth interviews

Poor sexual and reproductive health knowledge is a barrier in utilisation of sexual health services among the young people

33

Shah 2015 [38]

To identify the socio-demographic, socio-cultural, and health service-related factors influencing institutional delivery uptake in rural areas of Chitwan district,

Cross sectional

673 women

Role of the husband, role of wife in household decision making, access to material resources, literacy rates, dependency on husband, geographical accessibility, and lack of established transportation infrastructure affects the utilisation of institutional delivery services by women.

34

Sharma 2007 [32]

To examine the association of access to health services and women’s status with utilization of prenatal, delivery, and postnatal care

Cross sectional

3,845 women

Maternal health worker visits, educational status of women, household economic status, number of living children and place of residence are associated with utilisation of maternal health services.

35

Simkhada 2006 [53]

To identify some challenges and suggests way forward in the improvement of maternal health in Nepal.

Review

Number of papers not mentioned

Lack of access to basic maternal healthcare, difficult geographical terrain, poorly developed transportation and communication systems, poverty, illiteracy, women's low status in the society, political conflict, and shortage of healthcare professional are barriers to maternal health in Nepal.

36

Smith-estelle 2003 [46]

To identify isues that affect vulnerability to HIV/STI infection among rural women from migrant communities in Nepal

Cross Sectional

900 ever-married women

Gender discrimination, lack of access to healthcare and education in rural areas, and the precarious economic, legal and social circumstances make the women more vulnerable to HIV/STI.

37

Updhyay 2014 [43]

To determine the perceived influential person on a woman’s decision to utilize antenatal and delivery care services among teen, young adult and adult pregnant women

Cross sectional

315 women

Involvement of husband in family planning decision for healthcare seeking for maternal health services.

38

Witter 2011 [71]

To understand the effects of the policy on health facilities. Study methods included structured forms to retrieve financial and activity data from national, district and facility records

Qualitative

Health managers from 22 health facilities

The utilisation of delivery services is facilitated by availability of free services.