Local Language Research Articles

Challenges in Obtaining and Seeking Information Among Breast Cancer Survivors in an Asian Country: a Qualitative Study.

Breast cancer survivors on adjuvant endocrine therapy (AET) have distinct information-seeking experience compared to those in the diagnosis and intensive treatment phase. This study aimed to understand the challenges in obtaining and seeking information among Malaysian breast cancer survivors. We conducted semi-structured, one-to-one interviews among patients using AET from two hospitals and a local cancer organization. Interviews were conducted until theme saturation was achieved (N = 25). Interviews were de-identified, transcribed verbatim, and analysed using thematic analysis. To ensure rigor, coding was conducted through regular discussions between two researchers and the findings were shared with several participants after analysis was completed. Three main themes were identified: limitations in the healthcare system, pitfalls of seeking information online, and limited information from local sources. The participants perceived that their information needs were not met by their healthcare providers and sought information on the Internet to complement their information needs. However, they were faced with risks of misinformation, information overload, and unethical promotion of health products. Those with limited English proficiency had difficulties in accessing quality information, and suggested that there should be more content created by local health advocates in local languages, with information that is tailored for local cultures. As the Internet has become an important medium of health education, healthcare providers and patients should be equipped with the skills to share and search for information online. Digital health literacy needs to be incorporated in patient education modules to create a more informed and empowered patient community.

Learning to safeguard: exploring adult safeguarding officers' readiness for online learning and their perceptions of a blended learning safeguarding training programme

PurposeThis paper aims to present commentary on adult safeguarding designated officers’ (nominated senior staff members in the Health Service Executive and its funded services) in Ireland readiness for online learning and their perception of the blended approach used in their training and considers the implications of this for practice.Design/methodology/approachIn total, 233 designated officers were surveyed. A self-administered online survey comprising of two instruments was used. The questionnaire combines two previously validated tools measuring readiness for online learning and perceptions of blended learning. Minor modifications were made to account for local circumstance and language. Demographic questions relevant to the survey population were added. The response rate was 49%.FindingsDesignated officers regarded specified competencies for online learning as important to very important with highest importance placed in time management. Designated officers expressed they were confident to very confident in their ability to accomplish all competencies in online learning. The highest confidence was in the technical competencies. Designated officers are demonstrating high readiness for online learning. Designated officers reported positively on online contributions and on blended learning workload. The scores indicate positive perceptions of the blended learning experience. Responses to an open-ended question were largely positive with some suggestions for improvement made.Practical implicationsFindings have helped inform planning and development of the Health Service Executive’s adult safeguarding training for designated officers with changes made since this survey was undertaken.Originality/valueTo the best of the author’s knowledge, this is the first time a survey was undertaken of designated officers in Ireland with a view to improving safeguarding training. Recommendations for adaptions to the blended designated officer programme were proposed and subsequently accepted and implemented.

Reflections on the vernacular mosques in the Souf region, Algeria. An attempt to Inventory the local architectural language

Reflections on the vernacular mosques in the Souf region, Algeria. An attempt to Inventory the local architectural language

Where It Really Matters: Few-Shot Environmental Conservation Media Monitoring for Low-Resource Languages

Environmental conservation organizations routinely monitor news content on conservation in protected areas to maintain situational awareness of developments that can have an environmental impact. Existing automated media monitoring systems require large amounts of data labeled by domain experts, which is only feasible at scale for high-resource languages like English. However, such tools are most needed in the global south where the news of interest is mainly in local low-resource languages, and far fewer experts are available to annotate datasets on a sustainable basis. In this paper, we propose NewsSerow, a method to automatically recognize environmental conservation content in low-resource languages. NewsSerow is a pipeline of summarization, in-context few-shot classification, and self-reflection using large language models (LLMs). Using at most 10 demonstration example news articles in Nepali, NewsSerow significantly outperforms other few-shot methods and can achieve comparable performance with models fully fine-tuned using thousands of examples. With NewsSerow, Organization X has been able to deploy the media monitoring tool in Nepal, significantly reducing their operational burden, and ensuring that AI tools for conservation actually reach the communities that need them the most. NewsSerow has also been deployed for countries with other languages like Colombia.

“Only this time in English”

While English is widely used as the working language in multinational companies, local languages still play an important role in the workplace. This puts international employees in a difficult position, as they face pressure to become competent in the local language in addition to being proficient in English. This paper aims to shed light on the language learning experience of migrant engineers in Norway by exploring their investment (Darvin & Norton, 2015) in learning Norwegian and its interplay with their language learning trajectories. The analysis of the participants’ autobiographic narrative accounts (Pavlenko, 2007) shows that different workspaces lead to different ideologies at play and a shifting value of linguistic capital over time. The reported language practices in the workplace devalue the participants’ English language capital and create pressure for them to use Norwegian for work. Despite the participants’ investment in learning the local language(s), it does not always translate to a sense of belonging and career progression due to ideologies that marginalize these migrant employees, such as raciolinguistic ideologies (Alim et al., 2016). This study provides new insights into the lived experience of highly skilled professionals as learners of languages other than English in multinational companies.

Re-thinking the Future of the English Preparatory Program in the Context of Higher Education in Kuwait

This paper examines the complex role of English within the context of Kuwait's higher education. The role of English as a mediator between Kuwait and the Western world has catalyzed the rise of institutions offering 'American-style' education across the region, leading to the proliferation of courses delivered in English as a Medium of Instruction (EMI). Such institutions have adopted a monolingual policy with the intention of enhancing students' career opportunities through proficiency in English. At the same time, an 'English only' discourse seems to negatively affect local knowledge, language, and culture, leading to their marginalization. This study highlights the tensions between the global appeal of English for job market readiness and the local cultural and linguistic realities that are marginalized by an English-medium instructional policy. The article sets out to examine the dominant monolingual discourse at the English Preparatory Program (EPP) at one university in Kuwait, henceforth referred to as 'the university' . The study identifies several concerns, including the impact of globalization in promoting the misguided belief in English as the sole avenue to success, the cultural and linguistic disconnect in the curriculum, and the inadequacy of westernized teaching approaches. By drawing on theories of postmodernism and postcolonialism, this paper proposes strategies to disrupt colonial and neo-colonial frameworks within the EPP and suggests a more balanced approach to English language teaching that values both global and local perspectives.

Assessing the Influence of Taxpayer Services on Value Added Tax Compliance among Small and Medium Enterprises in Zanzibar

Recent years have seen SMEs' tax compliance become a major challenge. Many SMEs in developing countries struggle with VAT compliance, despite their important economic contributions. However, the factors that affect SMEs' VAT compliance in Zanzibar are understudied, leaving a major information vacuum that must be filled. To fill this information vacuum, this work investigates extensively by utilizing a cross-sectional research design. This technique enabled the collection of 400 SMEs data, whereas the logit model and propensity score matching were used for data analyses. The logit model results reveal that simplified tax systems, computerized tax payments, tax audits, and taxpayer services improve VAT compliance. Providing tax audits to SMEs in Zanzibar annually increases VAT tax compliance by 11%, while tax knowledge increases the chance of SMEs complying with VAT tax by 10 percent. Conversely, secondary and university education lowered compliance. University education decreases the probability of SMEs complying with VAT tax by 57%. An investigation of matching propensity scores showed that VAT compliance hurt SMB income. Compliant SMEs lost money due to electronic tax payments and IT tax management systems. In contrast, non-compliant SMEs reported higher incomes after adopting EFDs. Research outcomes lend to the sustainable growth and development of small and medium-sized enterprises (SMEs) in Zanzibar. They also reinforce the government's efforts at revenue mobilization in a way that enhances economic stability. It is recommended that governments should simplify tax systems, provide clear guidelines in local languages, and implement categorization based on size and turnover.

Adherence to Anti-seizure Drugs and Associated Factors among Children with Epilepsy in central Sudan

Background: Epilepsies are the most common neurological disorder in children worldwide. They result in disability or even death. Adherence to anti-seizure drugs (ASDs) is challenging for children with epilepsies. Methods: This cross-sectional descriptive study was conducted on 67 children with epilepsies age between (2-16 years of age) on follow up visits at neurology refer clinic at Wad Medani Pediatric Teaching Hospital; Central Sudan from February to July. 2022. Adherence to ASDs was measured using Morisky’s Medication Adherence Scale eight – items (MMAS-8) translated to the local language. Descriptive analysis was conducted to calculate frequencies and percentages for categorical data, chi-square test for associated factors with adherence. A P-value of < 0.05 was considered statistically significant. Results: Gender analysis showed that 36 (53.7%) of patients were males. Forty-eight (71.6%) had good adherence to their medications. Thirty-three (49.3%) had 1-12 seizures/year. Thirty-nine (58.2%) of participants had generalized seizures while 22 (32.8%) had focal seizures. Sixty-six (95.5%) of study patients on poly therapy had good adherences. Adherence was not found to be associated with sex, age, parental education, employment status, ASDs, duration of epilepsy, type of epilepsy, seizures frequency or monotherapy versus poly therapy (p value > 0.05).

INCORPORATING LESSON PLAN IN DEVELOPING AN ITINERARY FOR A TOUR PACKAGE TO PROMOTE LOCAL CULTURE: A CASE STUDY IN KAMPOENG WISATA CINANGNENG, BOGOR REGENCY

Studies on tourism in Bogor have focussed on community-based tourism, natural and outdoor tourism, the preservation of natural environment and culture of its people. This research in particular focuses on specifically combining local culture and language learning.The aim of this study is to shed light on how lesson plans can be incorporated in developing existing tour packages of a tourist attraction that promotes local culture. It proposes lesson plan by Brown and the notion of Engage-Study-Activate by Harmer. Using qualitative approach, Kampoeng Wisata Cinangneng located in Bogor Regency is chosen as case study. As the tour packages in Kampung Wisata Cinangneng are popular amongst elementary school students to teenagers, the lesson plans are limited to these age groups. Data collection techniques applied in this study were literature studies, observations, interview and documentation. The findings also support the use of six stages for analysis to design and develop an itinerary as part of a tour package. The stages involve determining a tourist attraction that promote local culture, studying its tour packages or programs to seek the target market and what it advertises, identifying unique local culture advocated from the tourist destination, determining local culture which can be incorporated with language learning, researching further the local culture selected. The last stage entails, applying Browns’ lesson plan and Harmers’ Engage-Study-Activate in the procedure. The stages of analysis proposed is seen crucial to make tour packages not only entertaining but also have educational value. In this case, preserving and promoting local culture. Drawing on the results, this study gives an advantage in the applicability of writing a lesson plan that focuses on local culture and language learning for an itinerary.

Determinants of consumer adoption of multilingual self-service ordering systems in fast food restaurants

Due to the increasing number of international exchanges, foreign users have gradually become a significant consumer segment. Many of them are not proficient in the local language. Providing them with native language services will be an important trend, both from a business and a humanistic perspective. The purpose of this study is to investigate the fast-food restaurant ordering system that can provide multilingual services for foreigners, and to investigate factors that influence fast food restaurant consumers to adopt multilingual self-service ordering systems. Based on the characteristics of foreign users, we have proposed experience factors such as convenience, translation quality, social anxiety, and the Flow. According to research, the convenience of the service has a strong direct impact on consumers' intention to use, social anxiety has a weak direct impact on consumers' intention to use, and translation quality has a weak direct impact on consumers' intention to use through the intermediate variable of social anxiety. Particularly, Flow experience is not associated with intention to use. The Flow state is one in which users are completely immersed and do not notice time or the surroundings when the perceived difficulty of a task matches their abilities. The purpose of this study is to improve our understanding of the customer evaluation criteria for multilingual self-service systems, as well as to establish the MSSS model for future research on multilingual self-service systems.

Diversity without Adversity? Ethnic Bias toward Refugees in a Co-Religious Society

Abstract What shapes the host population’s willingness to accept refugees into social, economic, and political life in their country? We argue that refugees’ ethnicity plays a key role—both directly and indirectly—in shaping support for having refugees as neighbors and for granting them a work permit or citizenship. Fielding a conjoint experiment in Turkey (N = 2,362), we find that locals discriminate against Syrian Arab and Kurdish refugees compared to Turkomans. Although a university degree, social ties with locals, and knowledge of language boost prorefugee attitudes, ethnic bias may attenuate their effect. For example, local language knowledge increases support for Arab refugee profiles, but only when it comes to granting them a work permit, but not having them as neighbors or granting citizenship. In contrast, it increases support for profiles of Turkomans and Kurds in all the three domains. Thus, strategies such as learning the local language may not advance all refugees in all domains.

Islam's Integration with Local Culture through the Custom of Reciting the Qur'an at Death

Lasi, which is in Agam Regency, West Sumatra Province, is an area rich in Islamic culture and traditions. One of the Islamic traditions there is the recitation of death. The tradition of reciting the Qur’an for death is a practice that combines elements of the Islamic religion with local cultural values. This research aims to determine the integration of Islam and local culture manifested in the practice of reciting the Qur’an for death in the Lasi community. The research method used in this research is a field research method that uses a qualitative approach by conducting in-depth interviews with members of the Lasi community who are involved in the tradition of reciting the Qur’an for death. Direct observations were also carried out to understand the implementation of this practice. Qualitative data was carefully analyzed to identify patterns of integration between Islamic religion and local culture in the context of the Qur’an for death. The results of this research reveal that the tradition of reciting the Qur’an for death in Lasi, Agam Regency, reflects close integration between the Islamic religion and local culture. The use of local languages in this tradition strengthens the community's cultural identity, while Islamic religious messages are also maintained. This tradition also plays a role in maintaining Lasi cultural values, connecting the younger generation to their cultural heritage, and strengthening community ties. This integration has helped maintain harmony between religion and culture, creating a model that can serve as an example for efforts to preserve culture and religion in an increasingly globalized society.

"There is nothing that can prevent me from supporting her:" men's perspectives on their involvement and support of women's use of topical therapy for cervical precancer treatment in Kenya.

Cervical cancer disproportionately impacts women in low- and middle-income countries (LMICs). The World Health Organization's (WHO) 90/70/90 strategy aims to eliminate cervical cancer by 2030 by increasing HPV vaccination coverage to 90%, screening 70% of eligible women, and effectively treating 90% of those with abnormal results by 2030, potentially preventing 62 million deaths in LMICs. LMICs, however, struggle with limited access to cervical precancer treatment, in part due to a lack of trained professionals and weak health systems. Effective non-surgical, self-administered, which have demonstrated efficacy in high-income countries, could bridge the treatment gap in LMICs and may be more scalable and cost-effective than provider-administered therapies. To inform feasibility studies in LMICs, data are needed on the role of male partners in influencing the acceptability and uptake of self-administered topical therapies, including their support of recommended abstinence and contraception guidelines associated with these therapies. Between November 2022 and April 2023, we conducted five focus group discussions (FGDs) with men aged 25 to 65 years in Kenya to explore their perspective and perceived support regarding their female partners using topical self-administered therapies for cervical precancer treatment. The FGDs were moderated by local qualitative research assistants and conducted in local languages, transcribed, coded, and analyzed using qualitative description. Thirty-nine male participants meeting the eligibility criteria participated in five FGDs. The mean age of participants was 42.5 years. Most participants, 79.5%, had a female partner with a history of cervical precancer treatment, 5.1% did not, and 15.4% were unsure of their female partner's prior precancer treatment history. The study aimed to assess men's support of their female partners' use of topical therapies for treating cervical precancer. We find that male participants strongly express acceptance and willingness to support their wives or partners in using such therapies, if available. Reported supportive behavior included permitting the use of the therapies and support of maintaining abstinence during the recommended times. Additionally, participants desired male involvement in clinic and community-based education about topical therapies to facilitate widespread support. The use of self-administered topical therapies for cervical precancer treatment, if supported by efficacy studies in LMICs, may support achieving the WHO's 2030 goal of 90% treatment access. We find that with adequate education, men express overwhelming support of their female partner's use of topical therapies, including adherence to abstinence and contraception guidelines.

The economic impact of agroforestry practice in production forest areas, Сentral Java province, Indonesia

The concept of Joint Community Forest Management in Indonesia is an effort to involve communities in forest management through agroforestry to support forest sustainability. Agroforestry (or persilan in local language) carried out by pesanggem in the KPH Kebonharjo and KPH Mantingan Working Areas significantly contributes to the pesanggem household income. This research wants to measure the provision of agroforestry on pesanggem household income and examine agroforestry factors that influence pesanggem household income. Data collection techniques through surveys and observations of 216 pesanggem households were carried out in the KPH Kebonharjo and KPH Mantingan areas, divided into eight villages respectively. The data was then analyzed descriptively and by multiple linear regression analysis. The research results found that the agroforestry pattern through land plots refers to agricultural activities by pesanggem in forest areas by utilizing forest land belonging to Perum Perhutani as agricultural/persilan for planting seasonal crops. Persilan contributions provide a moderate contribution to pesanggem households in KPH Kebonharjo and KPH Mantingan with a total contribution percentage of 38% or IDR 11,000,000 per household per year with details for each KPH Kebonharjo 44% (IDR 10,900,000 per household per year) and KPH Mantingan 33% (Rp. 11,200,000 per household per year). Based on the results of linear regression analysis, some variables significantly influence measurements with degrees of confidence of 85%, 95%, and 99%. The variables agricultural equipment (sig. 0.133), distance to agroforestry land (sig. -0.051), labor utilization (sig. 0.038), and land area of land persil (sig. 0.001) show an influence on the agroforestry income of pesanggem households in KPH Kebonharjo. In addition, the variables farming income (sig. -0.143), other income (sig. 0.048), area of land plots (sig. 0.037), and distance to agroforestry land (sig. 0.001) show an influence on the agroforestry income of pesanggem households, at KPH Mantingan. This research provides valuable insights into the complex relationships between agroforestry, production forests, and economic dynamics, providing a foundation for sound policy-making and encouraging environmentally conscious economic growth

Preliminary Data on the Use of Juncture as Marker for Phonetic Recall in an EFL Context

The study of juncture in the perspective of the English as a Foreign Language (EFL) context is limited, particularly to the one associated with the recalling process. This research aims to describe a glimpse of the juncture phenomenon by indicating the phonetic recalling process. An experimental method was applied to conduct the research. An experiment involving stimuli to phonetic knowledge was given to participants in the EFL context. There were twenty students involved in this experimental study. Analysed acoustically, the result of the preliminary data shows that junctures may occur during speech production of the stimuli with the indication of the phonetic recalling process at the syllabic level. This indication might refer to the participants’ attempt to re-access the phonetic knowledge stored in the brain. The pause duration might mark the occurrence of junctures, indicating phonetic recalling. It was also revealed that the participants’ attitudes towards the English might influence the occurrence of junctures. The study showed that junctures happened before pronouncing the words in monosyllabic words. In contrast, juncture might occur in the first, middle, and last syllable in multisyllabic words. The locations of junctures might relate to the most unfamiliar syllable of the words from the participants’ perspective. From this perspective, juncture may also occur in other speakers, not only Sundanese but also other foreign languages, not only English. This preliminary research may serve as a foundation to conduct a relevant study on the other local or regional languages in Indonesia.

Gender Perspectives on the Service Quality of Low-Cost Hotels

Service sector has recently become quite important to the global economy. The Nigerian government and numerous public sector investors are developing infrastructure and implementing sound business plans to take advantage of the hospitality industry's enormous potential in the service sector. However, due to the intense competition in the marketplace and the hospitality sector's rapid development, many businesses have felt pressure to distinguish themselves from rivals through superior customer service. Despite the level of competition among the low-cost hotels, most of the low-cost hotels in Nigeria still lack marketing concepts to attract guests. Previous studies on SERVPERF (service performance) model focused on other classes of hotels, neglecting low-cost hotels. Thus, this study analysed the SERVPERF dimensions regarding guests' satisfaction in low-cost hotels, from the demographic perspective (gender). Five undergraduate students received authorization from low-cost hotels to collect research data with the assistance of hotel employees. Each of the five survey teams consisted of a hotel employee who speaks and understands Hausa language (local language) as well as an undergraduate student from Federal University Gusau, Zamfara state, Nigeria. Data were collected from 300 guests at low-cost hotels and analysed through structural equation modelling (SEM). Composite reliability, Cronbach’s alpha and average variance extracted were used to test the reliability and validity of the instrument. It was revealed that assurance positively influenced male guests’ satisfaction, while reliability positively influenced female guests’ satisfaction in low-cost hotels. Furthermore, assurance negatively influenced female guests’ satisfaction. Male guests in low-cost hotels cherish the staff’s expertise and civility, as well as their capacity to instil trust and confidence. They want the hotel employees to make them feel comfortable while the services are being provided. The study’s practical implications are elucidated in this paper.

Detecting Hidden Illegal Online Gambling on .go.id Domains Using Web Scraping Algorithms

The profitable gambling business has encouraged operators to promote online gambling using black hat SEO by targeting official sites such as government sites. Operators have used various techniques to prevent search engines from distinguishing between genuine and illegal content. This research aims to determine whether websites with the go.id domain have been compromised with hidden URLs affiliated with online gambling sites. The method used in this research is an experiment using a FOFA.info dataset containing a complete list of 450,000 .go.id domains. A web scraping algorithm developed in Python was used to identify potentially compromised websites from the targeted listby analyzing gambling-related keywords in local languages, such as ’slot,’ ’judi,’ ’gacor,’ and ’togel'. The results showed that 958 of the 1,482 suspected.go.id sites had been compromised with an accuracy rate of 99.1%. This implies that security gaps have been exploited by illegal online gambling sites, posing a reputational risk to the government. Lastly, the scrapping algorithm tool developed in this research can detect illegal online gambling hidden in domains such as .ac.id, .or.id, .sch.id, and help authorities take necessary action.

Cultural tuning of a disaster education tool: A comparative study of Japan, El Salvador, and Mexico

This paper describes the cultural tuning (CT) of Bosai Duck, a disaster education tool developed in Japan, for use in El Salvador and Mexico as well as the impact of its adaptation, dissemination, and utilization by local stakeholders. CT is the process of adjusting and adapting a tool or initiative used in one culture for use in a different culture, thereby lessening cultural conflicts and culturally embedding the tool or initiative into its new context. By comparing the experiences in three countries, this study aims to identify the elements of CT (i.e., what was culturally tuned) and suggest methods for implementing CT effectively. This study was conducted against a background in which the inherently asymmetric and unidirectional structure of international support obstructs the full implementation of CT. For example, educational materials supplied by developed countries to developing countries are merely translated into the local language. This causes two problems. First, the desired results often do not persist, and second, the support may elicit cultural conflict in the developing country. Therefore, this study used action research to implement CT of the original Japanese Bosai Duck to create the Salvadoran version as well as the Mexican version. A comparison of three versions revealed that values in terms of how each society views the relationship between nature and society, norms in terms of weighing disaster risks, and procedures in terms of organizational hierarchy were culturally tuned. As a result, continuous use of the materials by local stakeholders was realized without causing cultural conflicts.

"I don't want my marriage to end": a qualitative investigation of the sociocultural factors influencing contraceptive use among married Rohingya women residing in refugee camps in Bangladesh

BackgroundThe timely provision of comprehensive contraceptive services to Rohingya women is impeded due to a lack of clarity and understanding of their traditional beliefs and cultural frameworks. Recognizing this challenge, our paper aims to explore the socio-cultural factors influencing the utilization of contraceptives among married Rohingya women living in the refugee camps of Cox's Bazar, Bangladesh.MethodA qualitative study was conducted in two unregistered Rohingya camps (Camp 7&14) located in Ukhiya Upazila, Cox's Bazar from January 10th to 20th, 2022. A total of 14 In-Depth Interviews (IDIs) were conducted among married Rohingya women of reproductive age (15–49 years), along with 16 Key Informant Interviews (KIIs) involving stakeholders engaged in reproductive healthcare provision. Participants were selected using purposive sampling. All interviews were conducted in the local language, recorded, transcribed verbatim, and subsequently translated into English. The data were analyzed using NVivo (Version 11), and the analysis process followed Neuman’s three-phase coding system.ResultsFive broad themes were identified: Sociocultural expectations and values attached to births, power imbalances within marital relationships, the role of religious beliefs, fear of side effects, and misperceptions about contraception. Having a larger number of children is viewed positively as it is believed that children play a crucial role in preserving the lineage and contributing to the growth of the Islamic population. Despite expressing an inclination towards contraception, the disapproval of husbands becomes a significant barrier for women. Defying their husbands' wishes can result in instances of Intimate Partner Violence (IPV) and even marriage dissolution within the camps. Moreover, the fear of side effects, such as a particular method would cause infertility, discourages women from using contraception. Many of these fears stem from myths, misconceptions, and mistrust in the existing medical system.ConclusionAddressing the socio-cultural barriers that prevent women from using modern contraception will have important public health implications. These findings can support in crafting culturally sensitive programs and educational interventions. These initiatives can assist Rohingya refugee women in planning their pregnancies and reducing high-risk pregnancies, ultimately leading to a decrease in maternal mortality rates within the community.

Challenges in Effective Referral of Cardiovascular Diseases in Nepal: A Qualitative Study from Health Workers' and Patients' Perspective.

Nepal, currently facing a high burden of noncommunicable diseases (NCDs), including cardiovascular diseases (CVDs), which poses the highest mortality rate in the country, does not seem to have a proper referral strategy. This study explored the wide range of factors and challenges that affect the referral system of CVD cases in Nepal. In this qualitative study, we conducted face-to-face and telephone interviews with purposely selected 57 key participants which included 35 healthcare professionals from tertiary, secondary, and primary levels from Bagmati Province and 22 CVD patients (myocardial infarction and stroke) from Bagmati and Madhesh Provinces. We interviewed them using an interview guide with open-ended questions for in-depth information in a local language and in a private space. The interviews were audio-recorded, transcribed verbatim, coded, and analyzed using the thematic approach. The findings indicated that the referral system for CVD cases from primary- to secondary- to tertiary-level care is inadequate and malfunctioning. The major factors affecting referral of CVD cases are centralization of CVD-specific services in few urban areas, inadequate systematic communication between the centers, self-referential, lack of human resources for CVD care, and obstacles to patient transfer due to geographical and financial reasons. A referral system for CVD patients is absent in the context of Nepal. Understanding and addressing key factors that affect the referral system of CVD patients may help to improve cardiac outcomes and ultimately save lives.