Peer-reviewed article
Educating for equity, navigating reality: community health nurses implementing interventions to eradicate Chhaupadi in Karnali, Nepal.
Ghimire A, Neupane MS ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study explores how community health nurses in Nepal's Karnali Province implement educational interventions to end Chhaupadi, a practice of menstrual seclusion that harms girls' and women's health and wellbeing. Through interviews with eleven nurses actively involved in eradication efforts, the research identifies how nurses adapt their teaching for cultural sensitivity while facing challenges from resource scarcity, policy gaps, and community resistance. The findings show that ending Chhaupadi requires not just frontline education but also systemic support, inter-sectoral collaboration, and recognition of the complex social dynamics that sustain the practice.
Key points
- Community health nurses use culturally sensitive communication strategies and pedagogical adaptations to educate communities about Chhaupadi's harms
- Nurses struggle to measure the effectiveness of their interventions and define success in contexts where practices are concealed and cultural resistance persists
- Systemic constraints including resource scarcity, policy-practice gaps, cultural resistance, and workforce instability undermine intervention delivery
- Effective eradication requires targeted support for nurses, culturally appropriate intervention design, and enhanced resource allocation
- Inter-sectoral collaboration and sustained engagement with multiple stakeholders are essential for translating health education policy into practice
Limitations
This is a qualitative study based on interviews with nurses and does not measure actual changes in Chhaupadi prevalence or health outcomes among girls and women. The study captures nurse perspectives rather than community or family experiences of the interventions.
Abstract
BACKGROUND: Chhaupadi—a customary practice of menstrual seclusion rooted in notions of ritual impurity—persists in parts of Nepal, including Karnali Province, despite legal prohibition. Contemporary evidence has associated this practice with adverse health risks and psychosocial distress among women and girls. Community Health Registered Nurses (CHRNs) operate on the frontline of health services and are strategically positioned to deliver educational interventions addressing Chhaupadi. However, their specific experiences in designing and implementing such interventions, as well as the challenges and perceived effectiveness within this complex context, remain critically under‑explored. METHODS: This qualitative study employed an interpretive description approach. In-depth, semi-structured interviews were conducted with eleven CHRNs, selected based on purposive sampling for their active involvement in Chhaupadi eradication efforts. Initial participant recruitment utilized convenience sampling through self-registration via advertised flyers, which was supplemented by snowball sampling to reach more participants. An overarching maximum variation strategy guided the final sample composition to ensure diverse perspectives. Data were analyzed inductively through thematic analysis. RESULTS: Four interconnected themes emerged, depicting the operational realities faced by CHRNs: (1) Capacity Building at the Frontline, illustrating their pedagogical adaptations and culturally sensitive communication strategies; (2) Addressing Gaps and Navigating Complex Realities, highlighting the necessity for direct CHRN’s interventions and the intricacies of stakeholder engagement amid concealed practices; (3) Gauging Ripple Effects, revealing the profound challenges in measuring training effectiveness and defining success within an environment characterized by systemic ambiguities; and (4) Navigating System Constraints, detailing the impact of resource scarcity, policy–practice gaps, enduring cultural resistance, and workforce instability. CONCLUSION: This study reveals the multifaceted interplay between CHRN’s agency, community dynamics, and broader systemic factors in efforts to eradicate Chhaupadi. The results emphasize the need for targeted CHRN’s support, culturally congruent intervention design, enhanced resource allocation, and inter-sectoral collaboration to ensure effective policy enforcement and sustainable program delivery. By illuminating the frontline challenges of translating health education policy into practice, these findings contribute critical evidence for advancing health equity and gender equality in Nepal and similarly affected contexts, reinforcing the essential role of Community Health Registered Nurses as skilled facilitators and strategic navigators of social change. CLINICAL TRIAL NUMBER: Not applicable.
Findings the Hub has extracted
Each claim below is labelled by its type of design and links back to this report.
- Intervention
- Health education interventions delivered by community health nurses using culturally sensitive communication strategies to educate communities about Chhaupadi's harms
- Population
- Community Health Registered Nurses (n=11) actively involved in Chhaupadi eradication efforts in Karnali Province, Nepal
Key finding
Nurses successfully adapted pedagogical approaches and used culturally sensitive communication strategies to deliver education
A et al. · Europe PMC · 4 Nov 2025