There is increasing access to mental health services in biomedical settings (e.g., primary care and specialty clinics) in low- and middle-income countries. Traditional healing continues to be widely available and used in these settings as well. Our goal was to explore how the general public, traditional healers, and biomedical clinicians perceive the different types of services and make decisions regarding using one or both types of care. We conducted in-depth interviews using a pilot tested semi-structured protocol around the subjects of belief, traditional healers, and seeking care. We conducted 124 interviews comprising 40 traditional healers, 79 general community members, and five physicians. We then performed qualitative analyses according to a grounded theoretical approach. A majority of the participants endorsed belief in both supernatural and medical causes of illness and sought care exclusively from healers, medical practitioners, and/or both. Our findings also revealed several pathways and barriers to care that were contingent upon patient-, traditional healer-, and medical practitioner-specific attitudes. Notably, a subset of community members duplicated care across multiple, equally-qualified medical providers before seeing a traditional healer and vice versa. In view of this, the majority of our participants stressed the importance of an efficient, medically plural society. Though participants desired a more collaborative model, no consistent proposal emerged on how to bridge traditional and biomedical practices. Instead, participants offered suggestions which comprised three broad categories: (1) biomedical training of traditional healers, (2) two-way referrals between traditional and biomedical providers, and (3) open-dialogue to foster mutual understanding among traditional and biomedical providers. Participants offered several approaches to collaboration between medical providers and traditional healers, however if we compare it to the history of previous attempts, education and understanding between both fields may be the most viable option in low- and middle-income contexts such as Nepal. Further research should expand and investigate opportunities for collaborative learning and/or care across not only Nepal, but other countries with a history of traditional and complimentary medicine.

中文翻译：

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尼泊尔农村地区心理健康的传统和生物医学护理途径


在低收入和中等收入国家，生物医学环境（例如初级保健和专科诊所）获得精神卫生服务的机会越来越多。传统疗法也继续在这些环境中广泛应用和使用。我们的目标是探索公众、传统治疗师和生物医学临床医生如何看待不同类型的服务，并就使用一种或两种类型的护理做出决定。我们使用经过试点测试的半结构化协议围绕信仰、传统治疗师和寻求护理等主题进行了深入访谈。我们进行了 124 次访谈，其中包括 40 名传统治疗师、79 名普通社区成员和 5 名医生。然后，我们根据扎实的理论方法进行定性分析。大多数参与者都相信疾病的超自然原因和医学原因，并专门向治疗师、医生和/或两者寻求护理。我们的研究结果还揭示了一些护理途径和障碍，这些途径和障碍取决于患者、传统治疗师和医疗从业者的具体态度。值得注意的是，一部分社区成员在看传统治疗师之前会在多个同等资质的医疗提供者那里重复护理，反之亦然。有鉴于此，我们的大多数参与者都强调了高效、医学多元化社会的重要性。尽管参与者希望有一个更具协作性的模式，但对于如何弥合传统和生物医学实践并没有出现一致的建议。 相反，参与者提出了包括三大类的建议：（1）传统治疗师的生物医学培训，（2）传统和生物医学提供者之间的双向转介，以及（3）公开对话以促进传统和生物医学提供者之间的相互理解。参与者提出了医疗提供者和传统治疗师之间合作的几种方法，但是，如果我们将其与之前尝试的历史进行比较，两个领域之间的教育和理解可能是尼泊尔等低收入和中等收入环境中最可行的选择。进一步的研究应该扩大和调查合作学习和/或护理的机会，不仅在尼泊尔，而且在其他具有传统和补充医学历史的国家。