title: The impact of ear disease and hearing impairment on the lives of Nepali patients in Pokhara: a qualitative study.
abstract: BACKGROUND
  Ear disease in Nepal is a common problem which, left untreated, can cause serious complications such as hearing impairment (HI). Evidence shows that HI is associated with educational difficulties, employment problems and social isolation. Currently, there is little qualitative literature investigating the long-term impact of ear disease, and none specifically reporting on Nepali populations. This qualitative study explored the experiences of individuals affected by ear disease, with a view to informing hospital services and educational programmes.
  
  
  METHODS
  A quota sampling technique was used, with 21 face-to-face semi-structured interviews conducted in Pokhara, Nepal during February-March 2014. Interviews were audiotaped, and verbatim transcripts were analysed using a conventional content analysis approach.
  
  
  RESULTS
  Three overarching themes were identified: stigma, non-disclosure and barriers as a result of HI, stigma and non-disclosure. Stigma was both experienced and feared by participants throughout their lives, and as a result, they would not disclose their problem to friends, teachers and employers. Participants faced barriers in their education and work but did not receive the support they required because people were unaware of their condition.
  
  
  CONCLUSIONS
  This research suggests that a 'stigma cycle' has developed and that participants are being trapped within it. This impacts adversely upon individuals' personal, social and economic development, limiting the human capital available to Nepal.
authors: School of Health and Population Sciences, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK mxs108@student.bham.ac.uk.
authors: Mica K
authors: MK
authors: Skilton
authors: School of Health and Population Sciences, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.
authors: Nicola
authors: N
authors: Poole
authors: City Hospital, Dudley Road, Birmingham, B18 7QH, UK.
authors: Christopher W
authors: CW
authors: Metcalfe
authors: Worcestershire Acute Hospitals NHS Trust, Worcester Royal Hospital, Charles Hastings Way, Worcester, WR5 1DD, UK.
authors: Thomas P C
authors: TP
authors: Martin
authors: Hereford County Hospital, Hereford, HR1 2ER, UK.
authors: Michael C F
authors: MC
authors: Smith
mesh_terms: D000328:Adult; D004427:Ear Diseases / Q000150:complications* / Q000453:epidemiology*; D005260:Female; D034381:Hearing Loss / Q000209:etiology* / Q000523:psychology*; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D009390:Nepal / Q000453:epidemiology; D036301:Qualitative Research; D057545:Social Stigma
keywords: Ear disease; Hearing impairment; Nepal; Non-disclosure; Qualitative; Stigma