Healthcare access barriers among deaf adolescents in nepal: a cross-sectional study to inform provider awareness

Evidence on healthcare access barriers among people with hearing loss in Nepal is limited, and research focusing specifically on Deaf adolescents is particularly scarce in low- and lower-middle-income countries. This study explored healthcare access barriers among Deaf adolescents whose primary mode of communication is sign language. A descriptive cross-sectional convergent mixed-methods design was used. Quantitative and qualitative data were collected concurrently at Dhaulagiri Deaf Residential Secondary School in Baglung, the only secondary-level institution in Nepal enrolling Deaf students nationwide and offering a diploma in computer engineering. A total of 135 Deaf students from grade eight to the diploma level completed structured questionnaires. To obtain deeper insights from older adolescents with greater independent healthcare-seeking experience, 10% of diploma-level students were randomly selected for in-depth interviews using a lottery method. Both questionnaires and interviews assessed four categories of healthcare access barriers: structural, communication with healthcare providers (HCPs), HCP attitudes, and financial barriers. Participants had a mean age of 19.9 years (SD 2.85); 70.4% were male, and 53.3% were enrolled in diploma programs. Most participants (90.4%) did not use assistive listening devices, and 74.1% reported congenital hearing loss. Structural barriers included long waiting times (64.4%) and transportation challenges (11.9%). Communication barriers were prominent, with only 25% reporting access to interpreters and just 37.8% finding communication with HCPs easy. Attitudinal barriers were also noted: only 31.1% perceived HCPs as friendly, 27.4% felt comfortable during consultations, and 15.6% reported mistreatment. Financial barriers included cost-related difficulties, limited awareness of health insurance (37%), and low insurance coverage (4.4%). Qualitative findings supported these results, highlighting difficulties understanding rapid speech, concerns about medications, and perceived gaps in HCP awareness of Deaf communication needs. Communication challenges and negative provider attitudes were the most significant barriers to healthcare access among Deaf adolescents. By integrating quantitative and qualitative findings, this study provides new insights into the healthcare experiences of Deaf adolescents in Nepal and underscores the need for targeted deafness-awareness program for HCPs to improve accessibility and equity.