Barriers and facilitators to child growth monitoring and promotion service utilization in Gorkha District, Nepal: a qualitative study

Growth Monitoring and Promotion (GMP) services are preventive child health interventions involving regular measurement of a child’s weight and height, growth chart interpretation, and nutritional counselling are critical for early detection of growth faltering and timely corrective measures. In Nepal, despite the high rate of child malnutrition, GMP utilization remains critically low. This study explored barriers and facilitators to GMP service utilization in Gorkha District, Nepal. A qualitative descriptive study was conducted across six municipalities of Gorkha District from December 2023 to May 2024. Three focus group discussions were held with 26 mothers of children aged 24–35 months, and six key informant interviews with healthcare providers. Interviews and key informant interviews were audio recorded, transcribed verbatim in Nepali, translated to English, and analyzed using Braun and Clarke’s six-phase thematic analysis framework, which combined inductive and deductive coding to identify barriers and facilitators at individual, community, and health system levels. Thematic saturation guided final sample size. Barriers to GMP utilization operated at individual, community, and health system levels. Major barriers included competing household and agricultural responsibilities, geographical inaccessibility with walking distances of 4–5 h, knowledge gaps about GMP importance, and health system constraints including understaffing, equipment shortages, and prioritization of curative over preventive services. Healthcare providers further identified inadequate GMP-specific training as a critical gap. Key facilitators included positive maternal attitudes, community support groups, structured follow-up by Female Community Health Volunteers (FCHVs), and integration of GMP with immunization and nutrition services. GMP underutilization stems from multiple interconnected geographical, individual, and health system barriers. Strengthening peripheral health infrastructure and FCHV-led community outreach, adapting service delivery schedules to local agricultural calendars and seasonal terrain constraints (including flexible scheduling during peak planting and harvesting periods), and systematically integrating GMP with immunization services through formalized policies and facility-level protocols that make service bundling standard practice represent the most feasible pathways to improved utilization. These findings complement the quantitative evidence from our prior population-based study and provide the contextual understanding needed to design effective, locally appropriate interventions.