Perspective Shifting: Developing a participatory photovoice training to support professional quality of life through participatory engagement of healthcare workers in Nepal.

Our research proposal, focused on the Nepali healthcare community, aimed to investigate local perspectives on wellness, burnout, social determinants of wellbeing, and culturally relevant mental health training methods. We planned to partner with community leaders at Scheer Memorial Adventist Hospital (SMAH) to create an integrative wellness training informed by local knowledge. Our plan was to conduct structured key-informant interviews, build local capacity and co-develop a wellness training for healthcare workers at Scheer.

However, upon arrival and engagement with local practices and leaders, we realized the need to adapt our approach to better fit the cultural context and operational realities of the hospital. We decided to pivot and focus solely on the key informant interviews, pausing training development and fully immersing ourselves in ethnographic research to ensure a community grounded understanding of the training program that could be created.

Through our partnership with SMAH, we engaged with a wide range of stakeholders, including healthcare providers, municipality officials, teachers and mental health counselors.We conducted two formal interviews and compiled 38 pages of ethnographic observations, interactions, semi-formal interviews and researcher reflections. Data was collected across five departments at SMAH (outpatient pediatric ward, inpatient pediatric ward, gynecology, emergency and psychiatry), four municipality hospitals, three local schools, and the Elijah Counseling & Training Centre in Kathmandu. 

Using thematic analysis methodology, we identified 43 codes, which we categorized into four major themes: societal factors, systems, struggle, and community. These themes highlight local perspectives on mental health in Nepal, healthcare worker wellness, mental health dynamics at SMAH, and the future of mental health in Nepal. The societal factors theme captures the impact of social influences on mental health in Nepal, such as stigma and collectivism. The theme systems is comprised of systemic/environmental factors impacting mental health, systemic challenges for healthcare providers - including those specific to providers at SMAH - and a call for systemic solutions such as policy reform. The theme struggle highlights clinical challenges faced by healthcare providers, presentation of mental health distress, and provider burnout. The theme community focused on community practices of healing, sources of community resilience, and the need for community oriented solutions. 

The results broadened our understanding of Nepali social determinants of wellness, social and cultural influences on mental health, and community led approaches to addressing mental health challenges. This reinforced our decision to prioritize understanding and strengthening existing efforts in Nepal, rather than introducing entirely new approaches. 

These results serving as our guideposts, we will proceed with remotely co-developing a wellness training program that is culturally and linguistically appropriate for the Nepali healthcare community at Scheer Memorial Adventist Hospital. We aim to launch this program next summer with continued support from the International Disaster Psychology (IDP) program and the Global Mental Health and Psychosocial Support (GMHPSS) Network. This revised approach reflects our dedication to creating an intervention that honors and integrates local knowledge and practices while allowing for methodological flexibility.