Your new experience awaits. Try the new design now and help us make it even better

ORIGINAL RESEARCH article

Front. Neurol.

Sec. Stroke

Volume 16 - 2025 | doi: 10.3389/fneur.2025.1562948

This article is part of the Research TopicBridging The Gap of Unmet Need in Stroke Care in Developing CountriesView all 12 articles

Toward Improved Stroke Care in Nepal: Insights from a Qualitative Study on Barriers and Success Factors

Provisionally accepted
Christine TunklChristine Tunkl1*Raju PaudelRaju Paudel2Lekhjung ThapaLekhjung Thapa3SHIRSHO SHREYANSHIRSHO SHREYAN4Alexandra KraussAlexandra Krauss1Ashim SubediAshim Subedi5Balgopal KarmacharyaBalgopal Karmacharya5Pankaj JalanPankaj Jalan6Nima Haji BegliNima Haji Begli1Patrick TunklPatrick Tunkl7Sunanjay BajajSunanjay Bajaj8Andrea KosinskiAndrea Kosinski9Christoph KosinskiChristoph Kosinski10Pradesh GhimirePradesh Ghimire11Bhupendra ShahBhupendra Shah12Avinash ChandraAvinash Chandra13Mahesh Raj GhimireMahesh Raj Ghimire14Prasad BikramPrasad Bikram15Jessica GoleniaJessica Golenia1Jan Van Der MerweJan Van Der Merwe16Christina StangChristina Stang1Rupal SedaniRupal Sedani17Christoph GumbingerChristoph Gumbinger1
  • 1Neurologische Klinik, UniversitätsKlinikum Heidelberg, Heidelberg, Germany
  • 2Grande International Hospital, Kathmandu, Nepal
  • 3National Neuro Center, Kathmandu, Nepal
  • 4Rajshahi Medical College, Rajshahi, Rajshahi, Bangladesh
  • 5Manipal Teaching Hospital, Pokhara, Nepal
  • 6Norvic International Hospital, Kathmandu, Nepal
  • 7Tunkl Consulting, Heidelberg, Baden-Württemberg, Germany
  • 8Department of Neurology, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas, United States
  • 9Praxis Meertens, Geilenkirchen, Germany
  • 10Rhein-Maas Klinikum, Wuerselen, Germany
  • 11Bharatpur Hospital, Chitwan, Nepal
  • 12B.P. Koirala Institute of Health Sciences, Kathmandu, Nepal
  • 13Annapurna Neurological Institute and Allied Sciences (ANIAS), Kathmandu, Nepal
  • 14Devdaha Medical College and Research Institute (DMCRI), Devdaha Municipality, Nepal
  • 15Tribhuvan University Teaching Hospital, Kathmandu, Nepal
  • 16Angels Initiative, Ingelheim, Germany
  • 17Health Health Management Institute z.u., NGO, Brno, Czechia

The final, formatted version of the article will be published soon.

Select one of your emails

You have multiple emails registered with Frontiers:

Notify me on publication

Please enter your email address:

If you already have an account, please login

You don't have a Frontiers account ? You can register here

Background: The Nepal Stroke Project (NSP) aims to improve stroke care in a resource-limited setting. This qualitative study explores healthcare professionals' experiences and perceptions of barriers and success factors in implementing stroke care in Nepal. Methods: Semi-structured interviews were conducted with eight healthcare professionals (six physicians, two nurses) involved in the NSP. Interviews were analyzed using qualitative content analysis, following a constructivist approach. Results: Success factors encompassed the dedication of healthcare professionals, involvement of hospital boards, effective training initiatives, and the formation of stroke teams. Positive developments noted were increased thrombolysis availability, improved stroke awareness, and growing interest in stroke care among medical professionals. Key barriers identified included lack of government ownership in stroke care advocacy, financial constraints for patients, inadequate public awareness, and challenges in implementing quality monitoring. Conclusion: While the NSP has initiated positive changes in Nepal's stroke care landscape, significant barriers persist. The study highlights the importance of addressing systemic issues such as government involvement and financial accessibility of treatments. Success factors, particularly the motivation of healthcare professionals and local ownership of the project, provide a foundation for future improvements. These findings can inform strategies for enhancing stroke care delivery in other resource-limited settings and guide ongoing initiatives within the NSP.

Keywords: Stroke, Nepal, implementation research, qualitative research, public awareness, Quality Monitoring, stroke care advocacy Tables: 3 Figure: 1

Received: 18 Jan 2025; Accepted: 22 Jul 2025.

Copyright: © 2025 Tunkl, Paudel, Thapa, SHREYAN, Krauss, Subedi, Karmacharya, Jalan, Begli, Tunkl, Bajaj, Kosinski, Kosinski, Ghimire, Shah, Chandra, Ghimire, Bikram, Golenia, Van Der Merwe, Stang, Sedani and Gumbinger. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Christine Tunkl, Neurologische Klinik, UniversitätsKlinikum Heidelberg, Heidelberg, Germany

Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.

Supplementary Material