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

Abstract

Background

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.

Methods

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.

Results

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.

Conclusions

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.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-026-26492-4.

Background of the study

Hearing loss is a major public health concern that disrupts communication and contributes to poorer health outcomes, reduced healthcare access, and an increased risk of chronic and mental health conditions [1–3]. Effective communication between patients and healthcare providers (HCPs) is critical for accurate diagnosis, treatment adherence, and patient satisfaction [4]. However, individuals with hearing loss frequently encounter communication barriers in healthcare settings, leading to misunderstandings, misdiagnoses, and delays in care [2, 5]. Despite equitable healthcare access being a recognized right, these barriers remain substantial [1]. In addition to communication challenges, structural obstacles, provider attitudes, and financial constraints further limit equitable healthcare access, particularly in low- and middle-income countries (LMICs) [1].

Globally, nearly 80% of individuals with hearing loss reside in LMICs[6], yet most research on healthcare access among this population has been conducted in high-income countries [7–13]. A systematic review covering studies from 2000 to 2015 further highlighted the limited evidence from LMICs [3]. In Nepal, hearing loss is common[14–16], and prior studies have explored its severity, mental health consequences, and social implications [14–18]. However, few studies have explored how people with hearing loss experience structural, attitudinal, and financial barriers within the healthcare system. Contributing factors may include shortages of trained professionals, limited healthcare infrastructure, and insufficient funding for hearing-related research [19].

According to the World Health Organization, hearing loss is classified as mild (26–40 dB), moderate (41–60 dB), severe (61–80 dB), and profound (over 81 dB) [20]. Individuals classified as Deaf (capital “D”) typically have severe to profound hearing loss, and use sign language as their primary mode of communication. Recruiting individuals with hearing loss for research or healthcare outreach presents additional challenges. In Nepal, most studies employ community visits, door-to-door approaches, personal networks, or recruitment at healthcare facilities and health camps[15–18], often including participants across a broad spectrum of hearing loss. For example, a nationwide school-based study reported a 5.7% prevalence of hearing impairment in mainstream schools, with most cases being mild and fewer moderate to profound [14]. Because communication barriers are more pronounced among individuals with severe or profound hearing loss, mixed-severity studies may overlook those facing the greatest healthcare challenges.

While previous research has largely focused on communication difficulties, other barriers such as long waiting times, transportation issues, HCP attitudes, and financial constraints remain underexplored. Understanding these multidimensional barriers is critical for improving healthcare access and equity. Research on Deaf adolescents who primarily use sign language is particularly scarce in LMICs [7, 12]. Recruiting this population in mainstream schools or community settings is challenging, as many may not use sign language or have severe to profound hearing loss. To address this gap, the present study focuses on Deaf adolescents attending a residential secondary school where sign language is the primary mode of instruction, providing a well-defined and underrepresented population for exploring healthcare access barriers comprehensively.

Research aim

The aim of this study was to explore four types of healthcare access barriers among Deaf adolescents who primarily use sign language: structural barriers, communication with healthcare providers (HCPs), HCPs’ attitudes, and financial barriers.

Specific objectives

1. To examine structural barriers that influence Deaf adolescents’ access to healthcare services.

2. To investigate communication barriers between Deaf adolescents and healthcare providers.

3. To assess healthcare providers’ attitudes as perceived by Deaf adolescents during healthcare visits.

4. To identify financial barriers affecting Deaf adolescents’ ability to access healthcare.

Research question

What healthcare access barriers do young Deaf adolescents experience across these four barrier categories?

Method

Study setting and site

Nepal has 22 government-run schools for Deaf students, where Nepali Sign Language (NSL) is the primary mode of instruction [21]. Most schools provide education only up to Class 5 or 8; six extend to Class 10, and four offer secondary-level education. Only one institution provides a bachelor’s program, and there are no private schools for Deaf students in the country [22, 23].

This study was conducted at Dhaulagiri Deaf Residential Secondary School in Baglung, a hilly district near Pokhara in western Nepal. Established two decades ago with 24 students, the school had 254 students at the time of the study. All students primarily use NSL and reside in on-campus hostels that provide free meals and accommodation. On-call healthcare is available from nearby public hospitals, though healthcare providers (HCPs) generally lack NSL proficiency.

Inclusion and exclusion criteria

Participants were Deaf adolescents with severe to profound hearing loss (≥ 61 dB) according to the WHO classification[20], who primarily used NSL for communication, were enrolled from Class 8 through the diploma level, and were able and willing to provide informed consent. According to school policy, at least 5% of students in each class have typical hearing and are selected from socioeconomically disadvantaged backgrounds to assist during emergencies. Of the 151 students enrolled from Class 8 to the diploma level, 16 students with typical hearing were excluded, resulting in a final sample of 135 Deaf adolescents meeting the eligibility criteria. The sample size is consistent with prior international studies on healthcare access among Deaf populations, which included 13 to 140 participants across interviews, questionnaires, and focus group discussions [7–13, 24].

Study design

A descriptive cross-sectional convergent mixed-methods design was employed, integrating quantitative and qualitative approaches. This design enabled concurrent collection of questionnaire and interview data, providing a comprehensive understanding of healthcare access barriers.

Selection of barrier categories

Health Care Access Barriers were conceptualized using the National Guidelines for Disability Inclusive Health Services (NGDIHS) in Nepal and the (HCAB) framework [25, 26]. Four categories were selected: structural barriers, communication with HCPs, HCP attitudes, and financial barriers. These categories represent the most relevant multidimensional barriers affecting Deaf adolescents. While these frameworks are not specific to hearing loss, they were adapted to address the unique challenges faced by sign-language-using adolescents, supported by prior literature and contextual evidence Nepal [25, 26].

Data collection tools and procedures

Quantitative data: A structured questionnaire aligned with the four healthcare access barrier categories was administered. The questionnaire was pretested with 10% of eligible students at the Central Deaf School in Kathmandu to ensure clarity, NSL comprehension, and cultural appropriateness (English version in Supplementary File 1). Translation and back-translation with certified interpreters ensured semantic accuracy, enhancing validity and reliability.

Qualitative Data: Semi-structured, face-to-face interviews were conducted with 10% of diploma-level students, randomly selected using a lottery method (one male and one female per diploma year). Interviews lasted approximately 30 min, conducted by the first author with NSL interpretation provided by a trained teacher. All interviews were audio-recorded, transcribed verbatim, and translated into English.

Data analysis

Quantitative data were analyzed using SPSS version 16.0. Descriptive statistics, including frequencies, percentages, means, and standard deviations, were calculated for demographic characteristics and variables related to healthcare access barriers.

Qualitative data were analyzed using a thematic framework based on the six pre-defined interview themes: (1) socio-demographic characteristics, (2) personal information and family history, (3) structural barriers, (4) communication with HCPs, (5) attitudes of HCPs, and (6) financial barriers. Transcripts were systematically reviewed and coded according to these themes. Within each theme, sub-categories and patterns were identified to comprehensively capture participants’ perspectives while maintaining alignment with the study objectives.

To enhance credibility and validity, qualitative findings were triangulated with quantitative results. Interrater reliability was ensured through independent coding by two researchers, with discrepancies resolved through discussion and consensus.

Ethics approval and consent to participate

Ethical approval was obtained from the Institutional Review Committee at Nobel College, Kathmandu (Ref No: BPH IRC 43/2019), along permission from the school management committee (Code no. 0041). The study was conducted in accordance with the ethical principles outlined in the Declaration of Helsinki.

Consent procedures included:

• Written informed consent from students aged 18 and above.

• Parental/guardian provided written informed consent and participant assent for minors.

• Specific consent for audio recording.

• Voluntary participation with the option to withdraw at any time; no incentives were provided.

• Confidentiality and anonymity were strictly maintained throughout the study.

Positionality statement

The study was conducted by two female researchers with typical hearing from Nobel College, Kathmandu. Reflexivity was maintained throughout the study, with respectful and inclusive communication facilitated via NSL interpretation. Researchers engaged ethically and sensitively with participants, acknowledging their positionality during data collection and interpretation.

Results

Demographics

A total of 135 participants were included, of whom 95 (70.4%) were male and 40 (29.6%) were female, with a mean age of 19.93 years (SD 2.85). Regarding educational level, 46.7% were from grades 8 to 10, and 53.3% were diploma students. Most participants (90.4%) did not use assistive listening devices; among those who did, 7.4% used hearing aids, 0.7% used a cochlear implant, and 1.5% used both devices. Congenital hearing loss accounted for 74.1% of participants, while among those with acquired hearing loss (25.9%), illness was the leading cause (74.3%), followed by trauma (20%) and swimming-related incidents (5.7%). The demographic profile is summarized in Table 1.

Table 1.

Demographic profile of participants (N = 135)

Variables	Number (n)	Percent (%)
Gender
Male	95	70.4
Female	40	29.6
Mean Age (SD) = 19.93 (2.851)
School Grade
Grade 8	19	14.1
Grade 9	25	18.5
Grade 10	19	14.1
Diploma 1 st year	22	16.3
Diploma 2nd year	20	14.8
Diploma 3rd year	30	22.2
Use of Assistive Listening Devices
Hearing aid	10	7.4
Cochlear implant	1	0.7
Both	2	1.5
None	122	90.4
Self-Reported Causes of Hearing Loss
Congenital:	100	74.1
Acquired:	35	25.9
Illness	26	74.3*
Trauma	7	20*
Swimming	2	5.7*

*Percentages under “Acquired” reflect proportions within that subgroup (n = 35)

Healthcare access barriers

Participants reported multiple barriers affecting healthcare access, including structural challenges, communication difficulties, provider attitudes, and financial constraints. Communication difficulties were widespread and often compounded by unfriendly provider attitudes, while structural issues such as long waiting times and lack of priority seating further hindered access. Participants offered practical recommendations including interpreters, visual aids, respectful interactions, and improved insurance coverage, reflecting their lived experiences and aligning with national guidelines for inclusive health services. Participants’ responses across barrier categories are summarized in Table 2.

Table 2.

Participants’ responses to healthcare access barriers (N = 135)

Barrier Category	Characteristics	n (%)
Structural Barriers	Faced transportation barriers to reach health facilities	16 (11.9)
	Bothered by long waiting times at hospitals	87 (64.4)
Communication with Healthcare Providers	Method used to communicate:
	Lip-reading	10 (7.4)
	Writing	56 (41.5)
	Gestures	35 (25.9)
	Interpreter	34 (25.2)
	Asked providers torepeat unclear instructions	24 (17.8)
	Found it easy to communicate with providers	51 (37.8)
Attitudes ofHealthcare Providers	Found the providers friendly	42 (31.1)
	Felt comfortable interacting with providers	37 (27.4)
	Received special attention by providers	41 (30.4)
	Felt mistreated by providers	21 (15.6)
	Felt mistreated by other staff in health facilities	18 (13.3)
Financial Barriers	Frequency of financial difficulties when accessing healthcare:
	Never	24 (17.8)
	Rarely	21 (15.6)
	Sometimes	67 (49.6)
	Regularly	23 (17)
	Heard about insurance	50 (37)
	Had health insurance	6 (4.4)
	Funding for Healthcare Services:(multiple responses)
	School (Government-funded)	105 (82)
	Out-of-pocket	67 (52.3)
	Free government health service	52 (40.6)
	Charity Organizations	52 (40.6)

Structural barriers

Structural barriers to healthcare were limited but notable. Only 11.9% of participants reported transportation difficulties when accessing health facilities. However, long waiting times were common, affecting 64.4% of participants. In-depth interviews revealed that participants faced additional challenges related to accessibility and waiting times:

“We do not get seats for the disabled cause we do not look disabled.”

“The waiting time in the hospital has bothered me a lot. There is no difference between people with and without hearing loss. Everyone has to wait. I feel there should be separate waiting lines for people with and without disabilities.”

“I hate waiting in the hospital—waiting for an appointment, waiting for a doctor, and then waiting for free medicines, which I rarely get.”

Participants suggested separate queues, designated seating, and streamlined service delivery, consistent with national guidelines recommending priority counters and reduced waiting times for individuals with hearing loss.

Communication with healthcare providers

Communication barriers emerged as the most significant challenge. Only 25% of participants had access to a sign language interpreter, while others relied on writing (41.5%), gestures (25.9%), or lip-reading (7.4%). Despite these efforts, only 37.8% reported being able to communicate easily with healthcare providers. Qualitative insights revealed that communication difficulties affected understanding, trust, and motivation to seek care:

“I can understand them if they speak slowly, but most talk very fast, and I just cannot catch their lip sync.”

“I always have doubts about medications because I cannot directly communicate with healthcare providers. I doubt whether I have received the right medication or not... these barriers demotivate us from going to the hospital.”

“There is an interpreter only in the central hospital. Every hospital should have an interpreter. An interpreter is like our bridge.”

“I think there should be interpreters in every hospital. That will be very helpful.”

Participants strongly recommended the provision of sign language interpreters in all hospitals to improve understanding, safety, and trust, aligning with national and international standards for accessible communication in healthcare.

Attitudes of healthcare providers

Perceptions of provider attitudes were mixed but tended toward negative experiences. Only 31.1% found providers friendly, and 27.4% felt comfortable during interactions. While 30.4% received special attention, 15.6% reported feeling mistreated by providers, and 13.3% by other staff. Qualitative responses highlighted the impact of provider attitudes on confidence and willingness to seek care:

“People with typical hearing can understand everything so easily, but we cannot. People should remember this. They always hesitate to explain things to us.”

“I write my symptoms on paper when going to the pharmacist. They sometimes laugh at me.”

“We fear and hesitate to access healthcare services because of poor communication.”

“We mistrust healthcare providers due to such poor communication.”

Participants emphasized the need for respectful communication and provider training, reinforcing guidelines for inclusive healthcare practices.

Financial barriers

Financial barriers were commonly reported. About half of participants (49.6%) sometimes experienced cost-related difficulties, while 17% faced regular financial challenges. Awareness of health insurance was limited (37%), and coverage was minimal (4.4%). Sources of healthcare financing included school support (82%), out-of-pocket payments (52.3%), free government health services (40.6%), and charitable organizations (40.6%). Qualitative responses further illustrated financial constraints:

“I have never heard about insurance. Nobody informed me about it.”

“I do not have health insurance, but I would like to have it.”

“We rarely get free medicine supplied by the government health service.”

“Health care should be made accessible and affordable, considering all the barriers we face.”

“I am so thankful for my school, which has loved and cared for us so well, taken us to the hospital when needed, called our parents in an emergency, and provided lodging and food to them when they visited us.”

Participants recommended improving insurance awareness and access to subsidized medicines, reflecting both lived experiences and national commitments to equitable healthcare access.

Discussion

Overview of the findings

This study explored healthcare access barriers among Deaf students in Nepal, focusing on structural barriers, communication with healthcare providers (HCPs), provider attitudes, and financial constraints, guided by the National Guidelines for Disability-Inclusive Health Services (NGDIHS) and the Health Care Access Barriers (HCAB) model [25, 26]. These frameworks enabled a systematic examination of how multiple, interrelated barriers shape healthcare access for Deaf adolescents. While previous research has largely emphasized communication difficulties alone[8, 9, 27], this study findings demonstrate that communication challenges are intertwined with provider attitudes, structural limitations, and financial barriers, underscoring the need for multidimensional strategies to support more inclusive healthcare in Nepal.

This study was conducted in one of four secondary schools for Deaf students in Nepal, including the country’s only institution offering a diploma in computer engineering. This context allowed in-depth exploration of adolescents who primarily use Nepali Sign Language (NSL) and have severe to profound hearing loss, addressing a critical gap in evidence from low- and lower-middle-income countries.

Demographic characteristics

Most participants (70.4%) were male, contrasting with national data showing similar hearing loss prevalence across genders [14]. Male predominance may reflect higher interest in technical education, parental reluctance to send daughters with hearing loss to a residential school, or the greater likelihood of children with severe hearing loss attending residential schools. Congenital hearing loss was most common (74.1%), with acquired cases primarily related to illness, trauma, or swimming-related infections.

Structural barriers

Transportation difficulties were minimal, likely due to the school’s proximity to health facilities. However, long waiting times were reported by nearly two-thirds of participants. Qualitative findings showed that Deaf adolescents experience waiting differently from hearing peers: because they often remain receive no verbal updates and delays increasing uncertainty and anxiety. Participants also noted that they “do not look disabled,” limiting access to priority seating. Suggested improvements included separate or prioritized queues and visual announcements about waiting times. Tools such as universal hearing-loss icons in patient records [4] and visual notification systems [28] may help ensure Deaf patients receive timely information, indicating that the core challenge is not the waiting itself but the lack of accessible communication.

Communication with healthcare providers

Communication difficulties were widespread. Only a small proportion had access to trained interpreters, while others relied on writing, gestures, or lip-reading. Many expressed uncertainties about medications and care instructions, which discouraged future healthcare utilization. Similar challenges have been documented internationally [29, 30]. Effective visual communication is essential to ensure understanding [1]. Participants consistently emphasized the need for sign language interpreters in all hospitals to improve comprehension, safety, and trust [7–13, 29].

For individuals with mild or moderate hearing loss who may not be proficient in sign language, communication-assistive devices and encouragement to use hearing aids could support clearer interactions [2, 31]. Common strategies such as writing, gestures, slow speech, teach-back, clear written instructions, and routine hearing checks were helpful but insufficient, highlighting the need for structured visual communication and patient-centered approaches [29].

Communication support strategies and innovations

Widespread proficiency in sign language among HCPs remains challenging [4, 5]. Targeted training for selected providers, particularly those working with Deaf youth, could improve communication and care quality. Evidence from Rwanda shows that teaching health-related signs to nurses and community health workers can be effective [32]. Video remote interpreting services (VRIS) may help where on-site interpreters are unavailable [5, 8]. Accompaniment by family, teachers, or peers may offer temporary support, though only one-fourth of participants had such assistance. Future technologies, including AI-supported sign language interpretation, hold promise for enhancing accessibility.

Attitudes of healthcare providers

Fewer than one-third of participants reported positive interactions with HCPs, and many described negative attitudes or perceived mistreatment. Interviews revealed that some providers hesitated to explain information, assuming Deaf patients would not understand, creating feelings of exclusion and diminishing trust. Reports of being laughed at by pharmacists further illustrate disrespectful behaviors that undermine care-seeking. These patterns mirror studies from Greece, Ecuador, and other settings where inadequate accommodation and dismissive provider behavior were noted [13, 29]. Reducing stigma through discreet hearing-aid technologies, strengthening provider training in inclusive practices, and promoting respectful, patient-centered communication could improve healthcare experiences, particularly for young people [15, 31, 33].

Financial barriers

Financial challenges were common: about half of the participants sometimes faced cost-related difficulties, and only a small fraction (under 5%) were enrolled in Nepal’s national health insurance program [34]. Although the scheme covers essential services and disability identity cards offer additional entitlements[35], awareness among participants was low. Students relied on various support mechanisms, including school assistance, out-of-pocket payments, government services, and charitable support.

Qualitative findings underscored limited awareness of insurance benefits and inconsistent access to subsidized medicines. Despite these constraints, the school played a crucial role by supporting hospital visits, informing parents during emergencies, and providing lodging and meals for visiting families. Increasing insurance awareness through schools and Deaf-support networks could help reduce out-of-pocket costs and promote more consistent healthcare engagement.

Implications for practice

Communication challenges and negative provider attitudes emerged as the most significant barriers in this study and therefore receive primary emphasis here. Many HCPs communicated using approaches typical for hearing patients such as rapid speech and solely verbal explanations, which did not always support clear understanding for Deaf individuals. This underscores the importance of strengthening provider awareness about hearing loss and equipping them with practical, accessible communication strategies. While HCP education on hearing loss is increasingly recognized in HICs[27, 36], it remains limited in LMICs. Evidence from Morisod et al. demonstrates that deafness awareness programs can improve interactions between providers and Deaf patients [3].

A short awareness course for HCPs and support staff, covering the prevalence and impact of hearing loss, basic concepts related to Deaf culture, and simple communication techniques such as clear speech, eye contact, unobstructed facial expressions, gestures, written notes, and use of interpreters, could help improve provider behaviors. Integrating such content into medical, nursing, and allied health training programs would better prepare future professionals.

In many LMICs, retail pharmacists are often the first point of contact, highlighting the need to include them in communication-awareness initiatives. Strategies such as gestures, written messages, proxy interpreters, or video/face-to-face interpreters can be applied depending on the clinical context [4, 5, 8, 37, 38]. Tools like the ‘AEIOU’ mnemonic (Ask, Environment, Interaction, Outline, and Understanding) offer a simple framework for supporting patients with hearing loss [37]. McKee et al. also outline practical system-, clinic-, provider-, and patient-level actions to make healthcare more accessible for people with hearing loss [2].

Table 3 summarizes key recommendations from this study to strengthen communication, improve provider responsiveness, and support more equitable healthcare access for Deaf individuals. Implementing these initiatives in low-resource settings will require collaboration and ongoing commitment from national and international partners, with approaches adapted to local contexts.

Table 3.

Recommendations for improving healthcare access for people with hearing loss

1. Half-day deafness awareness programs for healthcare providers, support staff, and retail pharmacists. 2.Integration of deafness education into medical, nursing, and allied health curricula. 3. Availability of hearing devices during medical consultations. 4. Deployment of qualified sign language interpreters in high-volume hospitals. 5. Implementation of video-remote interpreting services in community settings. 6. Implementation of video-remote interpreting services in community settings. 7. Use of universally recognized hearing loss icons in patient charts to alert healthcare staff. 8. Sign language training for Deaf children, adults, and close family members. 9. Encouragement for Deaf individuals to attend healthcare visits with trusted companions when possible. 10. Provision of visual or personalized notifications for unaccompanied Deaf patients awaiting care. 11. Promotion of disability identity cards and health insurance programs through schools and organizations. 12. Support for research and development of discreet, affordable hearing aids to reduce stigma and improve access.

Limitations

This study has several limitations. First, it was conducted in a single residential school for Deaf students, which may limit generalizability. However, because this institution is one of only four secondary schools for Deaf learners in Nepal and the only one offering a computer engineering diploma, its enrollment of students from diverse geographic regions provides meaningful variation and represents a relative strength. Second, the study focused specifically on Deaf adolescents, an under-researched population. While this age group offers important insights, the experiences of adults or individuals with mild to moderate hearing loss may differ and should be examined in future studies. Third, although the mixed-methods design was appropriate for the study objectives, a larger qualitative sample or the inclusion of focus group discussions could have enriched the depth of perspectives captured. Fourth, interviews were conducted in Nepali Sign Language with assistance from teachers, which may have influenced participants’ openness or introduced translation bias, particularly when discussing local healthcare providers. Finally, as this was a descriptive study, no inferential analyses were performed, limiting the ability to explore statistical associations or causal relationships. Despite these limitations, the study fills a critical evidence gap on healthcare access among Deaf adolescents in Nepal and offers preliminary findings to guide future practice. Further research should include diverse educational settings, individuals with varying degrees of hearing loss, and evaluations of interventions aimed at strengthening communication and healthcare access.

Conclusions

This exploratory study examined healthcare access barriers among young Deaf adolescents who primarily use sign language, offering preliminary insights into the challenges they experience in Nepal. Communication difficulties and healthcare provider attitudes were the most prominent issues, with many HCPs relying on rapid speech and conventional interaction styles that may not adequately support individuals with hearing loss. These barriers can hinder comprehension and reduce confidence during healthcare encounters. The findings highlight the need for greater awareness among HCPs on effective communication. Targeted interventions are essential to improve healthcare accessibility for Deaf and hard-of-hearing individuals, though further studies in varied settings are needed to validate and expand on these results.

Abbreviations

HCP

Healthcare providers

NGDIHS

National Guidelines for Disability-Inclusive Health Services

HCAB

Health Care Access Barrier

HIC

High-income country

LMIC

Low- and Middle-Income Countries

Authors’ contributions

SP and BP contributed to the conception and design of the study. SP collected the data. SP and BP analyzed and interpreted the findings. SP and BP drafted the manuscript. All authors read and approved the final manuscript.

Funding

The study did not receive any specific funding.

Data availability

All data generated or analyzed during this study are included in this published article.

Declarations

Ethics approval and consent to participate

Ethical approval was obtained from the Institutional Review Committee at Nobel College, Kathmandu (Ref No: BPH IRC 43/2019), along permission from the school management committee (Code no. 0041). The study was conducted in accordance with the ethical principles outlined in the Declaration of Helsinki.

Consent procedures included:

•Written informed consent from students aged 18 and above.

•Parental/guardian provided written informed consent and participant assent for minors.

•Specific consent for audio recording.

•Voluntary participation with the option to withdraw at any time; no incentives were provided.

•Confidentiality and anonymity were strictly maintained throughout the study.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.