An exploration of the views of people with leprosy in Nepal concerning the quality of leprosy services and their impact on adherence behaviour.

Based on a qualitative interview study conducted in eastern Nepal, this paper explores the quality of services received by people with leprosy and the impact of quality of services received on adherence behaviour. The study found that a person's status within the family and community influenced the quality of care, which in turn affected adherence to treatment. Five major types of deficiency in the quality of care experienced were identified, particularly by the poor people and by women. These were the attitude and behaviour of the health worker, the practitioner-centeredness of the care and lack of information sharing, the organization of the health services, barriers in accessibility of the leprosy services, and lack of, or carelessness in, patient referral. This paper explores these types of deficiencies and the way people affected by leprosy cope with them. People of a higher status had access to enabling factors which allowed them to continue treatment, people of a lower status had to endure many disadvantages which had a great influence on their adherence behaviour.