90 Perspectives of the social determinants of injury and how these shape the incidence of unintentional injuries in rural Nepal

Background Injuries are a public health concern in Nepal. The social determinants of unintentional injury are complex and multifaceted, involving numerous social, economic and geographic factors. However evidence is weak about what these determinants are and how they interact. To tackle this gap in evidence, key informant interviews (KIIs) were conducted to better understand what the social determinants of injury are and how they shape the incidence of unintentional injuries in rural Nepal, specifically the remote Western district of Mugu where unintentional injuries in families were reported. Objective To elicit experiences and perspectives of the determinants of unintentional injury from key informants and understand perspectives of how to tackle determinants. This formed part of a larger study which examined how implementation of an mHealth intervention functioned to prevent unintentional injury in the family in rural Nepal and the feasibility of scaling up the intervention in other rural areas of Nepal. Methods 27 semi structured KIIs were conducted with 47 adult participants in Mugu and Kathmandu, 5 of which were group interviews. Key informants included caregivers of children, road builders, farmers, doctors, community mobilisers and engineers. Interviews were conducted in Nepali with a translator, or in English. A thematic analytical approach, drawing upon Braun and Clarke's (2006) thematic analysis was used, and interviews were added to NVivo to support coding and identification of themes. Results There was a distinct difference between the themes which emerged from the KIIs conducted in Mugu and in Kathmandu. Participants in Mugu expressed how injuries were an inevitable consequence of carrying out everyday tasks within a precarious geographical landscape. Participants in Kathmandu also acknowledged the challenge of performing necessary tasks in a challenging geography, however their explanations for injuries in Mugu focused on resident's individual ignorance about risk and injury prevention. Conclusions The findings from these KIIs contribute new empirical data to the field of injury prevention by highlighting the need to develop effective injury prevention interventions which address tensions between individual and social explanations of injury.