Educating for equity, navigating reality: community health nurses implementing interventions to eradicate Chhaupadi in Karnali, Nepal.

backgroundChhaupadi—a customary practice of menstrual seclusion rooted in notions of ritual impurity—persists in parts of Nepal, including Karnali Province, despite legal prohibition. Contemporary evidence has associated this practice with adverse health risks and psychosocial distress among women and girls. Community Health Registered Nurses (CHRNs) operate on the frontline of health services and are strategically positioned to deliver educational interventions addressing Chhaupadi. However, their specific experiences in designing and implementing such interventions, as well as the challenges and perceived effectiveness within this complex context, remain critically under‑explored.

methodsThis qualitative study employed an interpretive description approach. In-depth, semi-structured interviews were conducted with eleven CHRNs, selected based on purposive sampling for their active involvement in Chhaupadi eradication efforts. Initial participant recruitment utilized convenience sampling through self-registration via advertised flyers, which was supplemented by snowball sampling to reach more participants. An overarching maximum variation strategy guided the final sample composition to ensure diverse perspectives. Data were analyzed inductively through thematic analysis.

resultsFour interconnected themes emerged, depicting the operational realities faced by CHRNs: (1) Capacity Building at the Frontline, illustrating their pedagogical adaptations and culturally sensitive communication strategies; (2) Addressing Gaps and Navigating Complex Realities, highlighting the necessity for direct CHRN’s interventions and the intricacies of stakeholder engagement amid concealed practices; (3) Gauging Ripple Effects, revealing the profound challenges in measuring training effectiveness and defining success within an environment characterized by systemic ambiguities; and (4) Navigating System Constraints, detailing the impact of resource scarcity, policy–practice gaps, enduring cultural resistance, and workforce instability.

conclusionThis study reveals the multifaceted interplay between CHRN’s agency, community dynamics, and broader systemic factors in efforts to eradicate Chhaupadi. The results emphasize the need for targeted CHRN’s support, culturally congruent intervention design, enhanced resource allocation, and inter-sectoral collaboration to ensure effective policy enforcement and sustainable program delivery. By illuminating the frontline challenges of translating health education policy into practice, these findings contribute critical evidence for advancing health equity and gender equality in Nepal and similarly affected contexts, reinforcing the essential role of Community Health Registered Nurses as skilled facilitators and strategic navigators of social change. CLINICAL TRIAL NUMBER: Not applicable.