{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T13:32:20Z","timestamp":1787837540072,"version":"build-2784847793"},"reference-count":49,"publisher":"BMJ","issue":"12","license":[{"start":{"date-parts":[[2025,12,11]],"date-time":"2025-12-11T00:00:00Z","timestamp":1765411200000},"content-version":"unspecified","delay-in-days":10,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2025,11,26]]},"published-print":{"date-parts":[[2025,12]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>The study aimed to assess the prevalence of financial catastrophe and explore patients\u2019 perceived effectiveness of the government support programme related to chronic kidney disease.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Cross-sectional mixed-method study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>A total of 120 patients receiving free regular haemodialysis under the government\u2019s Deprived Citizen Support Programme for at least 6\u2009months were included in the quantitative study, and 9 patients participated in the qualitative study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main outcome measures<\/jats:title>\n                    <jats:p>Prevalence of financial catastrophe and factors associated with financial catastrophe among chronic kidney disease patients undergoing haemodialysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      A convergent parallel mixed-method approach was carried out from 15 June to 15 December 2024, among chronic kidney disease patients undergoing haemodialysis at the National Kidney Center. Quantitative data were collected through face-to-face interviews using a semi-structured questionnaire. Financial catastrophe was defined as out-of-pocket (OOP) healthcare payments \u226540% of a household\u2019s disposable income, following the WHO-recommended threshold for severe financial burden. OOP expenditures were assessed over 6\u2009months, and associations were tested using \u03c7\n                      <jats:sup>2<\/jats:sup>\n                      and binary logistic regression at a 95%\u2009CI in SPSS V.25.0. For the qualitative arm, in-depth interviews were conducted with nine purposively selected patients, and inductive thematic analysis was applied to explore the perceived effectiveness of the government support programme. The quantitative and qualitative findings were then integrated to achieve convergence and divergence, allowing for a comprehensive understanding of the extent and context of financial hardship among patients.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The prevalence of financial catastrophe was 72.5%. The factors associated with financial catastrophe were the presence of complications (adjusted OR (AOR): 3.67, 95% CI 1.019 to 13.27), patients without financial support (AOR: 2.77, 95% CI 1.016 to 7.56) and reduction in food expenses (AOR: 0.313, 95% CI 0.109 to 0.896). Qualitative findings on awareness regarding government subsidies, financial strain, barriers to receiving treatment and perceived effectiveness of the programme revealed key aspects of utilisation and effectiveness of the government support programme.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The prevalence of financial catastrophe was substantially high, which highlights the importance of addressing economic challenges in chronic kidney disease care. The study emphasised the need to strengthen financial protection through the expansion of government subsidies and improved insurance coverage.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-109097","type":"journal-article","created":{"date-parts":[[2025,12,12]],"date-time":"2025-12-12T18:35:33Z","timestamp":1765564533000},"page":"e109097","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Financial catastrophe and its associated factors among chronic kidney disease patients undergoing haemodialysis in Kathmandu, Nepal: a mixed-method study"],"prefix":"10.1136","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-5290-5839","authenticated-orcid":false,"given":"Swastika","family":"Poudel","sequence":"first","affiliation":[{"name":"School of Public Health and Community Medicine, BP Koirala Institute of Health Sciences, Dharan, Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Deepak Kumar","family":"Yadav","sequence":"additional","affiliation":[{"name":"School of Public Health and Community Medicine, BP Koirala Institute of Health Sciences, Dharan, Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7883-9568","authenticated-orcid":false,"given":"Vijay Kumar","family":"Khanal","sequence":"additional","affiliation":[{"name":"BP Koirala Institute of Health Sciences, Dharan, Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gyanu","family":"Nepal Gurung","sequence":"additional","affiliation":[{"name":"School of Public Health and Community Medicine, BP Koirala Institute of Health Sciences, Dharan, Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-2403-9264","authenticated-orcid":false,"given":"Sadiksha","family":"Pokhrel","sequence":"additional","affiliation":[{"name":"BP Koirala Institute of Health Sciences, Dharan, Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashok","family":"Pudasaini","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Critical Care, Shahid Gangalal National Heart Centre, Kathmandu, Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8370-9511","authenticated-orcid":false,"given":"Ashish Govinda","family":"Amatya","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Critical Care, Shahid Gangalal National Heart Centre, Kathmandu, Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,12,12]]},"reference":[{"key":"2026010703480432000_15.12.e109097.1","doi-asserted-by":"publisher","DOI":"10.1038\/kisup.2012.64"},{"key":"2026010703480432000_15.12.e109097.2","doi-asserted-by":"crossref","first-page":"S37","DOI":"10.1681\/ASN.V13suppl_1s37","article-title":"Maintenance dialysis population dynamics: current trends and long-term implications","volume":"13 Suppl 1","author":"Lysaght","year":"2002","journal-title":"J Am Soc Nephrol"},{"key":"2026010703480432000_15.12.e109097.3","unstructured":"The Institute for Health Metrics and Evaluation . 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