PERCEPTION OF HOME-BASED NURSING CARE AMONG COMMUNITY MEMBERS AND HEALTH CARE PROVIDERS IN URBAN WESTERN MAHARASHTRA, INDIA: A MIXED METHODS STUDY INFORMING A CONTEXT-SPECIFIC CARE MODEL

Abstract

Background: Home-based nursing care is expanding in India, yet little is known about how communities and front-line providers actually perceive it, and no validated Indian model derived from such perceptions exists. This study assessed community perception of home-based nursing care across six dimensions, explored the perceptions of health care providers, identified perceived barriers and facilitators of utilisation, examined associations with socio-demographic characteristics, and developed and validated an Indian Home-Based Nursing Care model. Methods: A sequential explanatory mixed-methods design was used in selected urban areas of Western Maharashtra. Four hundred adults aged 21 years or above, sampled by multi-stage random sampling, completed a 30-item Perception Scale on Nursing Care at Home (six domains), a 24-item barrier scale and an 18-item facilitator scale. Twenty-three purposively selected providers (doctors, nurses, community health officers, paramedics) were interviewed and analysed thematically. Descriptive statistics, ANOVA, chi-square, logistic regression and framework validation were applied. Results: Mean perception was 107.54 ± 11.44 of 150 (71.7% of maximum). Emotional support (20.53/25) scored highest and accessibility (14.63/25) lowest. Although perception was favourable, only 146 participants (36.5%) had ever used home nursing care. Awareness (3.67), cost (3.59) and availability (3.52) were the dominant barriers, whereas verified identity, uniform and licence (4.37; 88.0% endorsement) was the strongest enabler. Barrier burden reduced the odds of utilisation (adjusted OR 0.417, 95% CI 0.276–0.617, p < 0.001). Providers emphasised care coordination with the family (96% of participants). An eight-pillar model was validated by 27 experts (content validity index 0.96). Conclusion: Perception is not the obstacle to home nursing care in this setting; awareness, cost and availability are. Credential transparency, scheme financing and a hub-and-spoke workforce offer the most defensible route to increasing uptake.