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Dr Ranjita Dhital's °×С½ãÂÛ̳ Innovation & Enterprise’s AHRC IAA (Impact Acceleration Account) Alcohol Co-design and Community Engagement (ACE) study.

Though most people in Nepal do not consume alcohol, those who do are drinking in increasingly harmful ways. This has become a worrying trend, leading to greater health and social problems for the drinkers, their families, and their communities. Alcohol holds long-standing historical and cultural significance in Nepal, being used in religious ceremonies, community festivals, and other activities. Of particular concern is the custom of consuming locally made alcohol (usually made from grain and containing between 10% and 40% pure ethanol). There is also a growing and dangerous illicit market for unregulated alcohol, on which many poor communities depend as their main source of household income.

Despite the limited research and policy development on alcohol in Low- and Middle-Income Countries (LMICs), few studies have explored the perspectives, contexts, or experiences of individuals and communities. Furthermore, there is no known intervention that has significantly reduced alcohol-related harm in Nepal. With scarcity of healthcare professionals and robust health systems, alternative approaches are therefore urgently needed. For example, the use of cultural and community assets in public health have been known to reduce stigma, raise awareness, and engage diverse communities. Such approaches would require participatory approaches and engagement with indigenous knowledge. This is likely to place increased value on cultural heritage; the arts, the natural environment; and community groups. This form of inquiry will also require an interdisciplinary lens, especially for its potential to reduce alcohol harm to be realised.

First steps to explore alcohol use in the Chitwan District of Nepal

We first scoped the range of existing cultural and community assets and how these were perceived by alcohol users and community health workers. The study took place in Chitwan, south-central Nepal, an area known for significant alcohol-related problems. Participatory asset mapping was conducted using field notes, photography, and community engagement to explore how these assets influence alcohol consumption. This was one of the first known studies in Nepal to investigate alcohol use in the context of cultural and community assets. This study was funded by Global Challenges Research Fund (GCRF; grant no. 48304AY). .Ìý

Alcohol Co-design and Community Engagement (ACE) study

Following the Chitwan study, we sought to creatively engage with communities to understand their experiences and ideas around cultural and community assets to reduce alcohol-related harm. This was achieved through sensory ethnographic work in Patan, Lalitpur District, near Kathmandu, an area renowned for its rich cultural heritage. The research involved exploring connections between culture, health, and the social consequences of alcohol use through regular observations (note-taking, photography, and filming) and engaging with local communities, including interactive workshops.

We hosted a Community Festival at Yasodhar Mahavihar, Bubahal in Patan (August 2024, see photos), bringing together diverse communities, artists, and stakeholders to enrich our study findings. Our Creative Health Artist Researchers engaged with festival guests to create artistic outputs using paint, clay, paper, and other materials, expanding on our four key study themes: "Diverse experiences and consequences of alcohol use"; "Alcohol-related stigma in Nepali society"; "Cultural assets and resources communities possess to reduce alcohol harm"; and "External support required to reduce alcohol harm and promote health". We also held discussions about future alcohol research and policy development in Nepal.

Future work

Our interdisciplinary team from Nepal and the UK is co-producing the first known Critical Realist Review to examine a range of evidence (forthcoming). The review includes published research from Nepal that incorporates creative or participatory methodologies, policy documents, and cultural resources identified by communities to reduce alcohol harm. This study will support the Nepali Government, WHO Nepal, and other organisations to reduce alcohol harm and strengthen their implementation roadmap, in line with WHO’s Global Alcohol Action Plan 2022–2030 and the Sustainable Development Goals. We will also present findings of our work at the Siddhartha Art Gallery in Kathmandu during winter 2024.

Informed by this work we are planning a larger study to scale up and implement the creative and participatory approaches to strengthen the Nepali Government’s alcohol policy, health practices, and foster an interdisciplinary research culture. The ACE study is funded by °×С½ãÂÛ̳ Innovation & Enterprise’s AHRC IAA (Impact Acceleration Account) (AHRC, Grant Reference AH/X003973/1) and °×С½ãÂÛ̳ Arts and Sciences Department Research Development fund awarded to .Ìý

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Contact:

Email: r.dhital@ucl.ac.uk Please follow us on Instagram: ; X: ; or LinkedIn: for ACE study updates. View our website and join our mailing list to learn more about our interdisciplinary creative health research in Nepal.ÌýÌý

About the Author:

is a Lecturer in Interdisciplinary Health Studies in the Arts and Sciences Department (UASc) at °×С½ãÂÛ̳. She is Director of Research and Graduate Research Tutor. She is a Fellow of the Royal Society of Public Health (FRSPH), a registered pharmacist, and a sculptor.

Her public health research is informed by creative and participatory methodologies. Her research applies arts and community-based approaches to reduce alcohol harm and promote mental well-being in high- and low-income countries. She is also using creative Participatory Action Research and Experience-based Co-design methods to optimize community pharmacy spaces (PRUK Leverhulme Fellowship) –Ìý.

She has practised as an addiction specialist pharmacist for the NHS, a community pharmacist, and worked in public health. She founded and leads the ÌýÌý research network and theÌý. She is Chair of the ‘Ìý and co-leads the ‘Neurodiversity In/& Creative Research Network’.

Links

• °×С½ãÂÛ̳ Arts and SciencesÌý

Photos by Sijendra Thapa of ACE study team, with collaborators and community festival guests at Yasodhar Mahavihar, Bubahal in Patan, Nepal (August 2024)