Exploring outdoor workers’ knowledge, attitudes, practices, and perceived risks of heatwaves in Nepal

Background: The rise in global temperatures due to climate change has intensified the frequency and severity of heat waves, disproportionately affecting outdoor workers. This is particularly concerning in low- and middle-income countries like Nepal, where inadequate policies and limited awareness leave outdoor workers highly vulnerable. This study explores the knowledge, attitudes, practices (KAP), and perceived risks of heatwaves among outdoor workers in Nepal. Methods: A cross-sectional mixed-method study was conducted across eight districts in five provinces of Nepal, surveying 356 outdoor workers from five occupational groups: street vendors, agricultural workers, rickshaw drivers/pullers, laborers, and service workers. Eleven focus group discussions (FGDs) were conducted to gain deeper insights. Descriptive statistics were used to assess KAP scores, while Kernel-Based Regularized Least Square (KRLS) analysis examined the variations in practice scores among groups. Thematic analysis was applied to FGDs. The quantitative analysis was done in STATA-14, and the qualitative analysis was conducted manually. Results: The average age of participants in the study was 37.2 years (SD = 10.5), and just over half (57%) were male. On average, they had worked outdoors for about 10.7 years (SD = 8.6). Among all participants, 43% had heard of heatwaves, 86.2% were aware of heat-related incidents, and 78.6% had personally experienced them. Awareness about heatwave was positively associated with the practices of heat protection for the overall sample (practice score = 1.46, p