Enablers & challenges of tribal women & health system for implementation of screening of non-communicable diseases & common cancers: A mixed-methods study in Palghar district of Maharashtra, India
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Background & objectives: Non-communicable diseases (NCDs) and cancers of breast, oral cavity and cervix contribute to around 5.87 million (60%) deaths in India. Despite this, there is limited evidence on preparedness of the tribal health system in mitigating these conditions. This mixed-methods study aimed at identifying enablers and challenges using a multistakeholder approach for the screening of NCDs and common cancers in a tribal block of Maharashtra, India. Methods: This study was conducted in a tribal community of Dahanu taluka in Palghar district of Maharashtra. A total of nine focus group discussions (FGDs) among tribal women and accredited social health activists (ASHAs), 13 key informant interviews (KIIs) among auxiliary nurse midwives (ANMs) and community health officers (CHO) and facility surveys of five public health facilities were conducted. The FGDs and KIIs were conducted using guides, recorded digitally, transcribed, analyzed and triangulated to identify emerging themes. Results: The tribal women had limited knowledge about NCDs and common cancers. Paucity of health facilities, out-of-pocket expenditure, misconceptions, belief on traditional healers and inability to prioritize health were identified as major challenges. The ASHAs were recognized as a key connecting link between health system and community while provision of culturally appropriate IEC materials and adequate training were recognized as critical enablers by healthcare providers in implementing screening for NCDs and common cancers. Interpretation & conclusions: The study recommends incorporating socioculturally relevant strategies in the tribal population and strengthening health facilities in terms of infrastructure and training with involvement of ASHAs for successful implementation of the National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS) through health and wellness centres.
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ASHAs and Anganwadi teachers are instrumental in providing frontline health services in rural India, and both played important roles in combating the COVID-19 pandemic, including coordinating vaccination efforts.
“As trusted members of their local communities, ASHAs and Anganwadi teachers are instrumental in providing frontline health services in rural India, [66–68] and both played important roles in combating the COVID-19 pandemic, including coordinating vaccination efforts [68, 69].”
From Acceptability of HPV vaccination for cervical cancer prevention amongst emerging adult women in rural Mysore, India: a mixed-methods study (2024) · cites this paper as [66]
The Results and Discussion describe ASHAs as trusted frontline links between tribal women and the health system. They do not establish a comparable role for Anganwadi teachers or describe either group coordinating COVID-19 vaccination. A Results quotation mentions taking blood-pressure readings at a vaccination programme, but does not identify it as a COVID-19 programme. (LLM, conf=0.88)
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Cites
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Coursey, K., Muralidhar, K., Srinivas, V., Jaykrishna, P., Begum, F., Ningaiah, N., Lee, S.-J., & Madhivanan, P. (2024) · BMC Public Health · doi:10.1186/s12889-024-19485-8 · Cited by 10 · see citing works
“As trusted members of their local communities, ASHAs and Angan-wadi teachers are instrumental in providing frontline health services in rural India, [66–68] and both played important roles in combating the COVID-19 pandemic, including coordinating vaccination efforts [68, 69].”
BackgroundOommen, A. M., Ashfaq, M., Tonsing, M. V., Cherian, A. G., Singarayar, P., Viswanathan, V., Muniswamy, V., Hawkes, D., Abraham, P., Pricilla, R. A., et al. (2025) · BMJ Open · doi:10.1136/bmjopen-2025-101599 · Cited by 1 · see citing works
“20 The formative phase of the SHE-CAN (Self-collected HPV evaluation for the prevention of cervical cancer) study used mixed methods research based on the INSPIRE (Integrative Systems Praxis for Implementation Research) methodology.”
- Authors
- Birje, S., Patil, A. D., Munne, K. R., Chavan, V., Joshi, B. N., Akula, A., Salvi, N., Nair, S., Valawalkar, S. P., Tandon, D., Chauhan, S., Patil, D., & Babu, B. V.
- Affiliations
- ICMR National Institute for Research on Women's Health (IN)
- King Edward Memorial Hospital and Seth G.S. Medical College (IN)
- Department of Operational Research, ICMR-National Institute for Research in Reproductive & Child Health, Mumbai, Maharashtra, India
- Department of Health Research (IN)
- Tata Institute of Social Sciences (IN)
- Savitribai Phule Pune University (IN)
- Ashagad PHC, Dahanu, Maharashtra, India
- Indian Council of Medical Research (IN)
- Corresponding author
- Patil, Anushree Devashish
- Patil, Devendra
- ORCID
- Venue
- Indian Journal of Medical Research
- Publisher
- Scientific Scholar
- Published
- 2022-08
- Volume
- 156
- Issue
- 2
- Pages
- 319-329
- ISSN
- 0975-5276 (ISSN-L)
- 0971-5916
- 0975-9174
- PMC
- PMC10057353
- OpenAlex
- W4308639191
- Cited by
- 17
- References
- 1
- Citations by year
- 2026: 4 · 2025: 6 · 2024: 6 · 2023: 1
- FWCI
- 2.49
- Type
- journal article
- Language
- en
- Open access
- diamond
- doi.org
- Licence
- cc-by-nc-sa
- Locations
- International Journal of Microbiology Research (publishedVersion, cc-by-nc-sa)
- PubMed Central (publishedVersion, cc-by-nc-sa)
- PubMed (publishedVersion)
- Funders
- Indian Council of Medical Research
- Topics
- Social Sciences › Health › Indigenous Health, Education, and Rights
- Health Sciences › Medicine › Oncology › Global Cancer Incidence and Screening
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Women's cancer prevention and management
- Keywords
- non-communicable diseases, cancer screening, breast cancer, oral cancer, cervical cancer, tribal women, Accredited Social Health Activists, health system implementation, health literacy, out-of-pocket costs, traditional healers, culturally appropriate health education, health facility infrastructure, Palghar district
- MeSH terms
- Noncommunicable Diseases, Female, Government Programs, Humans, India, Neoplasms, Early Detection of Cancer
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