Social Health Activists Research Articles

Development and Validation of the ScAbIeS Tool for Diagnosing Scabies by Community Healthcare Workers in Resource-Limited Settings.

Introduction Scabies can lead to community outbreaks if not diagnosed early. Developing and validating a relevant tool for diagnosing scabies at the community level is essential to bridging the early diagnosis and treatment gap. Objective The objective of this study is to develop and validate a newer tool to diagnose scabies at the community level by Community Healthcare Workers (CHWs) in resource-limited settings. Methods The developed "ScAbIeS" tool comprised five items divided into two major and three minor criteria. After its development, a longitudinal descriptive study validated the "ScAbIeS" tool. The eligible participants were included in the study through active screening in villages under the Rural Health Training Center (RHTC) Mendhasala. Those villages' Accredited Social Health Activists (ASHS) were included as CHWs for diagnosing scabies using the "ScAbIeS" tool. The participants with skin lesions and/or itching were diagnosed with scabies by CHWs using the "ScAbIeS" tool. The diagnosis of CHWs using the "ScAbIeS" tool was compared with those of physicians, including expert dermatologists, to determine the sensitivity and specificity. Results Kappa's agreement is found to be 0.896 for CHWs and trained physicians regarding the diagnosis of scabies by the "ScAbIeS" tool. Cronbach's alpha is 0.738 for major criteria and 0.565 for minor criteria. 0.778 is found to be Cronbach's alpha for the total scale. The "ScAbIeS" tool is 85% sensitive and 100% specific to diagnose scabies when used by CHWs. Conclusion The "ScAbIeS" tool can be used to diagnose scabies at the community level by CHWs with appropriate training. It will lead to the prevention of complications and community outbreaks of scabies.

Assessment of quality of routine immunization in rural areas of Doiwala Block, Dehradun

ABSTRACT Background: India initiated Expanded Programme on Immunization (EPI) in 1978 and was renamed to Universal Immunization Programme (UIP) in 1985 and subsequently integrated with National Rural Health Mission (NRHM) in 2005. Many studies have shown that health workers involved in immunization are more concerned towards coverage than the quality of immunization services provided. Aims and Objectives: This study aimed to assess the quality of routine immunization services in rural areas of Doiwala Block of Dehradun, Uttarakhand. Material and Methods: It was a cross-sectional study conducted for a duration of one year. Study participants included Auxillary Nurse Midwives (ANMs), Accredited Social Health Activists (ASHAs), Anganwadi Workers (AWWs) and parents/caregivers of children aged 12–23 months residing in that area who had received immunization services on the day of the survey. Institutional ethics committee clearance was obtained before the start of the study. A P value of <0.05 was considered as statistically significant. Results: ASHAs at two centres in low-performing centres had never undergone any training for routine immunization but there was no statistically significant difference found between high and low-performing centres (P > 0.05). The most common vaccine not available was the Bacillus Calmette–Guérin (BCG) vaccine. The majority of clients at both high (92%) and low-performing centres (96%) said that they never waited for at least 30 min post-vaccination at the vaccination site for observation. Conclusion: The study highlights that most of the ANMs at the immunization centre were having good knowledge and were adequately trained for maintaining cold chains at session sites.

Evaluation of the Effect of Project Diabetes with Dignity Intervention on Metabolic Parameters among Adults with Diabetes in a Rural Indian Community

Introduction: Knowledge about diabetes and access to health care in rural Indian settings are inadequate. This study aims to compare the effects of community health worker–based intervention on the glycemic parameters of type 2 diabetes, in a rural population. Methods: Diabetes with dignity (DWD) was a community-based, quasi-experimental trial conducted with 416 adults (30–70 years) with diabetes. All villages under five sub-centers of two Primary Health Centers formed part of the study. Accredited Social Health Activists (ASHAs) conducted screening of high-risk adults in all villages and implemented a 6-month DWD intervention (counseling of people with diabetes/family; monthly house-to-house visits; community awareness-raising) in the intervention area. The changes in glycated hemoglobin A1c (HbA1C), lipid profile, urine micro-albumin, blood pressure, body mass index, and waist circumference between participants from baseline to the end of follow-up were assessed through laboratory/clinical examination. Results: Out of the 416 participants, 216 (52%) belonged to the intervention group. There was a significant decline of 6.4% in mean HbA1C in the intervention group (from 8.79 at baseline to 8.23 at the end of follow-up) and a 10.4% increase in the control group (8.75%–9.66%) (P = 0.010). There was a significant decline in mean low-density lipoprotein cholesterol values from baseline to the end of follow-up in the intervention group versus an increase in the control group (−2.29% vs. 12.4%; P = 0.005). Conclusion: Engaging ASHAs through intervention was effective in strengthening the health system and resulted in improved glycemic control. Capacity-building of ASHAs for the prevention and management of diabetes in rural community settings is recommended.

A Cross-Sectional Study on the Epidemiology of Newly Diagnosed Breast Cancer Patients Attending Tertiary Care Hospitals in a Tribal Preponderant State of India: Regression Analysis.

Breast cancer (BC) is globally prevalent and the leading cause of death due to cancer in females. Due to changes in risk factor profiles, improved cancer registration, and cancer detection, its incidence and death rates have risen over the past three decades. Both modifiable and immutable risk factors for BC make up a sizable portion of the total risk factors. Methodology: This was a hospital-based cross-sectional study carried out in the Department of Surgery, Rajendra Institute of Medical Sciences (RIMS), Ranchi. Consecutive sampling was done with a complete enumeration of all newly diagnosed cases of breast cancer >15 years old. Those who consented to participate and those who were extremely ill, deaf, or dumb were excluded from the study. A total of 88 patients were included. Maximum patients diagnosed with breast cancer belonged to the age group of 40-50 years (37.5%), Hindu by religion (76.1%), non-tribal (80.68%), illiterate (89.8%), married (98.9%), housewives (92%), and of class IV socio-economic status (SES) (65.9%). Regular training of Sahiya (the local name of Accredited Social Health Activist (ASHA) in Jharkhand), empowerment of screening clinics for cancer, and upgraded diagnostic facilities for timely referral should be stressed upon.

Menstrual Hygiene Management (MHM): A Scheme for Improving Women Welfare

The Ministry of Health and Family Welfare implements the Scheme for Promotion of Menstrual Hygiene among adolescent girls in the age group of 10-19 years since 2011. The scheme is supported by the National Health Mission through State Programme Implementation Plan (PIP) route based on the proposals received from the States / UTs. The major objectives of the scheme are to increase awareness among adolescent girls on menstrual hygiene; to increase access to and use of high-quality sanitary napkins by adolescent girls and to ensure safe disposal of sanitary napkins in an environment friendly manner. Under the scheme, a pack of sanitary napkins are provided to adolescent girls by the Accredited Social Health Activist (ASHA) at subsidized rate of Rs. 6 per pack. In addition, Ministry of Drinking Water and Sanitation under Swachh Bharat Abhiyan has developed National Guidelines on Menstrual Hygiene Management (MHM) for creating awareness on Menstrual Hygiene Management (MHM) in rural areas as part of its overall interventions related to behaviour change on sanitation hygiene aspect. Further, to ensure access to sanitary napkins and good quality medicines at affordable price, Department of Pharmaceuticals under Ministry of Chemicals and Fertilizers implements the Pradhan Mantri BharatiyaJanausadhiPariyojna (PMBJP), an important step in ensuring the health security for women. Under the project, over 8700 JanaushidhiKendras have been set up across the country that provides Oxo-biodegradable sanitary napkins named Suvidha at Rs. 1/- per pad only.

"Oral Cancer Screening Through Accredited Social Health Activists- A Project Proposal"

"Oral Cancer Screening Through Accredited Social Health Activists- A Project Proposal"

Breast Cancer Literacy: Status of Peripheral Health Workers in Lucknow

Background: Every woman needs to know the facts, and the fact is, when it comes to breast cancer, every woman is at risk. India accounts for 7.2% of global cancer incidence, but in terms of mortality, the country accounts for 8.3% of global mortality. India faces a high burden of cancer with the late-stage presentation being a common feature. Early detection of cancer is an important strategy for improved survival and simple cost-effective treatment. Low levels of cancer awareness are a significant factor for delay in seeking treatment by women.Objective: The present study was conducted among Peripheral Health Workers (PHWs) in the Lucknow district to assess their perception of risk factors of breast cancer, knowledge of symptoms, early detection methods, and their availability in the district. Methods: The study was conducted from September 2017 to August 2018, among 450 female PHWs working in rural and urban areas of Lucknow. A semi-structured questionnaire was used to collect information about the awareness of PHWs regarding breast cancer. The awareness score was calculated based on their responses. Data were analyzed using SPSS version 24.0 (IBM Corporation).Results: The mean score for overall knowledge of breast cancer was statistically significantly high in BHWs in comparison to ASHAs (Accredited Social Health Activist). The mean knowledge score of signs and symptoms was significantly high among BHWs (Basic Health Workers). PHWs that had undergone training for breast cancer had about 5 times higher chances of having an above-median score. Conclusion: Current low awareness levels, scarcity of resources, and screening programs call for training and refresher pieces of training for peripheral level health workers to empower them to provide preventive health education and screening at the community level. Breastfeeding counseling sessions during home visits and VHNDs could be utilized as an opportunity to create awareness about breast cancer, especially its protective effect on breast cancer.

What they know about their work, barriers, and challenges faced by the community health workers while performing their multiple roles: mixed method study in India

Background: Accredited social health activist (ASHA) forms the backbone of National Health Mission (NHM) as they are the important link between the community and the health system, her services become very crucial for the success of NHM. They are occupied by multiples roles, responsibilities and they are expected to perform at optimum level. Aim was to assess the knowledge and practice of ASHA workers regarding their work responsibilities and to explore the barriers and challenges faced by them while performing their multiple roles. Methods: An explanatory mixed-methods study was conducted among community health workers (ASHA) of having at least one years of experience at Uttarakhand, India with 150 ASHAs for quantitative and 14 for qualitative. Purposive sampling was employed for both the approaches. Results: Quantitative approach shown that almost 91% of ASHA are having the knowledge about the importance of colostrum milk followed by importance of Anganwadi center (83%), immunization (79%), general health (70%), and birth preparedness (69%). The core thematic areas in qualitative result represented as personal, psychological, economic, social and environmental factors. They showed a level of unhappiness and distress related to their work overload and incentives. Conclusions: In general, ASHAs are having adequate knowledge about their job responsibilities, there is more training needed about maintaining the records and documentation process. There is immediate need to overcome the barriers and challenges they are facing, which can hamper their performance level.

The systematic medical appraisal, referral and treatment (SMART) mental health programme: Formative research informing a cluster randomized controlled trial

BackgroundGaps exist between prevalence and treatment options for mental disorders in India. Limited awareness, poor help-seeking, scarcity of trained mental health professionals, limited mental health services and stigma are few examples of reasons contributing to treatment gap. AimsThis paper highlights findings from formative research of a primary mental healthcare model comprising of a preliminary feasibility testing of the Electronic Decision Support System (EDSS) to provide care using mobile based applications, perceptions of the community towards mental health and incorporating cultural adaptations for pre-existing anti-stigma campaign materials. MethodsA cross-sectional mixed methods approach tested the user acceptability of the electronic decision support system EDSS for accredited social health activists (ASHAs) and Primary Health Centre (PHC) doctors using tablets in two villages and two PHCs in rural Haryana (Northern India). Five focus groups and six in-depth interviews along with non-participant observations were used to ascertain community perceptions about various aspects related to mental health. Findings of the study were analyzed and interpreted against the key themes of Andersen's model. ResultsOut of a total of 553 individuals screened for common mental disorders, 51 (9.2%) were screened positive and 32 visited PHC doctors for treatment. There was limited knowledge about common mental disorders amongst community; need to train primary health workers to identify and treat mental disorders; and incorporate cultural adaptation of anti-stigma awareness materials. ConclusionsThe EDSS was found to be acceptable and feasible by primary and community health workers. The findings guided refining of the intervention prior to implementation of a large-scale cluster randomized controlled trial.

Development of a character-strengths based coaching program for rural community health workers to address their work stress in Madhya Pradesh, India

While rural ‘Accredited Social Health Activists (ASHAs)’ delivering primary care at the village-level in India experience high levels of work stress and burnout, little is known about the potential of positive psychology interventions in helping them respond to stressful situations. We aim to describe a systematic approach to designing and developing a ‘character-strengths based’ coaching program for rural ASHAs to help reduce their work-stress and improve their delivery of routine primary care. The development of the coaching program involved: (1) formative work, (2) blueprint development, (3) content development, (4) content-testing, and focus groups discussions to evaluate the feasibility and acceptability of the intervention, specifically the coaching workshop. This was followed by thematic qualitative analysis of ASHA perspectives/feedback to inform further modifications to the workshop. Intervention development occurred over 11 months, and the final coaching material consisted of a ‘content manual’ (for ASHAs) with four modules including character-strengths based ‘strategies’ to address challenges/stressors arising at health facilities, village communities and homes. Coaching material also included a workshop ‘facilitator’s manual’ having session-wise detailed instructions, a list of ‘energizers’ and plans for the coaching workshop. Consistent efforts were made to tailor the case-examples and workshop activities (e.g., roleplays, videos and reflections or discussion-based activities) to the local culture and context. This study illustrates a step-wise approach to contextually adapt the evidence-based character-strengths intervention approaches with iterative feedback from stakeholders (ASHAs), to develop a face-to-face coaching program aiming to reduce work stress, tailored to the context of a rural low-resource setting.

"All my co-workers are good people, but…": Collaboration dynamics between frontline workers in rural Uttar Pradesh, India.

Multi-sectoral collaboration has been identified as a critical component in a wide variety of health and development initiatives. For India's Integrated Child Development Services (ICDS) scheme, which serves over 100 million people annually across more than one million villages, a key point of multi-sectoral collaboration - or "convergence", as it is often called in India - is between the three frontline worker cadres jointly responsible for delivering essential maternal and child health and nutritional services throughout the country: the Accredited Social Health Activist (ASHA), Anganwadi worker (AWW), and auxiliary nurse midwife (ANM), or "AAA" workers. Despite the long-recognized importance of collaboration within this triad, there has been relatively little documentation of what this looks like in practice and what is needed in order to improve it. Informed by a conceptual framework of collaborative governance, this study applies inductive thematic analysis of in-depth interviews with 18 AAA workers and 6 medical officers from six villages across three administrative blocks in Hardoi district of Uttar Pradesh state to identifiy key elements of collaboration. These are grouped into three broad categories: organizational (including interdependence, role clarity, guidance/support, and resource availability); relational (interpersonal, conflict resolution); and personal (flexibility, diligence, locus of control). These findings underscore the importance of personal and relational collaboration features, which are underemphasized in India's ICDS, the largest of its kind globally, and in the multi-sectoral collaboration literature more broadly - both of which place greater emphasis on organizational aspects of collaboration. These findings are largely consistent with prior studies, but are notably different in that they highlight the importance of flexibility, locus of control, and conflict resolution in collaborative relationships, all of which relate to one's ability to adapt to unexpected obstacles and find mutually workable solutions with colleagues. From a policy perspective, supporting these key element of collaboration may involve giving frontline workers more autonomy in how they get the work done, which may in some cases be impeded by additional training to reinforce worker role delineation, closer monitoring, or other top-down efforts to push greater convergence. Given the essential role that frontline workers play in multi-sectoral initiatives in India and around the world, there is a clear need for policymakers and managers to understand the elements affecting collaboration between these workers when designing and implementing programs.

Exploring access to HIV-related services and programmatic gaps for Men having Sex with Men (MSM) in rural India- a qualitative study.

Despite the Link Worker Scheme to address the HIV risk and vulnerabilities in rural areas, reaching out to unreached men having sex with men (MSM) remains a challenge in rural India. This study explored issues around health care access and programmatic gaps among MSM in rural settings of India. We conducted eight Focused Group Discussions (FGDs), 20 Key Informant Interviews (KIIs), and 20 In-Depth Interviews (IDIs) in four rural sites in Maharashtra, Odisha, Madhya Pradesh, and Uttar Pradesh between November 2018 and September 2019. The data in the local language were audio-recorded, transcribed, and translated. Data were analyzed in NVivo version 11.0 software using the grounded theory approach. Primary barriers to health care access were lack of knowledge, myths and misconceptions, not having faith in the quality of services, program invisibility in a rural setting, and anticipated stigma at government health facilities. Government-targeted intervention services did not seem to be optimally advertised in rural areas as MSM showed a lack of information about it. Those who knew reported not accessing the available government facilities due to lack of ambient services, fear of the stigma transforming into fear of breach of confidentiality. One MSM from Odisha expressed, "…they get fear to go to the hospital because they know that hospital will not maintain confidentiality because they are local people. If society will know about them, then family life will be disturbed" [OR-R-KI-04]. Participants expressed the desire for services similar to those provided by the Accredited Social Health Activists (ASHA), frontline health workers for MSM. Programme invisibility emerges as the most critical issue for rural and young MSM. Adolescent and panthis emerged as Hidden MSM and they need focused attention from the programme. The need for village-level workers such as ASHA specifically for the MSM population emerged. MSM-friendly health clinics would help to improve healthcare access in rural MSMs under Sexual and Reproductive Health Care.

ACCEPTANCE AND OUTCOMES OF CERVICAL CANCER SCREENING AMONG WOMEN OF NORTH INDIA

Cervical cancer is one of the preventable cancer, still it is fourth leading cause of death of women worldwide and second leading cause of death of women in India. Screening for cervical cancer using high performance test and vaccination against HPV(Human papilloma virus) are recommended by WHO as global strategy to eliminate cervical cancer. The very rst indigenous vaccine CERVAVAC is also launched in India in year 2023,however data from nationally representative survey(NFHS-5) showed very low awareness and acceptance of cervical cancer screening among women. Present study is a descriptive cross sectional study done in camp based settings (25-30 women in each camps) from November 2021 to november 2022 at peripheral health centers of Lucknow district of state Uttar Pradesh of North India. Aim of the study was to assess the acceptance and outcomes of cervical cancer screening among ASHA(accredited social health activist) from health centers and women visiting peripheral health centers. Result showed that total 43% women accepted screening(41.4% ASHA, 31.4% women visiting health center). On bivariate analysis education level(p=0.003 ), employment status (p<0.001)and knowledge of cervical cancer(p=0.02) found to be predictors of cervical cancer screening. Liquid based cytology test was carried to screen those who were willing and it was found that as per Bethesda system of classication among those who opted for screening(N=110), 4(3.1%) were having ASCUS (Atypical squamous cells of undetermined signicance), 2(1.5%) had LSIL (low squamous intraepithelial lesions), 4(3.1%) reported to have HSIL (High squamous intraepithelial lesion), 9 (7.7%) had non neoplastic inammation, 93(84.6%) were negative for any neoplastic or non- neoplastic lesion. All Positive screened participants were referred to higher centre for further management.

Perceptions of healthcare providers and mothers on management and care of severely wasted children: a qualitative study in Karnataka, India

ObjectivesTo explore perceptions of healthcare providers and mothers of children with severe wasting on the perceived reasons for severe wasting, constraints on the management and barriers to caregiving and care-seeking...

Exploring the Factors Affecting the Work-Life Balance of ASHA's Health Workers and their Impact on Performance in Rural Uttarakhand

Accredited Social Health Activists (ASHAs) are community health workers who play a crucial role in providing primary healthcare services and promoting public health in rural areas of India. However, they often face challenges related to their workload, working conditions, and inadequate support systems that can impact their work-life balance, job satisfaction, and ultimately, their performance. This study aimed to explore the factors affecting the work-life balance of ASHA workers and their impact on performance in rural Uttarakhand. A mixed-methods approach was employed to collect data from 300 ASHA workers in rural Uttarakhand. The study found that ASHA workers faced multiple challenges, including long working hours, low pay, inadequate training, lack of basic facilities, and insufficient support systems. These factors had a significant impact on their work-life balance, job satisfaction, and performance. Regression analysis revealed that work- life balance had a significant positive effect on job satisfaction and a negative effect on burnout and turnover intention among ASHA workers.

Assessing the Efficacy of Mental Health Assessment Training for Accredited Social Health Activists Workers in Rural India: A Pilot Study.

Background Mental health issues are a major concern in rural India, but the lack of trained professionals limits access to care. In this pilot study, we evaluated the efficacy of a mental health assessment training program for Accredited Social Health Activists (ASHA) in rural Maharashtra, India. Aim and objective To conduct a pilot study to evaluate the feasibility and potential efficacy of Mental Health Assessment Training by using the Global Mental Health Assessment Tool-Primary Care Marathi Android version (GMHAT/PC-M) on ASHA workers in the Wardha district to identify mental health problems. Methods The study enrolled 12 ASHA workers from two rural health centers in Maharashtra. The workers completed a pretest and then received training in mental health assessment using the GMHAT/PC Marathi Android version. Mental health knowledge and global mental health assessment tool checklist scale scores were assessed on day seven, month one, and month three after training. Results The ASHA workers had a mean age of 42.2 years and a mean experience of 9.6 years. The majority were Hindus (50%), with the remaining workers being Buddhist. Of the 12 workers, only four had prior mental health training. Mental health knowledge and global mental health assessment tool checklist scale score significantly improved from the pretest to day seven (p<0.001), and the scores continued to improve at month one and month three with a 0.001 level of significance. At the end of the study, the mean mental health knowledge score was 15.2 (out of 20), and the mean global mental health assessment tool checklist scale score was 55.5 (out of 60). Conclusion Our pilot study demonstrated the effectiveness of a mental health assessment training program for ASHA workers in rural Maharashtra, India, using the GMHAT/PC Marathi Android version. The training program improved the mental health knowledge and GMHAT checklist scale of the ASHA workers, suggesting that such programs can help bridge the gap in mental health care in rural areas. Further studies with larger sample sizes and longer follow-up periods are needed to confirm the effectiveness of this training program.

Attitude Towards the Mentally Ill Among Accredited Social Health Activist (ASHA) Workers in the Ahmedabad City of Gujarat.

The community misunderstands mental illness, resulting in stigmatizing attitudes toward persons with mental illness. High mental health literacy (MHL) among Accredited Social Health Activists (ASHA) workers can help spread mental health awareness to the community. The study aimed to assess the attitudes of ASHA workers toward the mentally ill. A cross-sectional survey was conducted among ASHA workers in the city of Ahmedabad using the Community Attitude toward Mentally Ill (CAMI) scale - Gujarati version. Census sampling was used to collect data from ASHA workers at various Urban Health Centers (UHC). We analyzed 265 responses. The mean (SD) of authoritarianism (AU), benevolence (BE), social restrictiveness (SR), and community mental health ideology (CMHI) subscales were 29.77(3.35), 35.33(3.78), 34.55(3.49), and 37.15(4.42), respectively (a higher mean suggests a negative attitude in the AU and SR subscales and a positive attitude in the BE and CMHI subscales). Although ASHA workers displayed goodwill and a welcoming attitude on the BE and CMHI subscales, they showed negative and stigmatizing attitudes on certain items of the AU and SR subscales. This necessitates a widespread mental health education campaign and training program for them.

Performance assessment of Accredited Social Health Activists under National Urban Health Mission in Bengaluru

ObjectivesTo assess the performance of “Accredited Social Health Activist (ASHA)” under National Urban Health Mission (NUHM) in Bengaluru. The NUHM renews and deepens the commitment and recognizes that ASHA and Mahila Arogya Samiti (MAS) are critical components towards achieving health outcomes. There has not been a systematic approach to assess their performance and this study is the first of its kind in Bengaluru City. MethodsThe study was conducted in Bengaluru among 130 ASHAs selected using Stratified Random Sampling. A pretested semi-structured questionnaire was used to interview ASHA regarding her work (involving Antenatal Care (ANC) registrations, institutional delivery, home visits, immunization, sterilization, management of childhood illness, attending monthly meetings, etc.) and tracking the incentives that she had received for work in the past one year from the database. ResultsThe mean age of 130 study participants was 36.4 ± 6.4 years. 53.8% of the study participants had scored >75% for their performance and categorized as Grade A. Out of 130 study participants, 30 (23%) had maintained the record of their claim sheets of the incentives received and among which 26.7% had received 75–100% of incentive of their work. ConclusionThe present study concluded that majority of study participants had a good performance and had been categorized as Grade A. Very small percentage of study participants maintained their records. Financial incentives and an opportunity for more exposure to health services were the main reasons among the study participants for joining as an ASHA. They received induction training before joining work, but refresher training was inadequate.

Effectiveness of family-centred sexual health education and HPV self-sampling in promoting cervical cancer screening among hard-to-reach indian women in rural and tribal areas: a community-based pilot study

BackgroundWhile cervical cancer deaths have declined steeply in high-income countries due to the widespread use of the Papanicolaou test (Pap test), the same trend has not emerged in low or middle-income countries (LMICs). Access to screening in LMICs like India is limited due to barriers such as limited healthcare infrastructures, lack of sexual health education, and stigma demarcating sexually transmitted infections (STIs). HPV self-sampling (HPV-SS), a woman–centered and at-home method for screening, can be utilized as a unique screening tool to overcome some of these barriers. Our study examined the effectiveness of HPV-SS, supported by family-centred arts-based sexual health literacy on the uptake of cervical cancer screening among hard-to-reach women in rural and remote areas in India.MethodsOur community-based mixed methods pilot study recruited 240 participants (120 women and 120 male partners or family members) through female Accredited Social Health Activists (ASHA) across 3 Indian villages of Shirgoan, Khodala, and Jamsar in Palghar district. Inclusion criteria included women ages 30–69 who were under or never screened (UNS) and their male partners/family members aged 18 or over. Knowledge and attitudes about cervical cancer and screening and their perceived stigma surrounding STI were assessed using validated scales prior to and after attending a 2-hour arts-based sexual health education (SHE). In addition, participants’ uptake of cervical cancer screening was assessed after attendance in SHE.FindingsResults revealed significant improvement in knowledge and attitudes about cervical cancer and screening, and a reduction in the STI stigma after participation in SHE sessions (overall mean difference in Knowledge: z = 6.1 ± 2.4, P < 0.001; attitudes about Pap-test and VIA: z = 2.2 ± 8.4, P < 0.001 and z = 2.9 ± 8.2, P < 0.001; STI stigma: z = 2.8 ± 12.4, P < 0.001). 118 out of 120 female participants chose to be screened and 115 opted for HPV-SS.ConclusionsThe implementation of HPV-SS coupled with family-centered arts-based and culturally appropriate SHE is highly promising in promoting cervical cancer screening among hard-to-reach women. Evidence from our study can be used to advance public health policies and inform the scale-up of similar initiatives in other villages and states across rural India and other LMICs.

India’s social health activists are tackling cancer in rural communities

India’s social health activists are tackling cancer in rural communities