BACKGROUND: Tobacco use is a major public health concern in India, contributing significantly to the burden of oral health conditions, including pre-cancerous and cancerous lesions. Primary Healthcare Workers (PHWs) serve as the first point of contact for healthcare in rural and underserved areas, positioning them as vital in the chain of early identification and management of tobacco-related oral lesions. Despite their pivotal role, there is a paucity of research on their knowledge, practices, and challenges in addressing these conditions. This study aims to explore the experiences, knowledge, attitudes, and challenges faced by PHWs in assessing and managing tobacco-related oral lesions in south India.
METHODS: A qualitative exploratory study was conducted using in-depth interviews and focus group discussions with 23 PHWs, including 8 Auxiliary Nurse Midwives (ANMs), 9 Accredited Social Health Activist (ASHA) workers, and 6 Community Health Officers (CHOs) from 4 rural and 4 urban primary health centres in Mangalore, India. Participants were purposively sampled to ensure diversity in experience and geographic representation. Data were analyzed using thematic analysis to identify key themes and patterns.
RESULTS: Five major themes emerged from the analysis: knowledge gaps, barriers to identification, current practices, facilitators, and training and resource needs. Knowledge gaps highlighted limited awareness of early signs of tobacco-related oral lesions. Barriers to identification included inadequate training and lack of diagnostic tools. Current practices showed minimal routine screening. Facilitators included community trust in PHWs. Training and resource needs emphasized the demand for targeted training programs and visual aids.
CONCLUSIONS: Primary Healthcare Workers play a critical role in the early detection of tobacco-related oral lesions but are reflected with significant knowledge and resource constraints. Strengthening their capacity through targeted training programs, provision of diagnostic tools, and integration of oral health services into primary care can bridge the existing gaps.