Improving Access to Control of Diseases for Women (IMPACD)

The aim of this study is to evaluate the feasibility and acceptability of the model of delivering CHW-driven home-based comprehensive NCD control services aimed to prevent premature deaths from cardio-vascular diseases, stroke and breast, cervix and oral cancers in the hard-to-reach women.

Specific objectives of this study are the evaluation of: The social, cultural and behavioral factors that impact the uptake of the NCD control services among rural women using the Rapid Assessment, Response and Evaluation (RARE) approach; The feasibility and acceptability of the strategy to deliver the following NCD control services to the rural women at their homes by the trained CHWs: Counselling of the tobacco habitués to give up the practice Early detection of hypertension and diabetes to ensure prompt and regular treatment Creating breast awareness and ensuring access to prompt diagnosis and treatment of the women with symptoms suggestive of breast cancer Screening for cervical cancer by self-collected HPV test and ensuring prompt treatment of screen detected precancers and cancers Screening of the habitual tobacco/alcohol users for oral cancer by OVE and ensuring prompt treatment of screen detected precancers and cancers

35,000 households in 228 villages, among which women between 30 to 60 years residing in the villages of the block are eligible to participate

Evaluation of the social, cultural and behavioral factors that impact the uptake of the NCD prevention and control services among women, using the RARE methodology

Evaluation of the feasibility and acceptability of delivery of the NCD early detections services by the trained community health workers at home settings

proportion of the participants who know about the adverse effect of smoking, chewing tobacco and consuming alcohol on health in general and NCDs in particular

proportion of the participants who know about the common NCDs including cancers and their early symptoms

screen positivity - proportion of the screened participants detected to have abnormal HPV detection test

screen positivity - proportion of the screened participants detected to have abnormal oral examination test

screen positivity - proportion of the screened participants detected to have abnormal visual examination test

compliance to further assessment - proportion of screen positive participants undergoing further assessment at the primary health center or at the hospital

positive predictive values of further assessment - proportion of participants with confirmed diagnosis of hypertension among those assessed for high BP

positive predictive values of further assessment - proportion of participants with confirmed diabetes among those assessed for high sugar

positive predictive values of further assessment - proportion of participants with confirmed cervical neoplasias on colposcopy and/or biopsy among those assessed for positive HPV test

positive predictive values of further assessment - proportion of participants with confirmed oral premalignant and malignant lesions on examination and/or biopsy among those assessed for positive oral examination

positive predictive values of further assessment - proportion of participants with confirmed visual premalignant and malignant lesions on examination and/or biopsy among those assessed for positive visual examination

effect of different participant characteristics on the final diagnosis of hypertension and diabetes using multivariate analysis

effect of different participant characteristics on the final diagnosis of hypertension and diabetes using multivariate analysis

Women between 30 to 60 years residing in the villages of the Gogunda block in the district of Udaipur in Rajasthan, India, will be eligible to participate.

Inclusion Criteria: Women between 30 to 60 years residing in the villages of the Gogunda block in the district of Udaipur in Rajasthan, India, will be eligible to participate. Exclusion Criteria: Women suffering from debilitating illnesses, pregnant women and women refusing to participate will be excluded.

Mahajan M, Naik N, Jain K, Patira N, Prasad S, Mogri S, Muwonge R, Lucas E, Faruq F, Sankaranarayanan R, Iyer S, Basu P. Study of Knowledge, Attitudes, and Practices Toward Risk Factors and Early Detection of Noncommunicable Diseases Among Rural Women in India. J Glob Oncol. 2019 Apr;5:1-10. doi: 10.1200/JGO.18.00181.

Basu P, Mahajan M, Patira N, Prasad S, Mogri S, Muwonge R, Lucas E, Sankaranarayanan R, Iyer S, Naik N, Jain K. A pilot study to evaluate home-based screening for the common non-communicable diseases by a dedicated cadre of community health workers in a rural setting in India. BMC Public Health. 2019 Jan 3;19(1):14. doi: 10.1186/s12889-018-6350-4.