Assessment of Knowledge, Attitudes and Needs of Accredited Social Health Activist (ASHA) in Community based Cancer Awareness and Screening Programme: A Mixed Method Study from a Rural Area in Central Kerala, Southern India

Introduction: Cancer is the leading cause of death worldwide. Primary prevention through health education and secondary prevention through early detection and treatment can alter cancer burden and outcomes. The current study focuses on the possibility of establishing Accredited Social Health Activist (ASHAs) as facilitators in cancer awareness generation and screening. Aim: To assess the knowledge and attitudes of ASHAs in awareness generation and encouraging screening for cancers, and to explore their needs as facilitators in cancer control. Materials and Methods: A mixed-method study was conducted in Kuzhalmannam Panchayath in Palakkad district of Kerala, India, among 30 ASHAs, for two-months from 15th August 2022 to 14th October 2022 in two phases. In phase 1, data regarding knowledge about common cancers, risk factors, danger signs, and screening methods, along with attitudes toward functioning as facilitators, were collected (cross-sectional). Phase 2 comprised Focus Group Discussions (FGDs) for exploring needs. Data were analysed using Statistical Packages for Social Sciences (SPSS) version 20.0 (phase 1). Thematic analysis followed in phase 2. Quantitative and qual itative variables were summarised as means and percentages. Results: The mean age of the ASHAs surveyed was 44.73±5 years. All ASHAs were aware that cancer did not transmit through contact, and 27 (90%) participants knew about the existence of risk factors. Knowledge about family history and the human papillomavirus as risk factors for cancers of the breast and cervix was inadequate. Breast lumps 6 (20%) and blood loss 5 (16.67%) were the common danger signs known. Though 26 (87.67%) participants knew that screening could detect cancers early, knowledge about PAPs smear 6 (20%) and breast self-examination 5 (16.6%) was inadequate. All ASHAs had positive attitudes to raise awareness and encourage screening. For 10 (33.33%) participants, incomplete knowledge created anxiety. Their needs as facilitators emerged under two global themes: functional and aspirational. The quantitative data showed a gap in specific knowledge areas, which was also echoed in FGDs, where ASHAs requested more training and supervision. Conclusion: The ASHAs had a positive attitude to serve as advocates for cancer control. Knowledge gaps created anxiety. Interventions including training, supervision, and better payment are required to address their needs.