From Policy to Practice: Knowledge gaps and training outcomes related to MASLD guidelines among medical officers in Chhattisgarh, India

Metabolic dysfunction-associated steatotic liver disease (MASLD) has emerged as the leading cause of chronic liver disease globally, affecting approximately 25% of adults worldwide. Despite India’s Ministry of Health and Family Welfare integrating MASLD into the National Non-Communicable Diseases (NP-NCD) Programme in February 2021, with revised guidelines in September 2024, substantial implementation gaps persist. This study evaluates the knowledge and preparedness of medical officers in Chhattisgarh regarding MASLD screening and management guidelines. A cross-sectional pre-post intervention study was conducted involving 207 medical officers representing all 33 districts of Chhattisgarh. Participants underwent a three-day training-of-trainers programme under the Healthy Liver Healthy India initiative. A self-designed, pretested, structured questionnaire assessed knowledge before and immediately after training. Statistical analysis was performed using McNemar’s test and Wilcoxon signed-rank test. Of the 207 participating medical officers, 29% were posted at Primary Health Centres, 60.9% at Community Health Centres, and 8.7% at tertiary care centres. “Baseline assessment revealed significant knowledge deficits, with only 14% of participants correctly estimating MASLD prevalence. The mean pre-training score was 2.86 ± 1.42, which improved significantly to 3.89 ± 1.39 post-training (p < 0.001), representing a mean difference of 1.03 (95% CI: 0.77–1.29). However, the absolute post-test scores remained modest, suggesting substantial room for improvement. While the training intervention demonstrated statistically significant improvements in knowledge, the modest absolute gains highlight the need for sustained, multi-level interventions. Effective MASLD integration into routine healthcare requires updated reporting formats, enhanced digital health systems, systematic capacity building, and structural reforms beyond one-time training. Multi-stakeholder collaboration is essential to bridge the policy-to-practice gap in MASLD care delivery across Chhattisgarh’s healthcare system.