Assessment of Knowledge, Awareness, and Perceptions of Cancer Among Accredited Social Health Activists (ASHAs): A Multistate Qualitative Study From India

Background This qualitative study aims to assess the knowledge, awareness, attitudes, beliefs, and perceived barriers related to cancer prevention and screening among Accredited Social Health Activist (ASHA) workers across three Indian states (Punjab, Uttar Pradesh, and Meghalaya). Methods Focus group discussions (FGDs) were conducted with ASHA workers using a semi-structured guide covering awareness of cancer symptoms, screening practices, risk perception, and cultural beliefs. The study included a total of 90 ASHA workers, of whom 50 were from Ludhiana, 25 from Uttar Pradesh, and 15 from Meghalaya. Data were thematically analyzed using ATLAS.ti software (Scientific Software Development GmbH, Berlin, Germany). Themes were coded across categories, including general awareness, screening behavior, personal experience, trusted information sources, and community recommendations. Results ASHAs demonstrated partial but varied knowledge of cancer symptoms, with higher awareness of oral cancer compared to breast and cervical cancers. Key barriers to screening included fear of infection, stigma, lack of facility availability, and sociocultural myths. Despite recognizing the benefits of early detection, most ASHAs had not undergone screening themselves. Personal experience with cancer cases led to greater engagement. ASHAs suggested community-based interventions such as free screening camps, collaboration with religious centers, and enhanced government support. Conclusion While ASHAs have the potential to serve as change agents for cancer control at the grassroots level, their knowledge and practices are constrained by systemic, educational, and cultural barriers. Strengthening their capacity through standardized oncology training, improving primary healthcare infrastructure, and integrating noncommunicable disease (NCD) services into Health and Wellness Centers are key steps toward improving cancer outcomes in India.