Community and health workers perspectives on barriers to diabetes and hypertension screening in North Eastern India: a qualitative study

Non-communicable diseases (NCDs) such as diabetes and hypertension are growing global health concerns, including in India. Despite the launch of the National Programme for Cancer, Diabetes, Cardiovascular Diseases, and Stroke in 2010, screening uptake for diabetes and hypertension remains low in Meghalaya, a state in northeast India. We conducted a qualitative study with 52 participants including healthcare providers, frontline workers, community members, and Village Health Council members (VHC) to document barriers of uptake of diabetes and hypertension screening services. Health workers were selected from a sample of Health and Wellness Centres (HWCs) and the VHCs were drawn from the HWC catchment villages with active engagement in health activities. The research involved seven in-depth interviews and six focus group discussions across three blocks in West Garo Hills District. Data were transcribed, translated into English, uploaded into Taguette, and thematically analyzed. Our analysis identified several barriers to hypertension and diabetes screening across levels of the socio-ecological model. At the individual level, the cause and prevention of diabetes and hypertension were often associated primarily with diet. Work obligations, fear of diagnosis, and concern about long-term treatment discouraged participation in screening. Interpersonally, family members - particularly elders - played a key role in determining participation in screening. At the community level, limited involvement of VHCs and a preference for traditional medicine constrained screening efforts. At the policy level, a high village-to-HWC ratio, workforce vacancies and limited training created systemic barriers to screening. These same factors point to opportunities through intervention: providing screening and care that is reliable and easy to access, reaching out to trusted community messengers, and reducing logistical barriers to screening could all be effective strategies. These findings highlight the need for multipronged strategies that address individual, community, and systemic factors to enhance screening for early detection and management of NCDs in Meghalaya.