Tuberculosis Knowledge, Attitude, and Practice (TB-KAP) among the volunteers: Findings from community-based intervention training outcome in Tribal Hard-to-Reach Areas in Manipur

BACKGROUND: Involving community volunteers in the tuberculosis (TB) program is widely acknowledged and considered a key element of the community engagement strategy in the TB program of India, especially in predominantly tribal North Eastern districts. Inadequate TB knowledge, attitudes and Practices (KAPs) about health and related risk factors could be a key barrier to using community volunteers or lay persons in health program. METHODS: We trained 708 volunteers from student and women organisation (SAWOs) in 189 villages, Senapati District, Manipur between February 2023 and August 2025. A training on identifying TB symptomatics, sputum collections, transportations, patient support and follow-up during their treatment, counselling were provided. A TB-KAP pre and post data were collected in REDCap software and analysed using Stata. To assess the impact of the training on participants' KAP regarding TB, both descriptive and inferential statistical methods were used. Statistical significance was determined at p-value <0.05. RESULTS: Of 708 trained volunteers, 339 were retained during the full training and assessment. With respect to the knowledge score, the probability of being in the highest knowledge category increased from 10% to 65% after training, while the likelihood of being in the lowest two categories dropped from 61% to 8%. The mean attitude score about TB increased from 24.53 (SD = 4.79) to 25.40 (SD = 4.83) after training. This difference of 0.87 points was statistically significant (t(353)=-3.58, p = 0.0004), with a 95% confidence interval of [-1.35, -0.39]. Significant positive changes were seen in the anticipated health-seeking intentions of the volunteers in terms of seeking care for symptoms within 1-2 weeks (p = 0.0009). CONCLUSION: Our study demonstrated that focused and culturally appropriate short term training can produce significant immediate gains in TB knowledge, with modest improvements in attitudes and reported health-seeking intentions, even in the remotest tribal areas among community volunteers.