Strengthening healthy aging through community-based integrated care: A study protocol evaluating functional decline and quality of life among middle-aged and elderly tribals in Jharkhand

Background India is undergoing a significant demographic shift, with the elderly population (60+) projected to reach 20% by 2050. Tribal populations, such as those in Jharkhand, face accumulated disparities, including premature aging, lower life expectancy (63.9 years), and a dual burden of communicable and non-communicable diseases. Despite these challenges, there is a substantial research gap regarding early-onset functional decline—often beginning at age 45 due to physical labour and undernutrition—and the lack of culturally adapted healthcare models for these underserved groups. Objectives This study aims – Phase 1 (Needs Assessment): Assess functional decline, quality of life (QoL), and prevalent health conditions/risk factors among middle-aged and elderly tribal adults in East Singhbhum, Jharkhand and Phase 2 (Model Development): Design and evaluate the feasibility and acceptability of a culturally sensitive, community-based integrated healthcare model to improve functional ability and QoL. Methods The study employs a two-phase concurrent mixed-methods study design. Setting & Participants: Conducted in 25 villages across five tribal-dominated 5 blocks of East Singhbhum, targeting 520 tribal individuals aged 45 years and above. In Phase 1, Quantitative Component: A cross-sectional needs assessment will use tools like Barthel’s Activity of Daily Living (ADL), Lawton’s Instrumental Activities of Daily Living (IADL), and WHOQOL-BREF to establish baseline health and functional data. Qualitative Component: In-depth interviews, focus group discussions, and key informant interviews with community members, traditional healers, and health workers will explore contextual barriers and cultural perceptions of aging. Quantitative and qualitative findings will be analysed independently and integrated to identify priority domains for healthcare model development. In Phase 2, these findings will inform the co-development of a culturally sensitive, community-based integrated healthcare model through stakeholder consultation. The model will subsequently be implemented in a selected village to assess its effectiveness, feasibility, and community acceptability before refinement. Expected Outcomes The study will establish critical baseline data on tribal aging and develop a validated, scalable healthcare model. Expected results include improved health service utilization, early detection of functional decline, and policy-level impact on geriatric and tribal health strategies in India. Conclusion By prioritizing vulnerable populations and integrating indigenous knowledge with formal health systems, this protocol aligns with Sustainable Development Goals (SDGs 3, 10, and 17) to promote social equity and lifelong well-being for India’s tribal communities.