Development of a structured teaching programme module on prevention and management of diarrheal diseases in under-five children for grassroot-level workers at selected PHCs in Yadadri Bhuvanagiri District, Telangana – A mixed method study

Abstract Background Diarrheal diseases remain a leading cause of mortality among children under five in India, with approximately 1,58,209 deaths annually. Grassroots health workers—Accredited Social Health Activists (ASHAs) and Auxiliary Nurse Midwives (ANMs) are pivotal in community-level prevention and management. This study assessed their knowledge, attitudes, and practices (KAP), compared differences between ASHA and ANM cadres, identified associated demographic factors, and explored barriers and challenges encountered in diarrheal disease management, to inform the development of a structured teaching programme module. Methods An explanatory sequential mixed-methods design was employed in selected Primary Health Centres of Yadadri Bhuvanagiri District, Telangana. Quantitative data were collected from 95 grassroots health workers (74 ASHAs, 21 ANMs) using a semi-structured knowledge questionnaire, Likert attitude scale, and practice checklist. Qualitative data were collected through 2 focus group discussions and 6 in-depth interviews, analyzed using six-step thematic analysis. Integration was achieved through triangulation and meta-inference development. The module was developed based on the integrated findings and validated by experts. Results Among participants, 43.46% had good knowledge, 37.89% average, and 18.95% poor. Attitudes were predominantly favorable (65.26%), with 31.58% neutral and 3.16% unfavorable. Practice levels showed 43.16% good, 29.47% average, 18.95% excellent, and 8.42% poor. ANMs demonstrated significantly more favorable attitudes than ASHAs (p = 0.047, Cohen's d = 0.51), but no significant differences in knowledge (p = 0.189) or practice (p = 0.109). Knowledge was significantly associated with age (p = 0.04) and education (p = 0.01); attitude with education (p = 0.05) and worker type (p = 0.03); practice with education (p = 0.04) and experience (p = 0.04). Knowledge correlated significantly with attitude (r = 0.480, p = 0.001) and practice (r = 0.321, p = 0.001). Qualitative analysis revealed five themes: knowledge and perception; case management practices; challenges and barriers; health system navigation and community engagement; and capacity and confidence. A conceptual model was developed illustrating the dynamic interplay between clinical competency, community dynamics, and systemic constraints. A structured teaching programme module was developed and validated, with an overall Scale Content Validity Index (S-CVI/average) of 0.88. Conclusions Despite universal training coverage, significant gaps persist in knowledge and practice among grassroots health workers. Barriers are multi-layered, encompassing community myths, supply-chain disruptions, administrative burdens, and insufficient refresher training. Effective interventions must move beyond knowledge transfer to address systemic and contextual constraints. The developed structured teaching programme module addresses these identified gaps and provides a contextually grounded, evidence-based training resource for strengthening frontline health worker capacity.