Kamalini Mukhopadhyaya, P S Rakesh
Community-based TB screening was perceived as accessible and acceptable when services aligned with women's social realities and daily routines. Gender-responsive approaches that prioritise flexible delivery, trusted community spaces, frontline worker engagement, and peer-supported participation may improve women's engagement with TB screening programmes.
BACKGROUND: Women living in urban slums may face social, gender-related, and structural barriers that influence participation in community-based tuberculosis (TB) screening. Understanding these factors is important for designing gender-responsive active case finding (ACF) strategies in high-burden settings.
OBJECTIVES: To explore the enablers and barriers influencing women's participation in community-wide systematic TB screening in urban slums of Delhi.
METHODS: A qualitative exploratory study was conducted in selected urban slums of Delhi where community-wide TB screening interventions using ultra-portable chest X-ray units with computer-aided detection were being implemented. In-depth interviews were conducted among women who participated in screening, women who did not participate, and frontline workers including Accredited Social Health Activists (ASHAs) and Anganwadi Workers (AWWs). Interviews were conducted until thematic saturation was attained. Data were transcribed verbatim and analysed thematically using an inductive-deductive approach and interpreted using the Socio-Ecological Model.
RESULTS: Women perceived community-based TB screening as convenient, time-saving, and financially accessible. Proximity of screening camps, trusted community spaces, involvement of frontline workers, and collective participation emerged as key enablers for participation. Major barriers included low perceived need for screening among asymptomatic women, domestic responsibilities, mobility constraints, dependence on accompaniment, social visibility, and inflexible service timings. Women's participation was shaped by interactions between individual, interpersonal, community, and structural factors. Subtle forms of social observation and stigma surrounding TB-related follow-up were also evident within communities.
CONCLUSION: Community-based TB screening was perceived as accessible and acceptable when services aligned with women's social realities and daily routines. Gender-responsive approaches that prioritise flexible delivery, trusted community spaces, frontline worker engagement, and peer-supported participation may improve women's engagement with TB screening programmes.