{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T20:27:59Z","timestamp":1792787279520,"version":"4.5.0"},"reference-count":46,"publisher":"BMJ","issue":"3","license":[{"start":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T00:00:00Z","timestamp":1790726400000},"content-version":"unspecified","delay-in-days":91,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"DBT Wellcome Trust India Alliance","award":["IA\/CPH\/21\/1\/505957"],"award-info":[{"award-number":["IA\/CPH\/21\/1\/505957"]}],"id":[{"id":"https:\/\/ror.org\/04reqzt68","id-type":"ROR","asserted-by":"crossref"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["bmjph"],"accepted":{"date-parts":[[2026,9,7]]},"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Dog-mediated rabies disproportionately affects marginalised and geographically isolated communities, including tea-estate (TE) populations in Assam, India. Although epidemiological patterns of rabies transmission are well documented, the structural, behavioural and governance mechanisms shaping prevention and response within estate-based health systems remain poorly understood. This study used a constructivist grounded theory approach to examine how TE health systems perceive and respond to rabies risk.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted 26 interview events comprising 25 in-depth individual interviews and one group interview, involving 28 participants from estate healthcare, welfare, management and labour representative roles across 10 TE in Udalguri district, Assam. Purposive maximum-variation sampling ensured representation across roles, responsibilities and decision-making influence. Initial line-by-line coding, constant comparison, focused category development and memo writing informed the development of an emergent explanatory model, which subsequently informed an applied theory of change. Rigour was ensured through reflexive team discussions, consensus-based resolution of coding discrepancies and adherence to Consolidated Criteria for Reporting Qualitative Research (COREQ) criteria.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Responses to rabies risk were shaped by five interacting mechanisms: structural inequities in access to postexposure prophylaxis; incident-driven vigilance; fragmented governance and the absence of institutionalised dog-population management; limited health literacy resulting from ineffective communication approaches and weak surveillance systems. Collectively, these processes produced a system that remains predominantly reactive rather than preventive, perpetuating cycles of delayed care, incomplete prophylaxis and unmanaged dog-human interfaces. The emergent theory of change highlights feasible opportunities for shifting estate-based systems towards proactive rabies prevention.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This study offers an analytically transferable health-systems model that may inform structurally peripheral or semi-autonomous labour communities across comparable plantation, industrial and labour settlements in South and Southeast Asia, identifying implementation pathways aligned with India\u2019s National Action Plan for Rabies Elimination 2030 and the global \u2018Zero by 30\u2019 agenda.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjph-2025-004805","type":"journal-article","created":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T11:10:20Z","timestamp":1790766620000},"page":"e004805","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Rabies risk and response in tea-estate health systems in Assam, India: a constructivist grounded theory analysis"],"prefix":"10.1136","volume":"4","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-2300-3013","authenticated-orcid":false,"given":"Dipika","family":"Bumb","sequence":"first","affiliation":[{"name":"Ramaiah International Centre for Public Health Innovations, Bangalore, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shanti Priya","family":"Kindo","sequence":"additional","affiliation":[{"name":"Jyoti and Bhupat Mehta School of Health Science and Technology, Indian Institute of Technology Guwahati, Guwahati, Assam, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rasika G","family":"Shirke","sequence":"additional","affiliation":[{"name":"DY Patil University School of Public Health, Mumbai, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aina U","family":"Kurup","sequence":"additional","affiliation":[{"name":"DY Patil University School of Public Health, Mumbai, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chalasani","family":"Satwik","sequence":"additional","affiliation":[{"name":"Indian Institute of Public Health-Delhi, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Parimala","family":"Mohanty","sequence":"additional","affiliation":[{"name":"Indian Institute of Technology Guwahati, Guwahati, Assam, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jully","family":"Gogoi-Tiwari","sequence":"additional","affiliation":[{"name":"School of Veterinary Medicine, Murdoch University, Murdoch, Western Australia, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ganesh","family":"Daimary","sequence":"additional","affiliation":[{"name":"JH CreIndia Foundation, Guwahati, Assam, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Riya","family":"Shigwan","sequence":"additional","affiliation":[{"name":"JH CreIndia Foundation, Guwahati, Assam, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2911-9895","authenticated-orcid":false,"given":"Harish Kumar","family":"Tiwari","sequence":"additional","affiliation":[{"name":"Jyoti and Bhupat Mehta School of Health Science and Technology, Indian Institute of Technology Guwahati, Guwahati, Assam, India"},{"name":"JH CreIndia Foundation, Guwahati, Assam, India"},{"name":"DBT\/Wellcome Trust India Alliance, Hyderabad, Telangana, 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National action plan for dog-mediated rabies elimination from india by 2030. National Centre for Disease Control, Directorate General of Health Services, Ministry of Health and Family Welfare; 2021."},{"key":"2026093004101359000_4.3.e004805.7","unstructured":"National Rabies Control Programme, Centre for One HealthNCDC. Operational Guidelines: Rabies Free City Initiative \u2013 A Step towards Rabies Free India by 2030. 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