{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T01:03:31Z","timestamp":1789434211023,"version":"build-2803163510"},"reference-count":36,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,6,29]],"date-time":"2026-06-29T00:00:00Z","timestamp":1782691200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T00:00:00Z","timestamp":1789430400000},"content-version":"vor","delay-in-days":78,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Oral Health"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Smokeless tobacco products and areca nut, widely used in Uttar Pradesh, are strongly associated with oral cancer, which ranks among the top three cancers in India. Data from the Population-Based Cancer Registry, Varanasi, highlights one of the highest oral cancer burdens across India. Despite the availability of national guidelines, frontline health workers (ASHAs) remain underutilised for tobacco cessation counselling and oral cancer symptom-based screening. This study assessed the impact of a structured training intervention on their knowledge, practices, and legal awareness.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A pre\u2013post intervention study was conducted in one rural block of Varanasi district between January and May 2023. A total of 202 ASHAs were enrolled through purposive sampling. The one-day training, based on Government of India modules, covered epidemiology, clinical features, determinants of tobacco use, cessation counselling, symptom-based oral cancer screening, and relevant legislation. Data were collected using a validated questionnaire before and after training. Descriptive statistics, Stuart\u2013Maxwell tests, and Spearman\u2019s correlations were applied for analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Baseline scores revealed substantial knowledge and practice gaps: 45.6% of ASHAs had poor epidemiological awareness, 56.9% poor clinical knowledge, and 81.7% poor understanding of determinants of tobacco use. Only 19.8% reported routinely performing symptom-based screening for oral cancer, and while 64.8% \u201calways\u201d provided counselling, legal literacy was limited (only 38.1% aware of the COTPA Act). Following the intervention, significant improvements were observed across all domains (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.01). Post-intervention most ASHAs reported willingness for oral cancer screening (64.8%) and provide tobacco cessation counselling (75.7%). Awareness of the COTPA Act increased to 65.4%. Strong positive correlations were observed between knowledge domains, suggesting synergistic gains.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>A structured, government-endorsed training programme significantly improved ASHAs\u2019 knowledge, attitudes, and practices related to tobacco cessation and oral cancer screening, demonstrating the feasibility of leveraging frontline workers for community-based cancer prevention. However, achieving higher competency levels requires more intensive, competency-based training with supportive supervision. Integration within routine health systems and further research on long-term impact are warranted.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical trial registration number<\/jats:title>\n                    <jats:p>Trial registration Clinical Trials Registry India CTRI\/2021\/02\/031306. Date of registration 16\/02\/2021.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12903-026-08866-7","type":"journal-article","created":{"date-parts":[[2026,6,29]],"date-time":"2026-06-29T06:03:56Z","timestamp":1782713036000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Effectiveness of a capacity-building training for knowledge and practices of tobacco control and oral cancer prevention: a pre-post study from rural northern India"],"prefix":"10.1186","volume":"26","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7856-8059","authenticated-orcid":false,"given":"Divya","family":"Khanna","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Siva Santosh Kumar","family":"Pentapati","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1346-3453","authenticated-orcid":false,"given":"Priyanka","family":"Sharma","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9951-8517","authenticated-orcid":false,"given":"Tulika","family":"Shruti","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rajesh","family":"Vishawakarma","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anand","family":"Sharma","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P","family":"Balasundaram","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Niraj Kr","family":"Maurya","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vijay Kr","family":"Maurya","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rahul Kr","family":"Varma","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Atul","family":"Budukh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gauravi","family":"Mishra","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Satyajit","family":"Pradhan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pankaj","family":"Chaturvedi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,6,29]]},"reference":[{"key":"8866_CR1","unstructured":"World Health Organization. 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The parent study also received administrative clearance under the existing Memorandum of Understanding (MoU) between the MPMMCC and the District Health Authorities for community-based cancer prevention, control and surveillance activities in Varanasi [\n                      \n                      ].For the present capacity-building study, a separate IEC approval was not obtained because the activities meet the exemption criteria outlined in the Indian Council of Medical Research (ICMR)\u2013National Ethical Guidelines for Biomedical and Health Research Involving Human Participants (2017) [\n                      \n                      ]. According to these guidelines, programme evaluations conducted within public health programmes implemented by government agencies\u2014when undertaken solely for monitoring, refinement, or improvement, and where no individual identifiers are collected\u2014are exempt from Institutional Ethics Committee review. This study utilised only de-identified data routinely generated through these ongoing public-health outreach activities, which are part of the hospital\u2019s mandated service responsibilities. All procedures were conducted in accordance with international Good Clinical Practice (GCP) standards and the ethical principles of the Declaration of Helsinki. Written informed consent was obtained from all participating Accredited Social Health Activists (ASHAs) prior to data collection.","order":1,"name":"Ethics","label":"Ethics approval and consent to participate","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"All authors consented for the publication.","order":2,"name":"Ethics","label":"Consent for publication","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":3,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"1734"}}