{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T07:05:03Z","timestamp":1784617503893,"version":"3.55.0"},"update-to":[{"DOI":"10.12688\/f1000research.176835.1","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2026,6,25]],"date-time":"2026-06-25T00:00:00Z","timestamp":1782345600000}}],"reference-count":49,"publisher":"F1000 Research Ltd","license":[{"start":{"date-parts":[[2026,6,25]],"date-time":"2026-06-25T00:00:00Z","timestamp":1782345600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001411","name":"Indian Council of Medical Research","doi-asserted-by":"publisher","award":["GrantID:Tribal\/121\/2020-ECD-II"],"award-info":[{"award-number":["GrantID:Tribal\/121\/2020-ECD-II"]}],"id":[{"id":"10.13039\/501100001411","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["f1000research.com"],"crossmark-restriction":false},"short-container-title":["F1000Res"],"abstract":"<ns5:p>Background Among various Particularly Vulnerable Tribal Groups (PVTGs) in India, the Koraga community stands out as one that warrants focused attention through targeted public health efforts. Objective A community-based cross-sectional study was conducted to assess knowledge and attitudes toward healthcare services among 622 adult members (aged 18\u201370\u00a0years) of the Koraga tribe from a southern coastal district of Karnataka. Methods We employed a multistage cluster sampling approach, treating each block under the study as a cluster and selecting households using probability proportional to size (PPS) method. Data collection survey occurred from April 2021 to April 2022 through personal interviews with consenting adults, using a structured data collection tool.The data was entered and analyzed using Jamovi software version 2.6.26. Univariate and multivariable logistic regression was performed to examine associations between sociodemographic variables and the knowledge and attitude for communicable diseases, reproductive health, and mental health services. The results are represented as unadjusted odds ratio and adjusted odds ratio with 95% confidence intervals. Results The study found that, overall, 58% of respondents exhibited poor knowledge as well as unfavourable attitudes toward utilising healthcare services. The study revealed limited knowledge among tribal people regarding healthcare services, with scores of 62.2% for communicable diseases, 71.9% for reproductive health, and 50% for mental health. Additionally, attitudes toward these domains were largely unfavourable, measured at 50.2%, 54.8%, and 60.5%, respectively. These outcomes showed a statistically significant association with demographic variables, including head-of-household status, age, religion, family size, educational attainment, and residence (p\u00a0&lt;\u00a00.05). Conclusions PVTG community in Udupi district of South Karnataka, India, lack knowledge and favourable attitude towards healthcare services on communicable diseases, reproductive health and mental health. The findings underscore the urgent need for tailored health literacy initiatives and follow-up interventions among this PVTG to improve their health beliefs, and health status.<\/ns5:p>","DOI":"10.12688\/f1000research.176835.2","type":"journal-article","created":{"date-parts":[[2026,6,25]],"date-time":"2026-06-25T11:04:06Z","timestamp":1782385446000},"page":"542","update-policy":"https:\/\/doi.org\/10.12688\/f1000research.crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Knowledge and Attitudes Toward Healthcare Services Among a Particularly Vulnerable Tribal Group (PVTG) in Coastal Karnataka, India: Findings from a Community-Based Cross-Sectional Survey"],"prefix":"10.12688","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7540-2755","authenticated-orcid":false,"given":"Biju","family":"Soman","sequence":"first","affiliation":[{"name":"Department of Community Medicine, Kasturba Medical College Manipal Manipal Academy of Higher Education"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9407-2325","authenticated-orcid":false,"given":"Sneha D","family":"Mallya","sequence":"additional","affiliation":[{"name":"Department of Community Medicine, Kasturba Medical College Manipal Manipal Academy of Higher Education"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-7973-3711","authenticated-orcid":false,"given":"Rishi S","family":"Narayanan","sequence":"additional","affiliation":[{"name":"Department of Community Medicine, Kasturba Medical College Manipal Manipal Academy of Higher Education"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vani Lakshmi","family":"R.","sequence":"additional","affiliation":[{"name":"Centre for Digital Health, Applied Research and Technology, Prasanna School of Public Health Manipal Manipal Academy of Higher Education"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashwini","family":"Kumar","sequence":"additional","affiliation":[{"name":"Department of Community Medicine, Kasturba Medical College Manipal Manipal Academy of Higher Education"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0892-8551","authenticated-orcid":false,"given":"B.","family":"Unnikrishnan","sequence":"additional","affiliation":[{"name":"Department of Community Medicine, Kasturba Medical College, Mangalore Manipal Manipal Academy of Higher Education"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7143-8075","authenticated-orcid":false,"given":"Harpreet","family":"Kaur","sequence":"additional","affiliation":[{"name":"Division of Epidemiology and Communicable Diseases, Ministry of Health and Family Welfare New Delhi Delhi 110029 Indian Council of Medical Research"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3210-2293","authenticated-orcid":false,"given":"Ranjitha S","family":"Shetty","sequence":"additional","affiliation":[{"name":"Department of Community Medicine, Kasturba Medical College Manipal Manipal Academy of Higher Education"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2560","published-online":{"date-parts":[[2026,6,25]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"194-209","DOI":"10.1177\/2277436X241242528","article-title":"Tribal communities, their quality of life and the differences: evidence from an Indian district.","volume":"73","author":"P Debnath","year":"2024","journal-title":"J Anthropol Surv India."},{"key":"ref2","doi-asserted-by":"publisher","first-page":"1-7","DOI":"10.1016\/j.diabres.2013.06.011","article-title":"Burden of diabetes mellitus and prediabetes in tribal population of India: a systematic review.","volume":"102","author":"R Upadhyay","year":"2013","journal-title":"Diabetes Res. Clin. Pract."},{"key":"ref3","doi-asserted-by":"publisher","first-page":"771-786","DOI":"10.1017\/S0021932008002757","article-title":"Contextual correlates of child malnutrition in rural Maharashtra.","volume":"40","author":"M Bawdekar","year":"2008","journal-title":"J. Biosoc. Sci."},{"key":"ref4","doi-asserted-by":"publisher","first-page":"179-181","DOI":"10.4103\/ijmr.ijmr_1931_22","article-title":"Health equity and tribal populations: challenges and way forward.","volume":"156","author":"S Acharya","year":"2022","journal-title":"Indian J. Med. Res."},{"key":"ref5","doi-asserted-by":"publisher","first-page":"18-33","DOI":"10.5958\/2249-7315.2015.00132.X","article-title":"Barriers to use of contraceptive methods among rural young married couples in Maharashtra, India: qualitative findings.","volume":"5","author":"M Ghule","year":"2015","journal-title":"Asian J Res Soc Sci Humanit."},{"key":"ref8","doi-asserted-by":"publisher","first-page":"673-687","DOI":"10.4103\/0971-5916.159586","article-title":"Tribes in Karnataka: status of health research.","volume":"141","author":"S Roy","year":"2015","journal-title":"Indian J. Med. Res."},{"key":"ref9","doi-asserted-by":"publisher","first-page":"275-283","DOI":"10.4103\/ijmr.ijmr_3209_21","article-title":"Health status of Koraga community: a pilot study among a particularly vulnerable tribal group of Udupi District, Karnataka, India.","volume":"156","author":"S Mallya","year":"2022","journal-title":"Indian J. Med. Res."},{"key":"ref10","doi-asserted-by":"publisher","first-page":"867-877","DOI":"10.1108\/JHR-01-2021-0001","article-title":"Diminishing traditional methods and inaccessible modern healthcare: the dilemma of tribal health in India.","volume":"36","author":"D Negi","year":"2022","journal-title":"J Health Res."},{"key":"ref11","doi-asserted-by":"publisher","first-page":"3572-3583","DOI":"10.1007\/s40615-023-01810-3","article-title":"Tracing the disparity between healthcare policy-based infrastructure and health belief-led practices: a narrative review on indigenous populations of India.","volume":"11","author":"B Soman","year":"2024","journal-title":"J. Racial Ethn. Health Disparities."},{"key":"ref12","doi-asserted-by":"publisher","first-page":"114-117","DOI":"10.4103\/cmi.cmi_153_23","article-title":"Health of tribal population in India: a glimpse of the current scenario.","volume":"22","author":"A Linda","year":"2024","journal-title":"Curr Med Issues."},{"key":"ref13","doi-asserted-by":"publisher","first-page":"663-672","DOI":"10.4103\/0971-5916.159582","article-title":"Burden and pattern of illnesses among the tribal communities in central India: a report from a community health programme.","volume":"141","author":"Y Jain","year":"2015","journal-title":"Indian J. Med. Res."},{"key":"ref14","doi-asserted-by":"publisher","first-page":"5065-5071","DOI":"10.4103\/jfmpc.jfmpc_715_21","article-title":"Prevalence of hypertension and the associated factors among Sabar and Munda tribes of Eastern India.","volume":"11","author":"P Giri","year":"2022","journal-title":"J. Family Med. Prim. Care."},{"key":"ref15","doi-asserted-by":"publisher","first-page":"e0348880","DOI":"10.1371\/journal.pone.0348880","article-title":"Nourishing futures: Assessing nutritional health among children under-five years of age belonging to a particularly vulnerable tribal community in Southern India.","volume":"21","author":"S Mallya","year":"2026","journal-title":"PLoS One."},{"key":"ref16","doi-asserted-by":"publisher","DOI":"10.1007\/s40615-025-02586-4","article-title":"Knowledge, attitudes, and practices regarding nutrition and worm infestation among parents\/guardians of tribal children of Udupi district: a cross-sectional assessment.","author":"S Pujari","year":"2025","journal-title":"J. Racial Ethn. Health Disparities."},{"key":"ref17","doi-asserted-by":"publisher","DOI":"10.18103\/mra.v11i1.3472","article-title":"Association of substance abuse and tuberculosis among tribes: study in three tribal settings of Kerala, India.","volume":"11","author":"K Kumari","year":"2023","journal-title":"Med. Res. Arch."},{"key":"ref18","doi-asserted-by":"publisher","DOI":"10.1007\/s40615-025-02707-z","article-title":"Substance use and mental health among a particularly vulnerable tribal group in Karnataka: prevalence and associated determinants from a household survey.","author":"S Soans","year":"2026","journal-title":"J. Racial Ethn. Health Disparities."},{"key":"ref19","doi-asserted-by":"publisher","first-page":"101706","DOI":"10.1016\/j.cegh.2024.101706","article-title":"Mental health literacy, attitude, and help seeking intention among a particularly vulnerable tribe.","volume":"29","author":"F Noronha","year":"2024","journal-title":"Clin. Epidemiol. Glob. Health."},{"key":"ref20","doi-asserted-by":"publisher","first-page":"105","DOI":"10.1186\/s12939-020-01216-1","article-title":"\u201cEverything is provided free, but they are still hesitant to access healthcare services\u201d: why does the indigenous community in Attapadi, Kerala continue to experience poor access to healthcare?","volume":"19","author":"M George","year":"2020","journal-title":"Int. J. Equity Health."},{"key":"ref21","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.puhe.2019.10.010","article-title":"Raising the profile of the inequalities in health of indigenous peoples.","volume":"176","author":"F Sim","year":"2019","journal-title":"Public Health."},{"key":"ref22","doi-asserted-by":"publisher","first-page":"e421","DOI":"10.1371\/journal.pmed.0030421","article-title":"Indigenous health and socioeconomic status in India.","volume":"3","author":"S Subramanian","year":"2006","journal-title":"PLoS Med."},{"key":"ref23","doi-asserted-by":"publisher","first-page":"5887-5893","DOI":"10.4103\/jfmpc.jfmpc_254_22","article-title":"Understanding the trends of tribal research in India through bibliometric analysis.","volume":"11","author":"S Chinnaiyan","year":"2022","journal-title":"J. Family Med. Prim. Care."},{"key":"ref24","doi-asserted-by":"publisher","first-page":"e52","DOI":"10.22037\/emergency.v5i1.15215","article-title":"Sampling methods in clinical research; an educational review.","volume":"5","author":"M Elfil","year":"2017","journal-title":"Emerg Tehran."},{"key":"ref26","doi-asserted-by":"publisher","first-page":"e0251519","DOI":"10.1371\/journal.pone.0251519","article-title":"Prevalence of pulmonary tuberculosis among the tribal populations in India.","volume":"16","author":"B Thomas","year":"2021","journal-title":"PLoS One."},{"key":"ref27","doi-asserted-by":"publisher","first-page":"163-167","DOI":"10.4103\/ijmr.ijmr_2128_22","article-title":"Burden of tuberculosis & malaria among tribal populations & implications for disease elimination in India.","volume":"157","author":"J Narain","year":"2023","journal-title":"Indian J. Med. Res."},{"key":"ref28","doi-asserted-by":"publisher","first-page":"523","DOI":"10.1186\/s12913-019-4335-3","article-title":"Health literacy in Indigenous people with chronic disease living in remote Australia.","volume":"19","author":"H Rheault","year":"2019","journal-title":"BMC Health Serv. Res."},{"key":"ref30","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/1472-698X-5-1","article-title":"Rural Indian tribal communities: an emerging high-risk group for HIV\/AIDS.","volume":"5","author":"E Naik","year":"2005","journal-title":"BMC Int. Health Hum. Rights."},{"key":"ref31","first-page":"237-239","article-title":"Awareness and practices in relation to malaria in a tribal area in Kamrup District, Assam.","volume":"53","author":"P Phukan","year":"2009","journal-title":"Indian J. Public Health."},{"key":"ref32","doi-asserted-by":"publisher","first-page":"354","DOI":"10.1186\/s12936-021-03884-y","article-title":"Assessing community knowledge, attitude and practices to strengthen communication strategy for Malaria Elimination Demonstration Project in Mandla.","volume":"20","author":"H Rajvanshi","year":"2021","journal-title":"Malar. J."},{"key":"ref33","doi-asserted-by":"publisher","first-page":"805-806","DOI":"10.1136\/jech.2008.082909","article-title":"Prevalence of sexually transmitted disease syndromes in tribal population of central India.","volume":"63","author":"V Rao","year":"2009","journal-title":"J. Epidemiol. Community Health."},{"key":"ref34","doi-asserted-by":"publisher","first-page":"e0142323","DOI":"10.1371\/journal.pone.0142323","article-title":"Factors influencing the health behaviour of Indigenous Australians: perspectives from support people.","volume":"10","author":"P Waterworth","year":"2015","journal-title":"PLoS One."},{"key":"ref35","doi-asserted-by":"publisher","first-page":"163-172","DOI":"10.51220\/jmr.v18i2.18","article-title":"Tharu and Buksa tribes\u2019 attitudes toward child and maternal health and educational services in Uttarakhand: a qualitative study.","volume":"18","author":"J Bharti","year":"2023","journal-title":"J Mountain Res."},{"key":"ref36","doi-asserted-by":"publisher","first-page":"75","DOI":"10.1186\/s12884-023-05404-z","article-title":"Uptake of antepartum care services in a matrilineal-matrilocal society: a study of Garo indigenous women in Bangladesh.","volume":"23","author":"S Chowdhury","year":"2023","journal-title":"BMC Pregnancy Childbirth."},{"key":"ref37","doi-asserted-by":"publisher","first-page":"44","DOI":"10.1186\/s13002-015-0033-3","article-title":"Ethnomedicinal survey of various communities residing in Garo Hills of Durgapur, Bangladesh.","volume":"11","author":"M Khan","year":"2015","journal-title":"J. Ethnobiol. Ethnomed."},{"key":"ref38","doi-asserted-by":"publisher","first-page":"58-66","DOI":"10.4103\/0971-5916.193284","article-title":"Factors associated with utilization of antenatal care services among tribal women: a study of selected states.","volume":"144","author":"T Adhikari","year":"2016","journal-title":"Indian J. Med. Res."},{"key":"ref39","doi-asserted-by":"publisher","first-page":"769-776","DOI":"10.1007\/s10995-020-03029-8","article-title":"Community perspectives on men's role in the utilisation of maternal health services among Saharia tribes in Gwalior, Madhya Pradesh, India: insights from a qualitative study.","volume":"25","author":"S Nair","year":"2021","journal-title":"Matern. Child Health J."},{"key":"ref40","doi-asserted-by":"publisher","first-page":"88-93","DOI":"10.1007\/s40615-020-00760-4","article-title":"Knowledge, attitude and practices towards cervical cancer and its screening among women from tribal population: a community-based study from Southern India.","volume":"8","author":"S Ghosh","year":"2021","journal-title":"J. Racial Ethn. Health Disparities."},{"key":"ref41","doi-asserted-by":"publisher","first-page":"133-156","DOI":"10.1007\/s10935-024-00813-y","article-title":"Knowledge, attitude and practices towards cervical cancer and its screening among women from tribal population of Anuppur District.","volume":"46","author":"B Gupta","year":"2025","journal-title":"J. Prev. Dent."},{"key":"ref42","first-page":"213-224","article-title":"Indigenous birth as ceremony and a human right.","volume":"23","author":"A Hayward","year":"2021","journal-title":"Health Hum. Rights."},{"key":"ref43","first-page":"205-210","article-title":"Cervical cancer screening: current knowledge and practice among women in a rural population of Kerala, India.","volume":"136","author":"S Aswathy","year":"2012","journal-title":"Indian J. Med. Res."},{"key":"ref44","doi-asserted-by":"publisher","first-page":"192-208","DOI":"10.4103\/indianjpsychiatry.indianjpsychiatry_869_24","article-title":"Psychiatry research and prevalence of psychiatric disorders among tribal populations of India: a systematic review and meta-analysis.","volume":"67","author":"A Bakhla","year":"2025","journal-title":"Indian J. Psychiatry."},{"key":"ref45","doi-asserted-by":"publisher","first-page":"48","DOI":"10.1186\/s43045-020-00057-6","article-title":"Rural community attitude towards mental healthcare: a mixed-method study in Khurda district of Odisha, India.","volume":"27","author":"S Jena","year":"2020","journal-title":"Middle East Curr. Psychiatry."},{"key":"ref46","doi-asserted-by":"publisher","first-page":"S174-S178","DOI":"10.4103\/ipj.ipj_237_23","article-title":"Assessment of supernatural attitude toward mental health among tribal and non-tribal populations.","volume":"32","author":"T Ali","year":"2023","journal-title":"Ind. Psychiatry J."},{"key":"ref47","doi-asserted-by":"publisher","first-page":"90-95","DOI":"10.29120\/IJPSW.2021.v12.i2.275","article-title":"Supernatural attitude and mental health practices among the tribal with special reference to Jharkhand.","volume":"12","author":"N Hansda","year":"2021","journal-title":"Indian J Psychiatric Soc Work."},{"key":"ref48","doi-asserted-by":"publisher","first-page":"e39867","DOI":"10.7759\/cureus.39867","article-title":"The tribal health system in India: challenges in healthcare delivery in comparison to the global healthcare systems.","volume":"15","author":"A Deb Roy","year":"2023","journal-title":"Cureus."},{"key":"ref49","doi-asserted-by":"publisher","first-page":"589","DOI":"10.12688\/f1000research.164492.1","article-title":"Empowering Healthcare Access: Ethnographic Insights into Sustainable Solutions for a Particularly Vulnerable Tribal Group (PVTG) in South India- a Qualitative Research [version 1; peer review: 2 approved].","volume":"14","author":"B Soman","year":"2025","journal-title":"F1000Res."},{"key":"ref50","doi-asserted-by":"publisher","first-page":"e0250971","DOI":"10.1371\/journal.pone.0250971","article-title":"Understanding health care-seeking behaviour of the tribal population in India among those with presumptive TB symptoms.","volume":"16","author":"B Thomas","year":"2021","journal-title":"PLoS One."},{"key":"ref51","doi-asserted-by":"publisher","first-page":"508-512","DOI":"10.4103\/jfmpc.jfmpc_992_19","article-title":"Tribal population in India: a public health challenge and road to future.","volume":"9","author":"M Kumar","year":"2020","journal-title":"J. Family Med. Prim. Care."},{"key":"ref52","doi-asserted-by":"publisher","first-page":"3014","DOI":"10.3390\/ijerph18063014","article-title":"Enablers and barriers to accessing healthcare services for Aboriginal people in New South Wales, Australia.","volume":"18","author":"D Nolan-Isles","year":"2021","journal-title":"Int. J. Environ. Res. Public Health."},{"key":"ref53","doi-asserted-by":"publisher","first-page":"83","DOI":"10.1186\/1472-6963-13-83","article-title":"Factors influencing health care utilisation among Aboriginal cardiac patients in central Australia: a qualitative study.","volume":"13","author":"S Artuso","year":"2013","journal-title":"BMC Health Serv. Res."}],"container-title":["F1000Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/f1000research.com\/articles\/15-542\/v2\/xml","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/f1000research.com\/articles\/15-542\/v2\/pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/f1000research.com\/articles\/15-542\/v2\/iparadigms","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T06:49:08Z","timestamp":1784616548000},"score":1,"resource":{"primary":{"URL":"https:\/\/f1000research.com\/articles\/15-542\/v2"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,25]]},"references-count":49,"URL":"https:\/\/doi.org\/10.12688\/f1000research.176835.2","relation":{"has-version":[{"id-type":"doi","id":"10.12688\/f1000research.176835.1","asserted-by":"subject"}],"has-review":[{"id-type":"doi","id":"10.5256\/f1000research.204378.r498493","asserted-by":"subject"},{"id-type":"doi","id":"10.5256\/f1000research.204378.r498493","asserted-by":"object"}]},"ISSN":["2046-1402"],"issn-type":[{"value":"2046-1402","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,25]]},"assertion":[{"value":"Indexed","URL":"https:\/\/f1000research.com\/articles\/15-542\/v2#article-reports","order":0,"name":"referee-status","label":"Referee status","group":{"name":"current-referee-status","label":"Current Referee Status"}},{"value":"10.5256\/f1000research.194947.r476269, Prof. (Dr.) Roumi Deb, Department of Anthropology, AISS, Amity University, Noida, Uttar Pradesh, 05 May 2026, version 1, 1 approved, 1 approved with reservations","URL":"https:\/\/f1000research.com\/articles\/15-542\/v1#referee-response-476269","order":0,"name":"referee-response-476269","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"<b>Dr Ranjitha S Shetty<\/b>; \n<i>Posted: 19 Jun 2026<\/i>; \n<b>1: There is limited emphasis on recent (last 5 years) high-impact literature. Literature review lacks clear identification of knowledge gaps specific to this population. It is recommended to include more recent and regionally comparable studies.<\/b> Response: Thank you for the comment. We have revised the review of literature to add recent studies done among Koraga and other regional tribal studies. \n<b>2: Clearly articulate how this study adds new knowledge beyond existing evidence.<\/b> Response: The new knowledge that this study would add to the scientific field has been incorporated into the manuscript. \n<b>3: Limited detail has been provided on validation process (e.g., reliability coefficients not reported), no discussion of potential biases (interviewer bias, social desirability bias). It is recommended to provide psychometric properties (Cronbach\u2019s alpha, validity metrics) and include bias mitigation strategies.<\/b> Response: The instruments used in the study underwent content validation by a panel of seven experts comprising academicians and researchers with expertise in community medicine, reproductive health, and mental health. Public health experts and statisticians also evaluated the tools for relevance, clarity, and comprehensiveness. The overall Content Validity Index (CVI) was 0.82, demonstrating good content validity of the instrument. Reliability test of the tool was done by split half method for knowledge Questionnaire (0.84) and Cronbach\u2019s Alpha for attitude scale (0.92). A pilot study was conducted among 60 participants in Udupi taluk and found feasible, and the same village and settlements were excluded from the main study. \n<b>4. There is no mention of model diagnostics (goodness-of-fit, multicollinearity), handling of confounders. It is recommended to include model fit statistics (e.g., Hosmer\u2013Lemeshow test) and confounding variables.<\/b> Response: &nbsp;Multicollinearity was assessed using the Variance Inflation Factor (VIF), with all variables demonstrating VIF &lt; 2. Model fit was evaluated using the Hosmer\u2013Lameshow goodness-of-fit test. The results of Hosmer\u2013Lameshow test for goodness-of-fit are now reported in the paper.","URL":"https:\/\/f1000research.com\/articles\/15-542\/v2#referee-comment-16456","order":1,"name":"referee-comment-16456","label":"Referee Comment","group":{"name":"article-reports","label":"Article Reports"}},{"value":"10.5256\/f1000research.194947.r476278, Dr Jayashree Gothankar, Bharati Vidyapeeth Deemed University Medical College, Pune, 11 May 2026, version 1, 1 approved, 1 approved with reservations","URL":"https:\/\/f1000research.com\/articles\/15-542\/v1#referee-response-476278","order":2,"name":"referee-response-476278","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"<b>Dr Ranjitha S Shetty<\/b>; \n<i>Posted: 19 Jun 2026<\/i>; \n<b>1.The validation and pre-testing of research tools need to be written. &nbsp;<\/b> Response: Thank you for noting this. Validation and pretesting were done prior to IEC approval. However, we missed adding details in the manuscript. Please note that we have added the details of validation and pre-testing under methods section now. \n<b>2. Statistical analysis: It is preferred to use the prevalence ratio instead of the odds ratio. Since the outcome is common, here, the odds ratio can exaggerate the association. Thus, the prevalence ratio and the adjusted prevalence ratio with 95% confidence intervals may provide a more accurate measure of the association between various characteristics and the knowledge and attitude of the tribal population.<\/b> Response:\n<b> <\/b>Thank you for providing this valuable suggestion. We sincerely appreciate the reviewer's expertise in drawing our attention to this important methodological consideration, and we are glad to have the opportunity to clarify our analytical approach. We acknowledge that prevalence ratios are often preferred as a more direct and interpretable measure of association in cross-sectional studies. In the present analysis, logistic regression was used to model binary outcomes, as it is a well-established and robust method that provides stable estimates. \n<b>3. Regarding the limitations, kindly elaborate on the statement \u201cWe have conducted this study considering possible bias related to the subjects, samples (being a tribal population), and researchers.\u201d<\/b> Response:\n<b> <\/b>Thank you for the comment.\n<b> <\/b>We have clarified the statement as follows: Potential biases related to participants, sampling, researchers, and methodology were carefully considered. Although the researcher was not from the tribal community, the involvement of tribal leaders and local health workers familiar with the participants\u2019 language and culture helped minimize contextual bias.","URL":"https:\/\/f1000research.com\/articles\/15-542\/v2#referee-comment-16457","order":3,"name":"referee-comment-16457","label":"Referee Comment","group":{"name":"article-reports","label":"Article Reports"}},{"value":"10.5256\/f1000research.204378.r498493, Lalitha Rani Chellappa, Saveetha Dental College, Saveetha Institute of Medical and Technical Sciences, Chennai, Tamil Nadu, 21 Jul 2026, version 2, indexed","URL":"https:\/\/f1000research.com\/articles\/15-542\/v2#referee-response-498493","order":4,"name":"referee-response-498493","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"This research was funded by the Indian Council of Medical Research (ICMR), New Delhi, under grant number Tribal\/121\/2020-ECD-II. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.","order":5,"name":"grant-information","label":"Grant Information"},{"value":"This is an open access article distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.","order":0,"name":"copyright-info","label":"Copyright"}]}}