{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T18:35:18Z","timestamp":1786732518094,"version":"build-2736575974"},"reference-count":45,"publisher":"Public Library of Science (PLoS)","issue":"8","license":[{"start":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T00:00:00Z","timestamp":1786665600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001411","name":"Indian Council of Medical Research","doi-asserted-by":"publisher","award":["NER\/82\/2022-ECD-I"],"award-info":[{"award-number":["NER\/82\/2022-ECD-I"]}],"id":[{"id":"10.13039\/501100001411","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Involving community volunteers in the tuberculosis (TB) program is widely acknowledged and considered a key element of the community engagement strategy in the TB program of India, especially in predominantly tribal North Eastern districts. Inadequate TB knowledge, attitudes and Practices (KAPs) about health and related risk factors could be a key barrier to using community volunteers or lay persons in health program.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We trained 708 volunteers from student and women organisation (SAWOs) in 189 villages, Senapati District, Manipur between February 2023 and August 2025. A training on identifying TB symptomatics, sputum collections, transportations, patient support and follow-up during their treatment, counselling were provided. A TB-KAP pre and post data were collected in REDCap software and analysed using Stata. To assess the impact of the training on participants\u2019 KAP regarding TB, both descriptive and inferential statistical methods were used. Statistical significance was determined at\n                      <jats:italic>p-value<\/jats:italic>\n                      &lt;0.05.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Of 708 trained volunteers, 339 were retained during the full training and assessment. With respect to the knowledge score, the probability of being in the highest knowledge category increased from 10% to 65% after training, while the likelihood of being in the lowest two categories dropped from 61% to 8%. The mean attitude score about TB increased from 24.53 (SD\u2009=\u20094.79) to 25.40 (SD\u2009=\u20094.83) after training. This difference of 0.87 points was statistically significant (\n                      <jats:italic>t<\/jats:italic>\n                      (353)=\u22123.58,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.0004), with a 95% confidence interval of [\u22121.35, \u22120.39]. Significant positive changes were seen in the anticipated health-seeking intentions of the volunteers in terms of seeking care for symptoms within 1\u20132 weeks (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.0009).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Our study demonstrated that focused and culturally appropriate short term training can produce significant immediate gains in TB knowledge, with modest improvements in attitudes and reported health-seeking intentions, even in the remotest tribal areas among community volunteers.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0356469","type":"journal-article","created":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T17:58:24Z","timestamp":1786730304000},"page":"e0356469","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Tuberculosis Knowledge, Attitude, and Practice (TB-KAP) among the volunteers: Findings from community-based intervention training outcome in Tribal Hard-to-Reach Areas in Manipur"],"prefix":"10.1371","volume":"21","author":[{"given":"Karikalan","family":"Nagarajan","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen","family":"Arangba","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Basilea","family":"Watson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1209-4062","authenticated-orcid":true,"given":"Muniyandi","family":"Malaisamy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Linette","family":"Muanching","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suchita","family":"Singh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sanjay Kumar","family":"Mattoo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vijaya","family":"Elangbam","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"W. Shashi","family":"Singh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Senthil","family":"Sellappan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dahiiru","family":"Ngade","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amow","family":"Ngaopuo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lungnalii K.","family":"T","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thangpa","family":"Serto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pfokreho","family":"Pfoze","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dina","family":"Nair","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4932-0617","authenticated-orcid":true,"given":"Vignes Anand","family":"Srinivasalu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth","family":"R K","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pung","family":"Mark","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hanna","family":"R N","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Yonuo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sumpi","family":"Percy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Harpreet","family":"Kaur","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,8,14]]},"reference":[{"key":"pone.0356469.ref001","unstructured":"WHO. Global Tuberculosis Report 2024; 2024. Available from: https:\/\/www.who.int\/teams\/global-programme-on-tuberculosis-and-lung-health\/tb-reports\/global-tuberculosis-report-2024"},{"issue":"6","key":"pone.0356469.ref002","doi-asserted-by":"crossref","first-page":"3572","DOI":"10.1007\/s40615-023-01810-3","article-title":"Tracing the disparity between healthcare policy-based infrastructure and health belief-lead practices: a narrative review on indigenous populations of India","volume":"11","author":"B Soman","year":"2024","journal-title":"J Racial Ethn Health Disparities"},{"key":"pone.0356469.ref003","first-page":"1","article-title":"Health and health seeking behaviour among tribal communities in India: A socio-cultural perspective","volume":"2","author":"J Islary","year":"2014","journal-title":"JTICI"},{"issue":"3","key":"pone.0356469.ref004","article-title":"Bridging gaps in tuberculosis control: a culturally competent approach for tribal populations in India","volume":"17","author":"AG Prabhune","year":"2025","journal-title":"Cureus"},{"issue":"5","key":"pone.0356469.ref005","doi-asserted-by":"crossref","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":"BE Thomas","year":"2021","journal-title":"PLoS One"},{"issue":"11","key":"pone.0356469.ref006","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0309750","article-title":"Bridging the \u201cknow-do\u201d gap to improve active case finding for tuberculosis in India: a qualitative exploration into national tuberculosis elimination program staffs\u2019 perspectives","volume":"19","author":"HD Shewade","year":"2024","journal-title":"PLoS One"},{"key":"pone.0356469.ref007","first-page":"9746329","article-title":"Enablers and challenges in the implementation of active case findings in a selected district of Karnataka, South India: a qualitative study","volume":"2020","author":"AN Shamanewadi","year":"2020","journal-title":"Tuberc Res Treat"},{"issue":"4","key":"pone.0356469.ref008","doi-asserted-by":"crossref","first-page":"206","DOI":"10.3390\/tropicalmed6040206","article-title":"Active case finding for tuberculosis in India: a syntheses of activities and outcomes reported by the national tuberculosis elimination programme","volume":"6","author":"S Burugina Nagaraja","year":"2021","journal-title":"Trop Med Infect Dis"},{"key":"pone.0356469.ref009","unstructured":"CTD. Community Engagement Under National TB Elimination Program; 2021. Available from: https:\/\/tbcindia.mohfw.gov.in\/wp-content\/uploads\/2023\/04\/2239437973Guidance-Documents-on-Community-Engagement-under-NTEP.pdf"},{"issue":"4","key":"pone.0356469.ref010","doi-asserted-by":"crossref","first-page":"237","DOI":"10.1080\/19371918.2018.1454870","article-title":"Barriers to women\u2019s participation: experiences of volunteers and community healthcare authorities","volume":"33","author":"H Rezakhani Moghaddam","year":"2018","journal-title":"Soc Work Public Health"},{"key":"pone.0356469.ref011","doi-asserted-by":"crossref","first-page":"62","DOI":"10.3389\/fpubh.2017.00062","article-title":"Community health volunteers in primary healthcare in rural Uganda: factors influencing performance","volume":"5","author":"Y Kuule","year":"2017","journal-title":"Front Public Health"},{"key":"pone.0356469.ref012","doi-asserted-by":"crossref","DOI":"10.1186\/s12960-018-0304-x","article-title":"What do we know about community-based health worker programs? A systematic review of existing reviews on community health workers","volume":"16","author":"K Scott","year":"2018","journal-title":"Hum Resour Health"},{"issue":"1","key":"pone.0356469.ref013","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1186\/s13012-017-0554-3","article-title":"Understanding the performance of community health volunteers involved in the delivery of health programmes in underserved areas: a realist synthesis","volume":"12","author":"G Vareilles","year":"2017","journal-title":"Implement Sci"},{"key":"pone.0356469.ref014","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1186\/s12961-015-0001-3","article-title":"How does context influence performance of community health workers in low- and middle-income countries? Evidence from the literature","volume":"13","author":"MC Kok","year":"2015","journal-title":"Health Res Policy Syst"},{"issue":"3","key":"pone.0356469.ref015","doi-asserted-by":"crossref","first-page":"625","DOI":"10.4269\/ajtmh.14-0527","article-title":"Trained community volunteers improve tuberculosis knowledge and attitudes among adults in a periurban community in southwest Nigeria","volume":"92","author":"M Balogun","year":"2015","journal-title":"Am J Trop Med Hyg"},{"issue":"3","key":"pone.0356469.ref016","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1093\/inthealth\/iht012","article-title":"Training of community healthcare providers and TB case detection in Bangladesh","volume":"5","author":"S Islam","year":"2013","journal-title":"Int Health"},{"issue":"4","key":"pone.0356469.ref017","doi-asserted-by":"crossref","first-page":"142","DOI":"10.5588\/pha.12.0064","article-title":"Relationship between education and training activities and tuberculosis case detection in Fiji, 2008-2011","volume":"2","author":"MY Delai","year":"2012","journal-title":"Public Health Action"},{"key":"pone.0356469.ref018","unstructured":"WHO. WHO guideline on health workforce development, attraction, recruitment and retention in rural and remote areas; 2021. Available from: https:\/\/iris.who.int\/bitstream\/handle\/10665\/341139\/9789240024229-eng.pdf"},{"key":"pone.0356469.ref019","unstructured":"WHO. WHO guideline on health policy and system support to optimize community worker; 2018. Available from: https:\/\/iris.who.int\/bitstream\/handle\/10665\/275474\/9789241550369-eng.pdf"},{"key":"pone.0356469.ref020","unstructured":"WHO. Training of community health workers and community: facilitators\u2019 guide; 2015. Available from: https:\/\/iris.who.int\/bitstream\/handle\/10665\/178160\/9789241509176_eng.pdf;jsessionid=79AECBB94EED83E59BD71238831EDF82?sequence=1"},{"issue":"6","key":"pone.0356469.ref021","first-page":"573","article-title":"Study of the feasibility of involving male student volunteers in case holding in an urban tuberculosis programme","volume":"1","author":"R Rajeswari","year":"1997","journal-title":"Int J Tuberc Lung Dis"},{"issue":"6","key":"pone.0356469.ref022","doi-asserted-by":"crossref","first-page":"750","DOI":"10.5588\/ijtld.18.0741","article-title":"Community-based active case-finding to reach the most vulnerable: tuberculosis in tribal areas of India","volume":"23","author":"A Vyas","year":"2019","journal-title":"Int J Tuberc Lung Dis"},{"key":"pone.0356469.ref023","article-title":"Role of community health workers in improving cost efficiency in an active case finding tuberculosis programme: an operational research study from rural Bihar, India","volume":"10","author":"T Garg","year":"2020","journal-title":"BMJ Open"},{"issue":"5","key":"pone.0356469.ref024","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0196067","article-title":"Impact of involvement of non-formal health providers on TB case notification among migrant slum-dwelling populations in Odisha, India","volume":"13","author":"A Dutta","year":"2018","journal-title":"PLoS One"},{"key":"pone.0356469.ref025","article-title":"Role of community health workers in improving TB detection on scale: a case study from the Mitanin programme in Chhattisgarh, India","author":"S Garg","year":"2016","journal-title":"BMJ Glob Health"},{"issue":"2","key":"pone.0356469.ref026","doi-asserted-by":"crossref","first-page":"57","DOI":"10.53553\/JCH.v07i02.010","article-title":"Feasibility and performance of Accredited Social Health Activist (ASHA) led Active Case Finding (ACF) strategy for tuberculosis in a community health block of Himachal Pradesh","volume":"7","author":"A Bhardwaj","year":"2019","journal-title":"J Compr Health"},{"key":"pone.0356469.ref027","doi-asserted-by":"crossref","first-page":"04042","DOI":"10.7189\/jogh.11.04042","article-title":"Community health workers augment the cascade of TB detection to care in urban slums of two metro cities in India","volume":"11","author":"RS Potty","year":"2021","journal-title":"J Glob Health"},{"issue":"1","key":"pone.0356469.ref028","doi-asserted-by":"crossref","first-page":"15","DOI":"10.5588\/pha.15.0035","article-title":"Experience of active tuberculosis case finding in nearly 5 million households in India","volume":"6","author":"BM Prasad","year":"2016","journal-title":"Public Health Action"},{"issue":"7","key":"pone.0356469.ref029","article-title":"Breaking barriers for TB elimination: a novel community-led strategy revolutionizing tuberculosis case finding and treatment support in Senapati District Manipur-A quasi-experimental pre-post study protocol","volume":"20","author":"S Arangba","year":"2025","journal-title":"PLoS One"},{"key":"pone.0356469.ref030","volume-title":"Advocacy, communication and social mobilization for TB control: a guide to developing knowledge, attitude and practice surveys (WHO\/HTM\/STB\/2008.46)","author":"World Health Organization","year":"2008"},{"key":"pone.0356469.ref031","unstructured":"IIPS & ICF. National Family Health Survey (NFHS - 5), 2019\u201321 India Report; 2021. Available from: https:\/\/www.dhsprogram.com\/pubs\/pdf\/FR375\/FR375.pdf"},{"key":"pone.0356469.ref032","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1186\/1471-2334-13-16","article-title":"Prevalence of self-reported tuberculosis, knowledge about tuberculosis transmission and its determinants among adults in India: results from a nation-wide cross-sectional household survey","volume":"13","author":"CT Sreeramareddy","year":"2013","journal-title":"BMC Infect Dis"},{"issue":"1","key":"pone.0356469.ref033","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1016\/j.ijtb.2022.03.015","article-title":"Knowledge about tuberculosis among tribal population in Kerala in the backdrop of TB elimination goal by 2025","volume":"70","author":"SB Nair","year":"2023","journal-title":"Indian J Tuberc"},{"issue":"3","key":"pone.0356469.ref034","doi-asserted-by":"crossref","first-page":"189","DOI":"10.5588\/pha.14.0036","article-title":"Tuberculosis knowledge and awareness in tribal-dominant districts of Jharkhand, India: implications for ACSM","volume":"4","author":"P Kulkarni","year":"2014","journal-title":"Public Health Action"},{"key":"pone.0356469.ref035","unstructured":"MoHFW. Tribal health in India: bridging the gap and a roadmap for the future; 2018. Available from: https:\/\/tribalhealthreport.in\/"},{"issue":"1","key":"pone.0356469.ref036","doi-asserted-by":"crossref","first-page":"76","DOI":"10.1177\/09760016241277333","article-title":"Tribal health in India: overcoming public health challenges with a focus on tuberculosis","volume":"22","author":"R Kumari","year":"2024","journal-title":"Apollo Med"},{"key":"pone.0356469.ref037","doi-asserted-by":"crossref","first-page":"126","DOI":"10.15562\/phpma.v8i2.307","article-title":"Training program for tuberculosis (TB) patients to improve referrals of presumptive TB cases and sputum in Denpasar, Bali, Indonesia","volume":"8","author":"P Ayu","year":"2020","journal-title":"Public Health Prev Med Arch"},{"issue":"9","key":"pone.0356469.ref038","doi-asserted-by":"crossref","first-page":"30","DOI":"10.5539\/gjhs.v12n9p30","article-title":"The development of village health volunteers\u2019 competencies for tuberculosis care in Trang province, Thailand","volume":"12","author":"J Choowong","year":"2020","journal-title":"Glob J Health Sci"},{"key":"pone.0356469.ref039","doi-asserted-by":"crossref","first-page":"322","DOI":"10.4103\/jehp.jehp_1079_20","article-title":"Need-based training of community health officers for tuberculosis care in Ahmednagar district of Maharashtra, India: a before and after study","volume":"10","author":"MP Baviskar","year":"2021","journal-title":"J Educ Health Promot"},{"issue":"1","key":"pone.0356469.ref040","doi-asserted-by":"crossref","first-page":"96","DOI":"10.1186\/s12879-019-3688-x","article-title":"Knowledge, attitude and associated factors towards tuberculosis in Lesotho: a population based study","volume":"19","author":"TR Luba","year":"2019","journal-title":"BMC Infect Dis"},{"key":"pone.0356469.ref041","doi-asserted-by":"crossref","first-page":"536","DOI":"10.1186\/1471-2458-12-536","article-title":"Socio-demographic determinants and prevalence of Tuberculosis knowledge in three slum populations of Uganda","volume":"12","author":"EA Obuku","year":"2012","journal-title":"BMC Public Health"},{"issue":"1","key":"pone.0356469.ref042","doi-asserted-by":"crossref","first-page":"948","DOI":"10.1186\/s12913-024-11336-x","article-title":"Demographic and socioeconomic disparity in knowledge, attitude, and practice towards tuberculosis in Northwest, China: evidence from multilevel model study","volume":"24","author":"N Ma","year":"2024","journal-title":"BMC Health Serv Res"},{"issue":"1","key":"pone.0356469.ref043","article-title":"What affected Chinese parents\u2019 decisions about tuberculosis (TB) treatment: implications based on a cross-sectional survey","volume":"16","author":"T Xia","year":"2021","journal-title":"PLoS One"},{"issue":"4","key":"pone.0356469.ref044","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pntd.0008149","article-title":"Understanding the role of disease knowledge and risk perception in shaping preventive behavior for selected vector-borne diseases in Guyana","volume":"14","author":"C Aerts","year":"2020","journal-title":"PLoS Negl Trop Dis"},{"key":"pone.0356469.ref045","unstructured":"ICMR. National TB Prevalence Survey India 2019-2021; 2021. Available from: https:\/\/tbcindia.mohfw.gov.in\/wp-content\/uploads\/2023\/05\/25032022161020NATBPSReport.pdf"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0356469","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T17:58:33Z","timestamp":1786730313000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0356469"}},"subtitle":[],"editor":[{"given":"Yasir","family":"Alvi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,8,14]]},"references-count":45,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2026,8,14]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0356469","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,14]]}}}