A Hybrid Healthcare Access Model for OPMD Screening and Oral Cancer Prevention in Tribal Odisha,India

Background: Oral Potentially Malignant Disorders(OPMDs) and oral cancer constitute a significant, yet under-recognised, health challenge among tribal populations in Odisha, India. Prevalence of tobacco and alcohol use is notably high, contributing to increased risk and delayed diagnosis. Odisha, home to the largest number of tribal groups in India, faces unique barriers to healthcare access, including geographic isolation, cultural factors, and limited infrastructure. Despite high rates of tobacco consumption, no structured screening programme exists in these remote populations. This gap results in late-stage diagnoses and poor survival outcomes, highlighting the urgent need for prevention strategies. The present ICMR-funded initiative seeks to translate research into action by developing an early detection model for these underserved communities.

Objectives: The primary objective was to design and implement a sustainable oral healthcare access model for OPMD screening in tribal regions of Odisha. 
Specific aims included:
Estimating the prevalence of OPMDs 
Assessing risk factors associated 
Identifying barriers and facilitators to implementation
Promoting awareness and cessation of tobacco and alcohol use

Methods (Action & Innovation):
A modified Hybrid Type 3 design, integrating quantitative screening with qualitative evaluation of implementation outcomes. The study was conducted in two tribal-dominated districts: Sundargarh (Northern Odisha) and Koraput (Southern Odisha), encompassing four blocks with a tribal population of approximately 166,529 individuals aged 15 years & above.

The intervention comprised three core "Research into Action" approach:
Capacity Building: Recruitment and training of local field volunteers and frontline health workers (ASHAs) in OPMD identification and Toluidine blue testing, ensuring cultural relevance and community acceptance.
Digital Innovation: Development of an application, "OPMD Data Collector," in collaboration with IIT Kharagpur, enabling offline and online data and image capture in low-connectivity areas, and facilitating real-time documentation.
Implementation Science: Systematic door-to-door surveys, clinical examinations, and screening protocols to assess both disease prevalence and feasibility of the model.

Results:
Screening was successfully initiated (door to door survey) in both districts, with 29,498 participants in Koraput and 18,110 in Sundargarh. Oral Submucous Fibrosis(OSMF) and Leukoplakia,identified as the most prevalent OPMDs. The community-based model demonstrated feasibility despite challenging terrain, limited connectivity, and pandemic-related restrictions. Key barriers included lockdowns and staff turnover, while strong administrative support and incentivisation of local volunteers were critical facilitators. The cumulative prevalence of OPMDs was found to be 6.3% across both districts. Bhang emerged as the most commonly used tobacco product, with usage rates of 81% in Sundargarh and 74.6% in Koraput. The findings underscore the need for enhanced awareness and habit cessation initiatives.

Conclusions & Implications:
This project illustrates the translational potential of integrating digital health tools with community-based workforce training to advance cancer prevention in low-resource settings. By overcoming infrastructural and pandemic-related challenges, the model offers a scalable blueprint for moving from prevalence estimation to active barrier mitigation and policy advocacy. 

Key Innovations: 
(1) Task-shifting  community health workers for early detection; 
(2) Technology-enabled screening using locally developed mobile applications adaptable for low-resource settings; 
(3) Multi-institutional collaboration in the Indian scenario

Table 1:Prevalence of OPMDs Table 2:Facilitators & barriers of Oral cancer screening in the study areas