Table 4 Reflexive thematic analysis: major themes & Sub-themes

‘We are not conscious of these changes in our body. For example, older people may experience low blood pressure, causing them to faint frequently. We don’t usually consult them in hospitals, we will go there in the last stage. We only got to know about the problem after reaching the hospital.’ - P02

‘I don’t have that much idea about my illness. I’m daily taking the tablets prescribed by the doctor. I will tell the ASHA worker, if the tablet runs out, and she will bring me some more.’- P03

‘There is one person near my house with some serious disease named cancer, he was also bedridden, we do not interact with that family that much, my daughter’s children are there at my house, what if they get this disease?’- P01

‘I don’t have any idea about the medical schemes existing for tribal people, we are not getting anything.’- P01

‘A person has high blood sugar, which begins to harm their leg over time. He didn’t tell us anything, and it ended up getting complicated. They are not aware of the seriousness of the disease conditions’ -ASHA worker

‘First, they will try several Ayurvedic treatments; they will only inform me when the illness is really severe and cannot be under control.’-Promoter-1

Unaware of bodily changes, unwellness to consult a doctor, lack of knowledge about their health issues, fear of diseases, lack of awareness about their rights, Ayurvedic medication

Health-related knowledge, Fear of disease transmission, Healthcare schemes, healthcare-seeking behaviour.

Health-related knowledge- lack of knowledge related to their health issues and symptoms.

Fear of disease transmission- misconception about non-communicable diseases that will spread through interaction.

Healthcare schemes- Lack of knowledge about the existing health care schemes for tribes.

healthcare-seeking behaviour- poor understanding about when and where to seek help from medical professional.

Lack of awareness

‘It will take a while to get there in the hospital because there aren’t many vehicle facilities in this area, therefore we want to wait for a long time to get a vehicle.’-P07

‘If any medical emergency comes, we have to wait a lot to get an auto from this area to the hospital-P05

‘The tribal settlements are difficult to access because they are in remote areas, most of the tribal settlements are in hilly areas Transport facilities are very less in the area’-Observation

Geographical location of tribal settlement, lack of transport facilities,

Location of tribal settlement,

transportation

Location of tribal settlement- tribal settlements are located in remote and hilly areas.

Transportation- Lack of vehicle facilities in tribal areas.

Accessibility

‘I’m the only one who makes money for my family and children; my husband doesn’t give me any money; he drinks every day with the money he gets from his job.’-P06

‘Once tribal people’s jobs are over, the owner of the workplace offers them less money and more alcohol to make them consistent in the workplace. This is one among the elements causing their increasing alcohol usage and related problems among tribes.’- ASHA worker-2

“I don’t have enough money to cover my hospital costs.” Before we have enough money because of visiting the forest areas, we will spend one to two weeks in the forest by gathering honey, coconuts, and other healing plants to sell at the store. We aren’t going into the forest anymore because we have other work to do. All the women here are looking for MGNREGA, while the men are working in jobs like construction and farming. So that we get a regular amount of money.’- P03

‘The tribes are only getting very cheap wages for their hard work’- Promoter-2

Financial strain on women, Alcohol dependency, lack of money to access healthcare, underpaid daily wages jobs.

Alcohol consumption,

Underpaid Daily wages jobs

Alcohol consumption- Alcohol consumption after receiving payment from the job

Underpaid Daily wages jobs- tribal people are receiving low payments even after doing hard work.

Financial Issues

‘Ayurvedic medicines are part of our belief systems, this allopathy medication doesn’t have that much power to give relief’- P03

‘Medications supplied by doctors are ineffective since diseases will recur once the advised dosage is completed.’- P04

‘The tablets prescribed were temporarily giving relief, but Ayurvedic medicine was not like that if we are using Ayurvedic medicine it will completely cure the disease’- P03

‘First, they will try several Ayurvedic treatments; they will only inform me when the illness is really severe and cannot be under control by their natural medicines.’-Promoter-1

‘One child in this settlement is having a liver issue, and the child’s parents are not willing to go to the hospital for treatment, the parents are saying that allopathy treatment is complicated and the child will be hurt so we are not consulting the allopathic healthcare practitioner.’- P08

‘Now also some of the people are doing rituals to get rid of the disease, recently one incident happened for a child. The child had a fever for long days. The family members didn’t report me about this and they started consulting a priest, Finally, we found that and admitted that child to the nearby government hospital.’- ASHA worker 1

Trust in Ayurvedic medication, ineffective medicine, Preference for traditional medicine, fear of allopathy health care, cultural practices

Trust in Ayurvedic medication, Attitude towards allopathy, Cultural practices

Trust in Ayurvedic medication- Strong belief in ayurvedic treatment and medicines.

Attitude towards allopathy- negative thoughts and feeling towards allopathic medicine.

Cultural practices- rituals that exists in tribes for healing.

Cultural Belief and Practice

‘Language-related issues are also somewhat common in our community; sometimes the medical camp’s physicians and nurses will not understand what we are talking about.’. -P04

‘We lacked the confidence to engage with the other people living outside our colony; their attitude toward us is unsatisfactory’-P07

‘Most of the tribal people are not ready to talk with the researcher and even they are not coming out of their huts’- Observation

‘Fear of judgment and anxiety make most of them interact with outsiders hardly at all. They won’t directly interact with the medical professionals.’- ASHA worker

Language-related issues among tribes, lack of confidence, lack of interaction with outsiders, fear of judgement.

Language barrier,

Social withdrawal,

Fear of judgement

Language barrier- difficulty in communication.

Social withdrawal- Someone’s choice to avoid social interaction because of fear, anxiety, or lack of confidence.

Fear of judgement- Anxiety or distress that others judge them negatively

Fear and Communication Barrier

‘We are not getting other grains; rice is what we eat most of the time as the ration shop supplies only that mostly. ’- P04

‘Every time, we have black tea and rice porridge. We don’t have enough money to buy fruits and meats.’-P05

‘The women are unhealthy. Doctors assert that some minerals are lacking in these pregnant ladies, which is the reason they are not healthy enough to deliver a child.’- ASHA worker-1

‘Everyone, but particularly women, are extremely thin and unhealthy, this is one of the reasons for the onset of diseases’- Observation

Limited availability of required food, health issues due to lack of nutrients

Food availability constraints, Malnutrition

Food availability constraints- limited availability of diverse nutrients

Malnutrition- Undernourishment in the community and associated health issues

Poverty

‘The promoters won’t come regularly, sometimes they won’t pick up the call also’- P07

‘Sometimes the assigned healthcare workers won’t pick up the call’- P01

‘I did not get paid at the time of the delivery of my second child when I contacted the promoter about it, he said, We don’t have enough funds with us right now, I will discuss this with the authorities and call you back. After that, he didn’t get back to me.’- P07

‘The doctor and nurse come to our settlement once every two months’- P02

‘Medical camp is only held here once a month or once every two months, it is challenging to either monitor or follow-up our issues, and we are again consulting them in their next month visit.’- P04

ASHA workers are not giving any medications; rather, we are buying them from the hospital.’- P04

Lack of proper support from assigned healthcare workers, not getting government funds, inconsistent visits, inconsistent conduction of medical camps

Lack of support from healthcare workers,

Inaccessibility of government funds,

inconsistent medical follow-up

Lack of support from healthcare workers- inadequate assistance from assigned health care workers.

Inaccessibility of government funds- Not receiving needed government funds to the tribes.

inconsistent medical follow-up- inconsistent delivery of healthcare services for the tribes

Insufficient Healthcare Workforce

‘Palliative care services are not available in our settlement’- P06

‘Palliative care nurse is visiting one patient once a month, who is unable to get out of bed, they are not providing proper follow-up’- P07

‘The palliative care nurses will visit the patients, who are unable to get out of bed; I will accompany them for assistance. They will visit once a week or twice.’- ASHA worker-1

‘There are two to three stroke patients here in our settlement, palliative care services are provided to them once a month’- ASHA worker-2

The visiting palliative care team only includes nurses and doctors. Other professionals are not visiting the settlement. -Observation

Lack of proper palliative care services, inconsistent services, palliative care nurse, lack of multidisciplinary care

Lack of consistent palliative care services, inadequate follow-up, Lack of multidisciplinary care

Lack of consistent palliative care services- inconsistent delivery of palliative care services in tribal settlement

inadequate follow-up- improper follow-up from palliative care team.

Lack of multidisciplinary care- lack of psycho-social support from palliative care team.

Palliative Care Services

‘My grandfather had jaundice, which caused him to eat everything without realizing he had the illness. His death was brought on by a delayed diagnosis.’- P08

‘One person has been diagnosed with oral cancer in this settlement, that is mainly because of the uncontrolled tobacco use’-ASHA worker-1

“Patients with cancers of the mouth, throat, and stomach are there in some settlements” -AHSA worker-1

“5 Stroke patients are there because of tobacco use”-ASHA worker-1

“Many of the patients have problems with their blood pressure, which can lead to stroke. All of this was brought on by an unhealthful diet.”-ASHA worker 2

There is a lifestyle change happening among tribes from traditional to modern- observation.

Uncontrolled tobacco use, substance use diseases, health issues due to unhealthy diet, lifestyle change

Alcohol and tobacco-induced diseases, Lifestyle diseases

Alcohol and tobacco-induced diseases- Health conditions develop due to uncontrolled alcohol and tobacco use.

Lifestyle diseases- non-communicable diseases caused due to lifestyle change.

Health-related Issues