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

Knowledge and Attitudes Toward Healthcare... | F1000Research "use strict";function _typeof(t){return(_typeof="function"==typeof Symbol&&"symbol"==typeof Symbol.iterator?function(t){return typeof t}:function(t){return t&&"function"==typeof Symbol&&t.constructor===Symbol&&t!==Symbol.prototype?"symbol":typeof t})(t)}!function(){var t=function(){var t,e,o=[],n=window,r=n;for(;r;){try{if(r.frames.__tcfapiLocator){t=r;break}}catch(t){}if(r===n.top)break;r=r.parent}t||(!function t(){var e=n.document,o=!!n.frames.__tcfapiLocator;if(!o)if(e.body){var r=e.createElement("iframe");r.style.cssText="display:none",r.name="__tcfapiLocator",e.body.appendChild(r)}else setTimeout(t,5);return!o}(),n.__tcfapi=function(){for(var t=arguments.length,n=new Array(t),r=0;r 3&&2===parseInt(n[1],10)&&"boolean"==typeof n[3]&&(e=n[3],"function"==typeof n[2]&&n[2]("set",!0)):"ping"===n[0]?"function"==typeof n[2]&&n[2]({gdprApplies:e,cmpLoaded:!1,cmpStatus:"stub"}):o.push(n)},n.addEventListener("message",(function(t){var e="string"==typeof t.data,o={};if(e)try{o=JSON.parse(t.data)}catch(t){}else o=t.data;var n="object"===_typeof(o)&&null!==o?o.__tcfapiCall:null;n&&window.__tcfapi(n.command,n.version,(function(o,r){var a={__tcfapiReturn:{returnValue:o,success:r,callId:n.callId}};t&&t.source&&t.source.postMessage&&t.source.postMessage(e?JSON.stringify(a):a,"*")}),n.parameter)}),!1))};"undefined"!=typeof module?module.exports=t:t()}(); dataLayer = dataLayer || []; // Standard GTM initialization - Google Consent Mode handles consent automatically (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start': new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0], j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src= 'https://www.googletagmanager.com/gtm.js?id='+i+dl+ '>m_auth=hzk0Vc3qFsQYhCrIoHz68A>m_preview=env-1>m_cookies_win=x';f.parentNode.insertBefore(j,f); })(window,document,'script','dataLayer','GTM-MWFK8L5J'); ;window.NREUM||(NREUM={});NREUM.init={distributed_tracing:{enabled:true},privacy:{cookies_enabled:true},ajax:{deny_list:["bam.nr-data.net"]}}; ;NREUM.loader_config={accountID:"438030",trustKey:"438030",agentID:"772317073",licenseKey:"97f8f67f26",applicationID:"772317073"} ;NREUM.info={beacon:"bam.nr-data.net",errorBeacon:"bam.nr-data.net",licenseKey:"97f8f67f26",applicationID:"772317073",sa:1} ;/*! For license information please see nr-loader-spa-1.236.0.min.js.LICENSE.txt */ (()=>{"use strict";var e,t,r={5763:(e,t,r)=>{r.d(t,{P_:()=>l,Mt:()=>g,C5:()=>s,DL:()=>v,OP:()=>T,lF:()=>D,Yu:()=>y,Dg:()=>h,CX:()=>c,GE:()=>b,sU:()=>_});var n=r(8632),i=r(9567);const o={beacon:n.ce.beacon,errorBeacon:n.ce.errorBeacon,licenseKey:void 0,applicationID:void 0,sa:void 0,queueTime:void 0,applicationTime:void 0,ttGuid:void 0,user:void 0,account:void 0,product:void 0,extra:void 0,jsAttributes:{},userAttributes:void 0,atts:void 0,transactionName:void 0,tNamePlain:void 0},a={};function s(e){if(!e)throw new Error("All info objects require an agent identifier!");if(!a[e])throw new Error("Info for ".concat(e," was never set"));return a[e]}function c(e,t){if(!e)throw new Error("All info objects require an agent identifier!");a[e]=(0,i.D)(t,o),(0,n.Qy)(e,a[e],"info")}var u=r(7056);const d=()=>{const e={blockSelector:"[data-nr-block]",maskInputOptions:{password:!0}};return{allow_bfcache:!0,privacy:{cookies_enabled:!0},ajax:{deny_list:void 0,enabled:!0,harvestTimeSeconds:10},distributed_tracing:{enabled:void 0,exclude_newrelic_header:void 0,cors_use_newrelic_header:void 0,cors_use_tracecontext_headers:void 0,allowed_origins:void 0},session:{domain:void 0,expiresMs:u.oD,inactiveMs:u.Hb},ssl:void 0,obfuscate:void 0,jserrors:{enabled:!0,harvestTimeSeconds:10},metrics:{enabled:!0},page_action:{enabled:!0,harvestTimeSeconds:30},page_view_event:{enabled:!0},page_view_timing:{enabled:!0,harvestTimeSeconds:30,long_task:!1},session_trace:{enabled:!0,harvestTimeSeconds:10},harvest:{tooManyRequestsDelay:60},session_replay:{enabled:!1,harvestTimeSeconds:60,sampleRate:.1,errorSampleRate:.1,maskTextSelector:"*",maskAllInputs:!0,get blockClass(){return"nr-block"},get ignoreClass(){return"nr-ignore"},get maskTextClass(){return"nr-mask"},get blockSelector(){return e.blockSelector},set blockSelector(t){e.blockSelector+=",".concat(t)},get maskInputOptions(){return e.maskInputOptions},set maskInputOptions(t){e.maskInputOptions={...t,password:!0}}},spa:{enabled:!0,harvestTimeSeconds:10}}},f={};function l(e){if(!e)throw new Error("All configuration objects require an agent identifier!");if(!f[e])throw new Error("Configuration for ".concat(e," was never set"));return f[e]}function h(e,t){if(!e)throw new Error("All configuration objects require an agent identifier!");f[e]=(0,i.D)(t,d()),(0,n.Qy)(e,f[e],"config")}function g(e,t){if(!e)throw new Error("All configuration objects require an agent identifier!");var r=l(e);if(r){for(var n=t.split("."),i=0;i {r.d(t,{D:()=>i});var n=r(50);function i(e,t){try{if(!e||"object"!=typeof e)return(0,n.Z)("Setting a Configurable requires an object as input");if(!t||"object"!=typeof t)return(0,n.Z)("Setting a Configurable requires a model to set its initial properties");const r=Object.create(Object.getPrototypeOf(t),Object.getOwnPropertyDescriptors(t)),o=0===Object.keys(r).length?e:r;for(let a in o)if(void 0!==e[a])try{"object"==typeof e[a]&&"object"==typeof t[a]?r[a]=i(e[a],t[a]):r[a]=e[a]}catch(e){(0,n.Z)("An error occurred while setting a property of a Configurable",e)}return r}catch(e){(0,n.Z)("An error occured while setting a Configurable",e)}}},6818:(e,t,r)=>{r.d(t,{Re:()=>i,gF:()=>o,q4:()=>n});const n="1.236.0",i="PROD",o="CDN"},385:(e,t,r)=>{r.d(t,{FN:()=>a,IF:()=>u,Nk:()=>f,Tt:()=>s,_A:()=>o,il:()=>n,pL:()=>c,v6:()=>i,w1:()=>d});const n="undefined"!=typeof window&&!!window.document,i="undefined"!=typeof WorkerGlobalScope&&("undefined"!=typeof self&&self instanceof WorkerGlobalScope&&self.navigator instanceof WorkerNavigator||"undefined"!=typeof globalThis&&globalThis instanceof WorkerGlobalScope&&globalThis.navigator instanceof WorkerNavigator),o=n?window:"undefined"!=typeof WorkerGlobalScope&&("undefined"!=typeof self&&self instanceof WorkerGlobalScope&&self||"undefined"!=typeof globalThis&&globalThis instanceof WorkerGlobalScope&&globalThis),a=""+o?.location,s=/iPad|iPhone|iPod/.test(navigator.userAgent),c=s&&"undefined"==typeof SharedWorker,u=(()=>{const e=navigator.userAgent.match(/Firefox[/\s](\d+\.\d+)/);return Array.isArray(e)&&e.length>=2?+e[1]:0})(),d=Boolean(n&&window.document.documentMode),f=!!navigator.sendBeacon},1117:(e,t,r)=>{r.d(t,{w:()=>o});var n=r(50);const i={agentIdentifier:"",ee:void 0};class o{constructor(e){try{if("object"!=typeof e)return(0,n.Z)("shared context requires an object as input");this.sharedContext={},Object.assign(this.sharedContext,i),Object.entries(e).forEach((e=>{let[t,r]=e;Object.keys(i).includes(t)&&(this.sharedContext[t]=r)}))}catch(e){(0,n.Z)("An error occured while setting SharedContext",e)}}}},8e3:(e,t,r)=>{r.d(t,{L:()=>d,R:()=>c});var n=r(2177),i=r(1284),o=r(4322),a=r(3325);const s={};function c(e,t){const r={staged:!1,priority:a.p[t]||0};u(e),s[e].get(t)||s[e].set(t,r)}function u(e){e&&(s[e]||(s[e]=new Map))}function d(){let e=arguments.length>0&&void 0!==arguments[0]?arguments[0]:"",t=arguments.length>1&&void 0!==arguments[1]?arguments[1]:"feature";if(u(e),!e||!s[e].get(t))return a(t);s[e].get(t).staged=!0;const r=[...s[e]];function a(t){const r=e?n.ee.get(e):n.ee,a=o.X.handlers;if(r.backlog&&a){var s=r.backlog[t],c=a[t];if(c){for(var u=0;s&&u {let[t,r]=e;return r.staged}))&&(r.sort(((e,t)=>e[1].priority-t[1].priority)),r.forEach((e=>{let[t]=e;a(t)})))}function f(e,t){var r=e[1];(0,i.D)(t[r],(function(t,r){var n=e[0];if(r[0]===n){var i=r[1],o=e[3],a=e[2];i.apply(o,a)}}))}},2177:(e,t,r)=>{r.d(t,{c:()=>f,ee:()=>u});var n=r(8632),i=r(2210),o=r(1284),a=r(5763),s="nr@context";let c=(0,n.fP)();var u;function d(){}function f(e){return(0,i.X)(e,s,l)}function l(){return new d}function h(){u.aborted=!0,u.backlog={}}c.ee?u=c.ee:(u=function e(t,r){var n={},c={},f={},g=!1;try{g=16===r.length&&(0,a.OP)(r).isolatedBacklog}catch(e){}var p={on:b,addEventListener:b,removeEventListener:y,emit:v,get:x,listeners:w,context:m,buffer:A,abort:h,aborted:!1,isBuffering:E,debugId:r,backlog:g?{}:t&&"object"==typeof t.backlog?t.backlog:{}};return p;function m(e){return e&&e instanceof d?e:e?(0,i.X)(e,s,l):l()}function v(e,r,n,i,o){if(!1!==o&&(o=!0),!u.aborted||i){t&&o&&t.emit(e,r,n);for(var a=m(n),s=w(e),d=s.length,f=0;fn,p:()=>i});var n=r(2177).ee.get("handle");function i(e,t,r,i,o){o?(o.buffer([e],i),o.emit(e,t,r)):(n.buffer([e],i),n.emit(e,t,r))}},4322:(e,t,r)=>{r.d(t,{X:()=>o});var n=r(5546);o.on=a;var i=o.handlers={};function o(e,t,r,o){a(o||n.E,i,e,t,r)}function a(e,t,r,i,o){o||(o="feature"),e||(e=n.E);var a=t[o]=t[o]||{};(a[r]=a[r]||[]).push([e,i])}},3239:(e,t,r)=>{r.d(t,{bP:()=>s,iz:()=>c,m$:()=>a});var n=r(385);let i=!1,o=!1;try{const e={get passive(){return i=!0,!1},get signal(){return o=!0,!1}};n._A.addEventListener("test",null,e),n._A.removeEventListener("test",null,e)}catch(e){}function a(e,t){return i||o?{capture:!!e,passive:i,signal:t}:!!e}function s(e,t){let r=arguments.length>2&&void 0!==arguments[2]&&arguments[2],n=arguments.length>3?arguments[3]:void 0;window.addEventListener(e,t,a(r,n))}function c(e,t){let r=arguments.length>2&&void 0!==arguments[2]&&arguments[2],n=arguments.length>3?arguments[3]:void 0;document.addEventListener(e,t,a(r,n))}},4402:(e,t,r)=>{r.d(t,{Ht:()=>u,M:()=>c,Rl:()=>a,ky:()=>s});var n=r(385);const i="xxxxxxxx-xxxx-4xxx-yxxx-xxxxxxxxxxxx";function o(e,t){return e?15&e[t]:16*Math.random()|0}function a(){const e=n._A?.crypto||n._A?.msCrypto;let t,r=0;return e&&e.getRandomValues&&(t=e.getRandomValues(new Uint8Array(31))),i.split("").map((e=>"x"===e?o(t,++r).toString(16):"y"===e?(3&o()|8).toString(16):e)).join("")}function s(e){const t=n._A?.crypto||n._A?.msCrypto;let r,i=0;t&&t.getRandomValues&&(r=t.getRandomValues(new Uint8Array(31)));const a=[];for(var s=0;s {r.d(t,{Bq:()=>n,Hb:()=>o,oD:()=>i});const n="NRBA",i=144e5,o=18e5},7894:(e,t,r)=>{function n(){return Math.round(performance.now())}r.d(t,{z:()=>n})},7243:(e,t,r)=>{r.d(t,{e:()=>o});var n=r(385),i={};function o(e){if(e in i)return i[e];if(0===(e||"").indexOf("data:"))return{protocol:"data"};let t;var r=n._A?.location,o={};if(n.il)t=document.createElement("a"),t.href=e;else try{t=new URL(e,r.href)}catch(e){return o}o.port=t.port;var a=t.href.split("://");!o.port&&a[1]&&(o.port=a[1].split("/")[0].split("@").pop().split(":")[1]),o.port&&"0"!==o.port||(o.port="https"===a[0]?"443":"80"),o.hostname=t.hostname||r.hostname,o.pathname=t.pathname,o.protocol=a[0],"/"!==o.pathname.charAt(0)&&(o.pathname="/"+o.pathname);var s=!t.protocol||":"===t.protocol||t.protocol===r.protocol,c=t.hostname===r.hostname&&t.port===r.port;return o.sameOrigin=s&&(!t.hostname||c),"/"===o.pathname&&(i[e]=o),o}},50:(e,t,r)=>{function n(e,t){"function"==typeof console.warn&&(console.warn("New Relic: ".concat(e)),t&&console.warn(t))}r.d(t,{Z:()=>n})},2587:(e,t,r)=>{r.d(t,{N:()=>c,T:()=>u});var n=r(2177),i=r(5546),o=r(8e3),a=r(3325);const s={stn:[a.D.sessionTrace],err:[a.D.jserrors,a.D.metrics],ins:[a.D.pageAction],spa:[a.D.spa],sr:[a.D.sessionReplay,a.D.sessionTrace]};function c(e,t){const r=n.ee.get(t);e&&"object"==typeof e&&(Object.entries(e).forEach((e=>{let[t,n]=e;void 0===u[t]&&(s[t]?s[t].forEach((e=>{n?(0,i.p)("feat-"+t,[],void 0,e,r):(0,i.p)("block-"+t,[],void 0,e,r),(0,i.p)("rumresp-"+t,[Boolean(n)],void 0,e,r)})):n&&(0,i.p)("feat-"+t,[],void 0,void 0,r),u[t]=Boolean(n))})),Object.keys(s).forEach((e=>{void 0===u[e]&&(s[e]?.forEach((t=>(0,i.p)("rumresp-"+e,[!1],void 0,t,r))),u[e]=!1)})),(0,o.L)(t,a.D.pageViewEvent))}const u={}},2210:(e,t,r)=>{r.d(t,{X:()=>i});var n=Object.prototype.hasOwnProperty;function i(e,t,r){if(n.call(e,t))return e[t];var i=r();if(Object.defineProperty&&Object.keys)try{return Object.defineProperty(e,t,{value:i,writable:!0,enumerable:!1}),i}catch(e){}return e[t]=i,i}},1284:(e,t,r)=>{r.d(t,{D:()=>n});const n=(e,t)=>Object.entries(e||{}).map((e=>{let[r,n]=e;return t(r,n)}))},4351:(e,t,r)=>{r.d(t,{P:()=>o});var n=r(2177);const i=()=>{const e=new WeakSet;return(t,r)=>{if("object"==typeof r&&null!==r){if(e.has(r))return;e.add(r)}return r}};function o(e){try{return JSON.stringify(e,i())}catch(e){try{n.ee.emit("internal-error",[e])}catch(e){}}}},3960:(e,t,r)=>{r.d(t,{K:()=>a,b:()=>o});var n=r(3239);function i(){return"undefined"==typeof document||"complete"===document.readyState}function o(e,t){if(i())return e();(0,n.bP)("load",e,t)}function a(e){if(i())return e();(0,n.iz)("DOMContentLoaded",e)}},8632:(e,t,r)=>{r.d(t,{EZ:()=>u,Qy:()=>c,ce:()=>o,fP:()=>a,gG:()=>d,mF:()=>s});var n=r(7894),i=r(385);const o={beacon:"bam.nr-data.net",errorBeacon:"bam.nr-data.net"};function a(){return i._A.NREUM||(i._A.NREUM={}),void 0===i._A.newrelic&&(i._A.newrelic=i._A.NREUM),i._A.NREUM}function s(){let e=a();return e.o||(e.o={ST:i._A.setTimeout,SI:i._A.setImmediate,CT:i._A.clearTimeout,XHR:i._A.XMLHttpRequest,REQ:i._A.Request,EV:i._A.Event,PR:i._A.Promise,MO:i._A.MutationObserver,FETCH:i._A.fetch}),e}function c(e,t,r){let i=a();const o=i.initializedAgents||{},s=o[e]||{};return Object.keys(s).length||(s.initializedAt={ms:(0,n.z)(),date:new Date}),i.initializedAgents={...o,[e]:{...s,[r]:t}},i}function u(e,t){a()[e]=t}function d(){return function(){let e=a();const t=e.info||{};e.info={beacon:o.beacon,errorBeacon:o.errorBeacon,...t}}(),function(){let e=a();const t=e.init||{};e.init={...t}}(),s(),function(){let e=a();const t=e.loader_config||{};e.loader_config={...t}}(),a()}},7956:(e,t,r)=>{r.d(t,{N:()=>i});var n=r(3239);function i(e){let t=arguments.length>1&&void 0!==arguments[1]&&arguments[1],r=arguments.length>2?arguments[2]:void 0,i=arguments.length>3?arguments[3]:void 0;return void(0,n.iz)("visibilitychange",(function(){if(t)return void("hidden"==document.visibilityState&&e());e(document.visibilityState)}),r,i)}},1214:(e,t,r)=>{r.d(t,{em:()=>v,u5:()=>N,QU:()=>S,_L:()=>I,Gm:()=>L,Lg:()=>M,gy:()=>U,BV:()=>Q,Kf:()=>ee});var n=r(2177);const i="nr@original";var o=Object.prototype.hasOwnProperty,a=!1;function s(e,t){return e||(e=n.ee),r.inPlace=function(e,t,n,i,o){n||(n="");var a,s,c,u="-"===n.charAt(0);for(c=0;c 2?n-2:0),o=2;o {r(A[T],e,w),r(E[T],e,w)})),r(l._A,"fetch",y),t.on(y+"end",(function(e,r){var n=this;if(r){var i=r.headers.get("content-length");null!==i&&(n.rxSize=i),t.emit(y+"done",[null,r],n)}else t.emit(y+"done",[e],n)})),t}const O={},j=["pushState","replaceState"];function S(e){const t=function(e){return(e||n.ee).get("history")}(e);return!l.il||O[t.debugId]++||(O[t.debugId]=1,s(t).inPlace(window.history,j,"-")),t}var P=r(3239);const C={},R=["appendChild","insertBefore","replaceChild"];function I(e){const t=function(e){return(e||n.ee).get("jsonp")}(e);if(!l.il||C[t.debugId])return t;C[t.debugId]=!0;var r=s(t),i=/[?&](?:callback|cb)=([^&#]+)/,o=/(.*)\.([^.]+)/,a=/^(\w+)(\.|$)(.*)$/;function c(e,t){var r=e.match(a),n=r[1],i=r[3];return i?c(i,t[n]):t[n]}return r.inPlace(Node.prototype,R,"dom-"),t.on("dom-start",(function(e){!function(e){if(!e||"string"!=typeof e.nodeName||"script"!==e.nodeName.toLowerCase())return;if("function"!=typeof e.addEventListener)return;var n=(a=e.src,s=a.match(i),s?s[1]:null);var a,s;if(!n)return;var u=function(e){var t=e.match(o);if(t&&t.length>=3)return{key:t[2],parent:c(t[1],window)};return{key:e,parent:window}}(n);if("function"!=typeof u.parent[u.key])return;var d={};function f(){t.emit("jsonp-end",[],d),e.removeEventListener("load",f,(0,P.m$)(!1)),e.removeEventListener("error",l,(0,P.m$)(!1))}function l(){t.emit("jsonp-error",[],d),t.emit("jsonp-end",[],d),e.removeEventListener("load",f,(0,P.m$)(!1)),e.removeEventListener("error",l,(0,P.m$)(!1))}r.inPlace(u.parent,[u.key],"cb-",d),e.addEventListener("load",f,(0,P.m$)(!1)),e.addEventListener("error",l,(0,P.m$)(!1)),t.emit("new-jsonp",[e.src],d)}(e[0])})),t}var k=r(5763);const H={};function L(e){const t=function(e){return(e||n.ee).get("mutation")}(e);if(!l.il||H[t.debugId])return t;H[t.debugId]=!0;var r=s(t),i=k.Yu.MO;return i&&(window.MutationObserver=function(e){return this instanceof i?new i(r(e,"fn-")):i.apply(this,arguments)},MutationObserver.prototype=i.prototype),t}const z={};function M(e){const t=function(e){return(e||n.ee).get("promise")}(e);if(z[t.debugId])return t;z[t.debugId]=!0;var r=n.c,o=s(t),a=k.Yu.PR;return a&&function(){function e(r){var n=t.context(),i=o(r,"executor-",n,null,!1);const s=Reflect.construct(a,[i],e);return t.context(s).getCtx=function(){return n},s}l._A.Promise=e,Object.defineProperty(e,"name",{value:"Promise"}),e.toString=function(){return a.toString()},Object.setPrototypeOf(e,a),["all","race"].forEach((function(r){const n=a[r];e[r]=function(e){let i=!1;[...e||[]].forEach((e=>{this.resolve(e).then(a("all"===r),a(!1))}));const o=n.apply(this,arguments);return o;function a(e){return function(){t.emit("propagate",[null,!i],o,!1,!1),i=i||!e}}}})),["resolve","reject"].forEach((function(r){const n=a[r];e[r]=function(e){const r=n.apply(this,arguments);return e!==r&&t.emit("propagate",[e,!0],r,!1,!1),r}})),e.prototype=a.prototype;const n=a.prototype.then;a.prototype.then=function(){var e=this,i=r(e);i.promise=e;for(var a=arguments.length,s=new Array(a),c=0;c e())),t};function m(e,t){i.inPlace(t,["onreadystatechange"],"fn-",E)}function b(){var e=this,t=r.context(e);e.readyState>3&&!t.resolved&&(t.resolved=!0,r.emit("xhr-resolved",[],e)),i.inPlace(e,f,"fn-",E)}if(function(e,t){for(var r in e)t[r]=e[r]}(o,p),p.prototype=o.prototype,i.inPlace(p.prototype,J,"-xhr-",E),r.on("send-xhr-start",(function(e,t){m(e,t),function(e){h.push(e),a&&(y?y.then(A):u?u(A):(w=-w,x.data=w))}(t)})),r.on("open-xhr-start",m),a){var y=c&&c.resolve();if(!u&&!c){var w=1,x=document.createTextNode(w);new a(A).observe(x,{characterData:!0})}}else t.on("fn-end",(function(e){e[0]&&e[0].type===d||A()}));function A(){for(var e=0;e {r.d(t,{t:()=>n});const n=r(3325).D.ajax},6660:(e,t,r)=>{r.d(t,{A:()=>i,t:()=>n});const n=r(3325).D.jserrors,i="nr@seenError"},3081:(e,t,r)=>{r.d(t,{gF:()=>o,mY:()=>i,t9:()=>n,vz:()=>s,xS:()=>a});const n=r(3325).D.metrics,i="sm",o="cm",a="storeSupportabilityMetrics",s="storeEventMetrics"},4649:(e,t,r)=>{r.d(t,{t:()=>n});const n=r(3325).D.pageAction},7633:(e,t,r)=>{r.d(t,{Dz:()=>i,OJ:()=>a,qw:()=>o,t9:()=>n});const n=r(3325).D.pageViewEvent,i="firstbyte",o="domcontent",a="windowload"},9251:(e,t,r)=>{r.d(t,{t:()=>n});const n=r(3325).D.pageViewTiming},3614:(e,t,r)=>{r.d(t,{BST_RESOURCE:()=>i,END:()=>s,FEATURE_NAME:()=>n,FN_END:()=>u,FN_START:()=>c,PUSH_STATE:()=>d,RESOURCE:()=>o,START:()=>a});const n=r(3325).D.sessionTrace,i="bstResource",o="resource",a="-start",s="-end",c="fn"+a,u="fn"+s,d="pushState"},7836:(e,t,r)=>{r.d(t,{BODY:()=>A,CB_END:()=>E,CB_START:()=>u,END:()=>x,FEATURE_NAME:()=>i,FETCH:()=>_,FETCH_BODY:()=>v,FETCH_DONE:()=>m,FETCH_START:()=>p,FN_END:()=>c,FN_START:()=>s,INTERACTION:()=>l,INTERACTION_API:()=>d,INTERACTION_EVENTS:()=>o,JSONP_END:()=>b,JSONP_NODE:()=>g,JS_TIME:()=>T,MAX_TIMER_BUDGET:()=>a,REMAINING:()=>f,SPA_NODE:()=>h,START:()=>w,originalSetTimeout:()=>y});var n=r(5763);const i=r(3325).D.spa,o=["click","submit","keypress","keydown","keyup","change"],a=999,s="fn-start",c="fn-end",u="cb-start",d="api-ixn-",f="remaining",l="interaction",h="spaNode",g="jsonpNode",p="fetch-start",m="fetch-done",v="fetch-body-",b="jsonp-end",y=n.Yu.ST,w="-start",x="-end",A="-body",E="cb"+x,T="jsTime",_="fetch"},5938:(e,t,r)=>{r.d(t,{W:()=>o});var n=r(5763),i=r(2177);class o{constructor(e,t,r){this.agentIdentifier=e,this.aggregator=t,this.ee=i.ee.get(e,(0,n.OP)(this.agentIdentifier).isolatedBacklog),this.featureName=r,this.blocked=!1}}},9144:(e,t,r)=>{r.d(t,{j:()=>m});var n=r(3325),i=r(5763),o=r(5546),a=r(2177),s=r(7894),c=r(8e3),u=r(3960),d=r(385),f=r(50),l=r(3081),h=r(8632);function g(){const e=(0,h.gG)();["setErrorHandler","finished","addToTrace","inlineHit","addRelease","addPageAction","setCurrentRouteName","setPageViewName","setCustomAttribute","interaction","noticeError","setUserId"].forEach((t=>{e[t]=function(){for(var r=arguments.length,n=new Array(r),i=0;i 1?r-1:0),i=1;i {e.exposed&&e.api[t]&&o.push(e.api[t](...n))})),o.length>1?o:o[0]}(t,...n)}}))}var p=r(2587);function m(e){let t=arguments.length>1&&void 0!==arguments[1]?arguments[1]:{},m=arguments.length>2?arguments[2]:void 0,v=arguments.length>3?arguments[3]:void 0,{init:b,info:y,loader_config:w,runtime:x={loaderType:m},exposed:A=!0}=t;const E=(0,h.gG)();y||(b=E.init,y=E.info,w=E.loader_config),(0,i.Dg)(e,b||{}),(0,i.GE)(e,w||{}),(0,i.sU)(e,x),y.jsAttributes??={},d.v6&&(y.jsAttributes.isWorker=!0),(0,i.CX)(e,y),g();const T=function(e,t){t||(0,c.R)(e,"api");const h={};var g=a.ee.get(e),p=g.get("tracer"),m="api-",v=m+"ixn-";function b(t,r,n,o){const a=(0,i.C5)(e);return null===r?delete a.jsAttributes[t]:(0,i.CX)(e,{...a,jsAttributes:{...a.jsAttributes,[t]:r}}),x(m,n,!0,o||null===r?"session":void 0)(t,r)}function y(){}["setErrorHandler","finished","addToTrace","inlineHit","addRelease"].forEach((e=>h[e]=x(m,e,!0,"api"))),h.addPageAction=x(m,"addPageAction",!0,n.D.pageAction),h.setCurrentRouteName=x(m,"routeName",!0,n.D.spa),h.setPageViewName=function(t,r){if("string"==typeof t)return"/"!==t.charAt(0)&&(t="/"+t),(0,i.OP)(e).customTransaction=(r||"http://custom.transaction")+t,x(m,"setPageViewName",!0)()},h.setCustomAttribute=function(e,t){let r=arguments.length>2&&void 0!==arguments[2]&&arguments[2];if("string"==typeof e){if(["string","number"].includes(typeof t)||null===t)return b(e,t,"setCustomAttribute",r);(0,f.Z)("Failed to execute setCustomAttribute.\nNon-null value must be a string or number type, but a type of was provided."))}else(0,f.Z)("Failed to execute setCustomAttribute.\nName must be a string type, but a type of was provided."))},h.setUserId=function(e){if("string"==typeof e||null===e)return b("enduser.id",e,"setUserId",!0);(0,f.Z)("Failed to execute setUserId.\nNon-null value must be a string type, but a type of was provided."))},h.interaction=function(){return(new y).get()};var w=y.prototype={createTracer:function(e,t){var r={},i=this,a="function"==typeof t;return(0,o.p)(v+"tracer",[(0,s.z)(),e,r],i,n.D.spa,g),function(){if(p.emit((a?"":"no-")+"fn-start",[(0,s.z)(),i,a],r),a)try{return t.apply(this,arguments)}catch(e){throw p.emit("fn-err",[arguments,this,"string"==typeof e?new Error(e):e],r),e}finally{p.emit("fn-end",[(0,s.z)()],r)}}}};function x(e,t,r,i){return function(){return(0,o.p)(l.xS,["API/"+t+"/called"],void 0,n.D.metrics,g),i&&(0,o.p)(e+t,[(0,s.z)(),...arguments],r?null:this,i,g),r?void 0:this}}function A(){r.e(439).then(r.bind(r,7438)).then((t=>{let{setAPI:r}=t;r(e),(0,c.L)(e,"api")})).catch((()=>(0,f.Z)("Downloading runtime APIs failed...")))}return["actionText","setName","setAttribute","save","ignore","onEnd","getContext","end","get"].forEach((e=>{w[e]=x(v,e,void 0,n.D.spa)})),h.noticeError=function(e,t){"string"==typeof e&&(e=new Error(e)),(0,o.p)(l.xS,["API/noticeError/called"],void 0,n.D.metrics,g),(0,o.p)("err",[e,(0,s.z)(),!1,t],void 0,n.D.jserrors,g)},d.il?(0,u.b)((()=>A()),!0):A(),h}(e,v);return(0,h.Qy)(e,T,"api"),(0,h.Qy)(e,A,"exposed"),(0,h.EZ)("activatedFeatures",p.T),T}},3325:(e,t,r)=>{r.d(t,{D:()=>n,p:()=>i});const n={ajax:"ajax",jserrors:"jserrors",metrics:"metrics",pageAction:"page_action",pageViewEvent:"page_view_event",pageViewTiming:"page_view_timing",sessionReplay:"session_replay",sessionTrace:"session_trace",spa:"spa"},i={[n.pageViewEvent]:1,[n.pageViewTiming]:2,[n.metrics]:3,[n.jserrors]:4,[n.ajax]:5,[n.sessionTrace]:6,[n.pageAction]:7,[n.spa]:8,[n.sessionReplay]:9}}},n={};function i(e){var t=n[e];if(void 0!==t)return t.exports;var o=n[e]={exports:{}};return r[e](o,o.exports,i),o.exports}i.m=r,i.d=(e,t)=>{for(var r in t)i.o(t,r)&&!i.o(e,r)&&Object.defineProperty(e,r,{enumerable:!0,get:t[r]})},i.f={},i.e=e=>Promise.all(Object.keys(i.f).reduce(((t,r)=>(i.f[r](e,t),t)),[])),i.u=e=>(({78:"page_action-aggregate",147:"metrics-aggregate",242:"session-manager",317:"jserrors-aggregate",348:"page_view_timing-aggregate",412:"lazy-feature-loader",439:"async-api",538:"recorder",590:"session_replay-aggregate",675:"compressor",733:"session_trace-aggregate",786:"page_view_event-aggregate",873:"spa-aggregate",898:"ajax-aggregate"}[e]||e)+"."+{78:"ac76d497",147:"3dc53903",148:"1a20d5fe",242:"2a64278a",317:"49e41428",348:"bd6de33a",412:"2f55ce66",439:"30bd804e",538:"1b18459f",590:"cf0efb30",675:"ae9f91a8",733:"83105561",786:"06482edd",860:"03a8b7a5",873:"e6b09d52",898:"998ef92b"}[e]+"-1.236.0.min.js"),i.o=(e,t)=>Object.prototype.hasOwnProperty.call(e,t),e={},t="NRBA:",i.l=(r,n,o,a)=>{if(e[r])e[r].push(n);else{var s,c;if(void 0!==o)for(var u=document.getElementsByTagName("script"),d=0;d {s.onerror=s.onload=null,clearTimeout(h);var i=e[r];if(delete e[r],s.parentNode&&s.parentNode.removeChild(s),i&&i.forEach((e=>e(n))),t)return t(n)},h=setTimeout(l.bind(null,void 0,{type:"timeout",target:s}),12e4);s.onerror=l.bind(null,s.onerror),s.onload=l.bind(null,s.onload),c&&document.head.appendChild(s)}},i.r=e=>{"undefined"!=typeof Symbol&&Symbol.toStringTag&&Object.defineProperty(e,Symbol.toStringTag,{value:"Module"}),Object.defineProperty(e,"__esModule",{value:!0})},i.j=364,i.p="https://js-agent.newrelic.com/",(()=>{var e={364:0,953:0};i.f.j=(t,r)=>{var n=i.o(e,t)?e[t]:void 0;if(0!==n)if(n)r.push(n[2]);else{var o=new Promise(((r,i)=>n=e[t]=[r,i]));r.push(n[2]=o);var a=i.p+i.u(t),s=new Error;i.l(a,(r=>{if(i.o(e,t)&&(0!==(n=e[t])&&(e[t]=void 0),n)){var o=r&&("load"===r.type?"missing":r.type),a=r&&r.target&&r.target.src;s.message="Loading chunk "+t+" failed.\n("+o+": "+a+")",s.name="ChunkLoadError",s.type=o,s.request=a,n[1](s)}}),"chunk-"+t,t)}};var t=(t,r)=>{var n,o,[a,s,c]=r,u=0;if(a.some((t=>0!==e[t]))){for(n in s)i.o(s,n)&&(i.m[n]=s[n]);if(c)c(i)}for(t&&t(r);u {i.r(o);var e=i(3325),t=i(5763);const r=Object.values(e.D);function n(e){const n={};return r.forEach((r=>{n[r]=function(e,r){return!1!==(0,t.Mt)(r,"".concat(e,".enabled"))}(r,e)})),n}var a=i(9144);var s=i(5546),c=i(385),u=i(8e3),d=i(5938),f=i(3960),l=i(50);class h extends d.W{constructor(e,t,r){let n=!(arguments.length>3&&void 0!==arguments[3])||arguments[3];super(e,t,r),this.auto=n,this.abortHandler,this.featAggregate,this.onAggregateImported,n&&(0,u.R)(e,r)}importAggregator(){let e=arguments.length>0&&void 0!==arguments[0]?arguments[0]:{};if(this.featAggregate||!this.auto)return;const r=c.il&&!0===(0,t.Mt)(this.agentIdentifier,"privacy.cookies_enabled");let n;this.onAggregateImported=new Promise((e=>{n=e}));const o=async()=>{let t;try{if(r){const{setupAgentSession:e}=await Promise.all([i.e(860),i.e(242)]).then(i.bind(i,3228));t=e(this.agentIdentifier)}}catch(e){(0,l.Z)("A problem occurred when starting up session manager. This page will not start or extend any session.",e)}try{if(!this.shouldImportAgg(this.featureName,t))return void(0,u.L)(this.agentIdentifier,this.featureName);const{lazyFeatureLoader:r}=await i.e(412).then(i.bind(i,8582)),{Aggregate:o}=await r(this.featureName,"aggregate");this.featAggregate=new o(this.agentIdentifier,this.aggregator,e),n(!0)}catch(e){(0,l.Z)("Downloading and initializing ".concat(this.featureName," failed..."),e),this.abortHandler?.(),n(!1)}};c.il?(0,f.b)((()=>o()),!0):o()}shouldImportAgg(r,n){return r!==e.D.sessionReplay||!1!==(0,t.Mt)(this.agentIdentifier,"session_trace.enabled")&&(!!n?.isNew||!!n?.state.sessionReplay)}}var g=i(7633),p=i(7894);class m extends h{static featureName=g.t9;constructor(r,n){let i=!(arguments.length>2&&void 0!==arguments[2])||arguments[2];if(super(r,n,g.t9,i),("undefined"==typeof PerformanceNavigationTiming||c.Tt)&&"undefined"!=typeof PerformanceTiming){const n=(0,t.OP)(r);n[g.Dz]=Math.max(Date.now()-n.offset,0),(0,f.K)((()=>n[g.qw]=Math.max((0,p.z)()-n[g.Dz],0))),(0,f.b)((()=>{const t=(0,p.z)();n[g.OJ]=Math.max(t-n[g.Dz],0),(0,s.p)("timing",["load",t],void 0,e.D.pageViewTiming,this.ee)}))}this.importAggregator()}}var v=i(1117),b=i(1284);class y extends v.w{constructor(e){super(e),this.aggregatedData={}}store(e,t,r,n,i){var o=this.getBucket(e,t,r,i);return o.metrics=function(e,t){t||(t={count:0});return t.count+=1,(0,b.D)(e,(function(e,r){t[e]=w(r,t[e])})),t}(n,o.metrics),o}merge(e,t,r,n,i){var o=this.getBucket(e,t,n,i);if(o.metrics){var a=o.metrics;a.count+=r.count,(0,b.D)(r,(function(e,t){if("count"!==e){var n=a[e],i=r[e];i&&!i.c?a[e]=w(i.t,n):a[e]=function(e,t){if(!t)return e;t.c||(t=x(t.t));return t.min=Math.min(e.min,t.min),t.max=Math.max(e.max,t.max),t.t+=e.t,t.sos+=e.sos,t.c+=e.c,t}(i,a[e])}}))}else o.metrics=r}storeMetric(e,t,r,n){var i=this.getBucket(e,t,r);return i.stats=w(n,i.stats),i}getBucket(e,t,r,n){this.aggregatedData[e]||(this.aggregatedData[e]={});var i=this.aggregatedData[e][t];return i||(i=this.aggregatedData[e][t]={params:r||{}},n&&(i.custom=n)),i}get(e,t){return t?this.aggregatedData[e]&&this.aggregatedData[e][t]:this.aggregatedData[e]}take(e){for(var t={},r="",n=!1,i=0;i t.max&&(t.max=e),e 2&&void 0!==arguments[2])||arguments[2];super(e,r,j.t,n),c.il&&((0,t.OP)(e).initHidden=Boolean("hidden"===document.visibilityState),(0,N.N)((()=>(0,s.p)("docHidden",[(0,p.z)()],void 0,j.t,this.ee)),!0),(0,O.bP)("pagehide",(()=>(0,s.p)("winPagehide",[(0,p.z)()],void 0,j.t,this.ee))),this.importAggregator())}}var P=i(3081);class C extends h{static featureName=P.t9;constructor(e,t){let r=!(arguments.length>2&&void 0!==arguments[2])||arguments[2];super(e,t,P.t9,r),this.importAggregator()}}var R,I=i(2210),k=i(1214),H=i(2177),L={};try{R=localStorage.getItem("__nr_flags").split(","),console&&"function"==typeof console.log&&(L.console=!0,-1!==R.indexOf("dev")&&(L.dev=!0),-1!==R.indexOf("nr_dev")&&(L.nrDev=!0))}catch(e){}function z(e){try{L.console&&z(e)}catch(e){}}L.nrDev&&H.ee.on("internal-error",(function(e){z(e.stack)})),L.dev&&H.ee.on("fn-err",(function(e,t,r){z(r.stack)})),L.dev&&(z("NR AGENT IN DEVELOPMENT MODE"),z("flags: "+(0,b.D)(L,(function(e,t){return e})).join(", ")));var M=i(6660);class B extends h{static featureName=M.t;constructor(r,n){let i=!(arguments.length>2&&void 0!==arguments[2])||arguments[2];super(r,n,M.t,i),this.skipNext=0;try{this.removeOnAbort=new AbortController}catch(e){}const o=this;o.ee.on("fn-start",(function(e,t,r){o.abortHandler&&(o.skipNext+=1)})),o.ee.on("fn-err",(function(t,r,n){o.abortHandler&&!n[M.A]&&((0,I.X)(n,M.A,(function(){return!0})),this.thrown=!0,(0,s.p)("err",[n,(0,p.z)()],void 0,e.D.jserrors,o.ee))})),o.ee.on("fn-end",(function(){o.abortHandler&&!this.thrown&&o.skipNext>0&&(o.skipNext-=1)})),o.ee.on("internal-error",(function(t){(0,s.p)("ierr",[t,(0,p.z)(),!0],void 0,e.D.jserrors,o.ee)})),this.origOnerror=c._A.onerror,c._A.onerror=this.onerrorHandler.bind(this),c._A.addEventListener("unhandledrejection",(t=>{const r=function(e){let t="Unhandled Promise Rejection: ";if(e instanceof Error)try{return e.message=t+e.message,e}catch(t){return e}if(void 0===e)return new Error(t);try{return new Error(t+(0,D.P)(e))}catch(e){return new Error(t)}}(t.reason);(0,s.p)("err",[r,(0,p.z)(),!1,{unhandledPromiseRejection:1}],void 0,e.D.jserrors,this.ee)}),(0,O.m$)(!1,this.removeOnAbort?.signal)),(0,k.gy)(this.ee),(0,k.BV)(this.ee),(0,k.em)(this.ee),(0,t.OP)(r).xhrWrappable&&(0,k.Kf)(this.ee),this.abortHandler=this.#e,this.importAggregator()}#e(){this.removeOnAbort?.abort(),this.abortHandler=void 0}onerrorHandler(t,r,n,i,o){"function"==typeof this.origOnerror&&this.origOnerror(...arguments);try{this.skipNext?this.skipNext-=1:(0,s.p)("err",[o||new F(t,r,n),(0,p.z)()],void 0,e.D.jserrors,this.ee)}catch(t){try{(0,s.p)("ierr",[t,(0,p.z)(),!0],void 0,e.D.jserrors,this.ee)}catch(e){}}return!1}}function F(e,t,r){this.message=e||"Uncaught error with no additional information",this.sourceURL=t,this.line=r}let U=1;const q="nr@id";function G(e){const t=typeof e;return!e||"object"!==t&&"function"!==t?-1:e===c._A?0:(0,I.X)(e,q,(function(){return U++}))}function V(e){if("string"==typeof e&&e.length)return e.length;if("object"==typeof e){if("undefined"!=typeof ArrayBuffer&&e instanceof ArrayBuffer&&e.byteLength)return e.byteLength;if("undefined"!=typeof Blob&&e instanceof Blob&&e.size)return e.size;if(!("undefined"!=typeof FormData&&e instanceof FormData))try{return(0,D.P)(e).length}catch(e){return}}}var X=i(7243);class W{constructor(e){this.agentIdentifier=e,this.generateTracePayload=this.generateTracePayload.bind(this),this.shouldGenerateTrace=this.shouldGenerateTrace.bind(this)}generateTracePayload(e){if(!this.shouldGenerateTrace(e))return null;var r=(0,t.DL)(this.agentIdentifier);if(!r)return null;var n=(r.accountID||"").toString()||null,i=(r.agentID||"").toString()||null,o=(r.trustKey||"").toString()||null;if(!n||!i)return null;var a=(0,_.M)(),s=(0,_.Ht)(),c=Date.now(),u={spanId:a,traceId:s,timestamp:c};return(e.sameOrigin||this.isAllowedOrigin(e)&&this.useTraceContextHeadersForCors())&&(u.traceContextParentHeader=this.generateTraceContextParentHeader(a,s),u.traceContextStateHeader=this.generateTraceContextStateHeader(a,c,n,i,o)),(e.sameOrigin&&!this.excludeNewrelicHeader()||!e.sameOrigin&&this.isAllowedOrigin(e)&&this.useNewrelicHeaderForCors())&&(u.newrelicHeader=this.generateTraceHeader(a,s,c,n,i,o)),u}generateTraceContextParentHeader(e,t){return"00-"+t+"-"+e+"-01"}generateTraceContextStateHeader(e,t,r,n,i){return i+"@nr=0-1-"+r+"-"+n+"-"+e+"----"+t}generateTraceHeader(e,t,r,n,i,o){if(!("function"==typeof c._A?.btoa))return null;var a={v:[0,1],d:{ty:"Browser",ac:n,ap:i,id:e,tr:t,ti:r}};return o&&n!==o&&(a.d.tk=o),btoa((0,D.P)(a))}shouldGenerateTrace(e){return this.isDtEnabled()&&this.isAllowedOrigin(e)}isAllowedOrigin(e){var r=!1,n={};if((0,t.Mt)(this.agentIdentifier,"distributed_tracing")&&(n=(0,t.P_)(this.agentIdentifier).distributed_tracing),e.sameOrigin)r=!0;else if(n.allowed_origins instanceof Array)for(var i=0;i 2&&void 0!==arguments[2])||arguments[2];super(r,n,Z.t,i),(0,t.OP)(r).xhrWrappable&&(this.dt=new W(r),this.handler=(e,t,r,n)=>(0,s.p)(e,t,r,n,this.ee),(0,k.u5)(this.ee),(0,k.Kf)(this.ee),function(r,n,i,o){function a(e){var t=this;t.totalCbs=0,t.called=0,t.cbTime=0,t.end=E,t.ended=!1,t.xhrGuids={},t.lastSize=null,t.loadCaptureCalled=!1,t.params=this.params||{},t.metrics=this.metrics||{},e.addEventListener("load",(function(r){_(t,e)}),(0,O.m$)(!1)),c.IF||e.addEventListener("progress",(function(e){t.lastSize=e.loaded}),(0,O.m$)(!1))}function s(e){this.params={method:e[0]},T(this,e[1]),this.metrics={}}function u(e,n){var i=(0,t.DL)(r);i.xpid&&this.sameOrigin&&n.setRequestHeader("X-NewRelic-ID",i.xpid);var a=o.generateTracePayload(this.parsedOrigin);if(a){var s=!1;a.newrelicHeader&&(n.setRequestHeader("newrelic",a.newrelicHeader),s=!0),a.traceContextParentHeader&&(n.setRequestHeader("traceparent",a.traceContextParentHeader),a.traceContextStateHeader&&n.setRequestHeader("tracestate",a.traceContextStateHeader),s=!0),s&&(this.dt=a)}}function d(e,t){var r=this.metrics,i=e[0],o=this;if(r&&i){var a=V(i);a&&(r.txSize=a)}this.startTime=(0,p.z)(),this.listener=function(e){try{"abort"!==e.type||o.loadCaptureCalled||(o.params.aborted=!0),("load"!==e.type||o.called===o.totalCbs&&(o.onloadCalled||"function"!=typeof t.onload)&&"function"==typeof o.end)&&o.end(t)}catch(e){try{n.emit("internal-error",[e])}catch(e){}}};for(var s=0;s 1?e[1]=i:e.push(i)}else e[0]&&e[0].headers&&s(e[0].headers,n)&&(this.dt=n);function s(e,t){var r=!1;return t.newrelicHeader&&(e.set("newrelic",t.newrelicHeader),r=!0),t.traceContextParentHeader&&(e.set("traceparent",t.traceContextParentHeader),t.traceContextStateHeader&&e.set("tracestate",t.traceContextStateHeader),r=!0),r}}function x(e,t){this.params={},this.metrics={},this.startTime=(0,p.z)(),this.dt=t,e.length>=1&&(this.target=e[0]),e.length>=2&&(this.opts=e[1]);var r,n=this.opts||{},i=this.target;"string"==typeof i?r=i:"object"==typeof i&&i instanceof Y?r=i.url:c._A?.URL&&"object"==typeof i&&i instanceof URL&&(r=i.href),T(this,r);var o=(""+(i&&i instanceof Y&&i.method||n.method||"GET")).toUpperCase();this.params.method=o,this.txSize=V(n.body)||0}function A(t,r){var n;this.endTime=(0,p.z)(),this.params||(this.params={}),this.params.status=r?r.status:0,"string"==typeof this.rxSize&&this.rxSize.length>0&&(n=+this.rxSize);var o={txSize:this.txSize,rxSize:n,duration:(0,p.z)()-this.startTime};i("xhr",[this.params,o,this.startTime,this.endTime,"fetch"],this,e.D.ajax)}function E(t){var r=this.params,n=this.metrics;if(!this.ended){this.ended=!0;for(var o=0;o 2&&void 0!==arguments[2])||arguments[2];super(e,t,we.t,r),this.importAggregator()}}new class{constructor(e){let t=arguments.length>1&&void 0!==arguments[1]?arguments[1]:(0,_.ky)(16);c._A?(this.agentIdentifier=t,this.sharedAggregator=new y({agentIdentifier:this.agentIdentifier}),this.features={},this.desiredFeatures=new Set(e.features||[]),this.desiredFeatures.add(m),Object.assign(this,(0,a.j)(this.agentIdentifier,e,e.loaderType||"agent")),this.start()):(0,l.Z)("Failed to initial the agent. Could not determine the runtime environment.")}get config(){return{info:(0,t.C5)(this.agentIdentifier),init:(0,t.P_)(this.agentIdentifier),loader_config:(0,t.DL)(this.agentIdentifier),runtime:(0,t.OP)(this.agentIdentifier)}}start(){const t="features";try{const r=n(this.agentIdentifier),i=[...this.desiredFeatures];i.sort(((t,r)=>e.p[t.featureName]-e.p[r.featureName])),i.forEach((t=>{if(r[t.featureName]||t.featureName===e.D.pageViewEvent){const n=function(t){switch(t){case e.D.ajax:return[e.D.jserrors];case e.D.sessionTrace:return[e.D.ajax,e.D.pageViewEvent];case e.D.sessionReplay:return[e.D.sessionTrace];case e.D.pageViewTiming:return[e.D.pageViewEvent];default:return[]}}(t.featureName);n.every((e=>r[e]))||(0,l.Z)("".concat(t.featureName," is enabled but one or more dependent features has been disabled (").concat((0,D.P)(n),"). This may cause unintended consequences or missing data...")),this.features[t.featureName]=new t(this.agentIdentifier,this.sharedAggregator)}})),(0,T.Qy)(this.agentIdentifier,this.features,t)}catch(e){(0,l.Z)("Failed to initialize all enabled instrument classes (agent aborted) -",e);for(const e in this.features)this.features[e].abortHandler?.();const r=(0,T.fP)();return delete r.initializedAgents[this.agentIdentifier]?.api,delete r.initializedAgents[this.agentIdentifier]?.[t],delete this.sharedAggregator,r.ee?.abort(),delete r.ee?.get(this.agentIdentifier),!1}}}({features:[J,m,S,class extends h{static featureName=oe;constructor(t,r){if(super(t,r,oe,!(arguments.length>2&&void 0!==arguments[2])||arguments[2]),!c.il)return;const n=this.ee;let i;(0,k.QU)(n),this.eventsEE=(0,k.em)(n),this.eventsEE.on(se,(function(e,t){this.bstStart=(0,p.z)()})),this.eventsEE.on(ae,(function(t,r){(0,s.p)("bst",[t[0],r,this.bstStart,(0,p.z)()],void 0,e.D.sessionTrace,n)})),n.on(ce+ne,(function(e){this.time=(0,p.z)(),this.startPath=location.pathname+location.hash})),n.on(ce+ie,(function(t){(0,s.p)("bstHist",[location.pathname+location.hash,this.startPath,this.time],void 0,e.D.sessionTrace,n)}));try{i=new PerformanceObserver((t=>{const r=t.getEntries();(0,s.p)(te,[r],void 0,e.D.sessionTrace,n)})),i.observe({type:re,buffered:!0})}catch(e){}this.importAggregator({resourceObserver:i})}},C,xe,B,class extends h{static featureName=de;constructor(e,r){if(super(e,r,de,!(arguments.length>2&&void 0!==arguments[2])||arguments[2]),!c.il)return;if(!(0,t.OP)(e).xhrWrappable)return;try{this.removeOnAbort=new AbortController}catch(e){}let n,i=0;const o=this.ee.get("tracer"),a=(0,k._L)(this.ee),s=(0,k.Lg)(this.ee),u=(0,k.BV)(this.ee),d=(0,k.Kf)(this.ee),f=this.ee.get("events"),l=(0,k.u5)(this.ee),h=(0,k.QU)(this.ee),g=(0,k.Gm)(this.ee);function m(e,t){h.emit("newURL",[""+window.location,t])}function v(){i++,n=window.location.hash,this[ve]=(0,p.z)()}function b(){i--,window.location.hash!==n&&m(0,!0);var e=(0,p.z)();this[pe]=~~this[pe]+e-this[ve],this[ye]=e}function y(e,t){e.on(t,(function(){this[t]=(0,p.z)()}))}this.ee.on(ve,v),s.on(be,v),a.on(be,v),this.ee.on(ye,b),s.on(ge,b),a.on(ge,b),this.ee.buffer([ve,ye,"xhr-resolved"],this.featureName),f.buffer([ve],this.featureName),u.buffer(["setTimeout"+le,"clearTimeout"+fe,ve],this.featureName),d.buffer([ve,"new-xhr","send-xhr"+fe],this.featureName),l.buffer([me+fe,me+"-done",me+he+fe,me+he+le],this.featureName),h.buffer(["newURL"],this.featureName),g.buffer([ve],this.featureName),s.buffer(["propagate",be,ge,"executor-err","resolve"+fe],this.featureName),o.buffer([ve,"no-"+ve],this.featureName),a.buffer(["new-jsonp","cb-start","jsonp-error","jsonp-end"],this.featureName),y(l,me+fe),y(l,me+"-done"),y(a,"new-jsonp"),y(a,"jsonp-end"),y(a,"cb-start"),h.on("pushState-end",m),h.on("replaceState-end",m),window.addEventListener("hashchange",m,(0,O.m$)(!0,this.removeOnAbort?.signal)),window.addEventListener("load",m,(0,O.m$)(!0,this.removeOnAbort?.signal)),window.addEventListener("popstate",(function(){m(0,i>1)}),(0,O.m$)(!0,this.removeOnAbort?.signal)),this.abortHandler=this.#e,this.importAggregator()}#e(){this.removeOnAbort?.abort(),this.abortHandler=void 0}}],loaderType:"spa"})})(),window.NRBA=o})(); window.jQuery || document.write(' ') CKEDITOR_BASEPATH='https://f1000research.com/js/vendor/ckeditor/' window.reactTheme = 'research'; window.MathJax = { CommonHTML: { linebreaks: { automatic: true } }, 'HTML-CSS': { linebreaks: { automatic: true } }, SVG: { linebreaks: { automatic: true } }, AuthorInit: function() { MathJax.Hub.Register.MessageHook('End Process', function () { let timeout = false; // holder for timeout id const delay = 250; // delay after event is "complete" to run callback const reflowMath = function() { const dispFormulas = document.querySelectorAll('.disp-formula.panel'); if (!dispFormulas) { return; } for (const dispFormula of dispFormulas) { const child = dispFormula.querySelector('.MathJax_Preview').nextSibling.firstChild; const isMultiline = MathJax.Hub.getAllJax(dispFormula)[0].root.isMultiline; if (dispFormula.offsetWidth < child.offsetWidth || isMultiline) { MathJax.Hub.Queue(['Rerender', MathJax.Hub, dispFormula]); } } }; window.addEventListener('resize', function() { clearTimeout(timeout); // clear the timeout timeout = setTimeout(reflowMath, delay); // start timing for event "completion" }); }); }, }; if (window.location.hash == '#_=_'){ window.location = window.location.href.split('#')[0] } !function(f,b,e,v,n,t,s){if(f.fbq)return;n=f.fbq=function() {n.callMethod? n.callMethod.apply(n,arguments):n.queue.push(arguments)} ;if(!f._fbq)f._fbq=n; n.push=n;n.loaded=!0;n.version='2.0';n.queue=[];t=b.createElement(e);t.async=!0; t.src=v;s=b.getElementsByTagName(e)[0];s.parentNode.insertBefore(t,s)}(window, document,'script','https://connect.facebook.net/en_US/fbevents.js'); fbq('init', '1641728616063202'); fbq('track', "PixelInitialized", {}); (function(h,o,t,j,a,r){ h.hj=h.hj||function(){(h.hj.q=h.hj.q||[]).push(arguments)}; h._hjSettings={hjid:2318163,hjsv:6}; a=o.getElementsByTagName('head')[0]; r=o.createElement('script');r.async=1; r.src=t+h._hjSettings.hjid+j+h._hjSettings.hjsv; a.appendChild(r); })(window,document,'https://static.hotjar.com/c/hotjar-','.js?sv='); search file_upload Submit your research search menu close search Browse Gateways & Collections How to Publish Submit your Research My Submissions Article Guidelines Article Guidelines (New Versions) Open Data, Software and Code Guidelines Open Data and Accessible Source Materials Guidelines (HSS) Open Data, Software and Code Guidelines (PSE) Prepublication Checks Production Process Posters and Slides Guidelines Document Guidelines Article Processing Charges Peer Review Finding Article Reviewers About How it Works For Reviewers Our Advisors Policies Glossary FAQs For Developers Newsroom Contact My Research Submissions Content and Tracking Alerts My Details Sign In file_upload Submit your research { "@context": "https://schema.org", "@type": "ScholarlyArticle", "mainEntityOfPage": { "@type": "WebPage", "@id": "https://f1000research.com/articles/15-542" }, "headline": "Knowledge and Attitudes Toward Healthcare Services Among a Particularly Vulnerable Tribal Group (PVTG) in...", "datePublished": "2026-04-16T11:22:04", "dateModified": "2026-04-16T11:22:04", "author": [ { "@type": "Person", "name": "Biju Soman" }, { "@type": "Person", "name": "Sneha D Mallya" }, { "@type": "Person", "name": "Rishi S Narayanan" }, { "@type": "Person", "name": "Vani Lakshmi R." }, { "@type": "Person", "name": "Ashwini Kumar" }, { "@type": "Person", "name": "B. Unnikrishnan" }, { "@type": "Person", "name": "Harpreet Kaur" }, { "@type": "Person", "name": "Ranjitha S Shetty" } ], "publisher": { "@type": "Organization", "name": "F1000Research", "logo": { "@type": "ImageObject", "url": "https://f1000research.com/img/AMP/F1000Research_image.png", "height": 480, "width": 60 } }, "image": { "@type": "ImageObject", "url": "https://f1000research.com/img/AMP/F1000Research_image.png", "height": 1200, "width": 150 }, "description": " 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 18–70 years) 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 < 0.05). 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. " } { "@context": "http://schema.org", "@type": "BreadcrumbList", "itemListElement": [ { "@type": "ListItem", "position": "1", "item": { "@id": "https://f1000research.com/", "name": "Home" } }, { "@type": "ListItem", "position": "2", "item": { "@id": "https://f1000research.com/browse/articles", "name": "Browse" } }, { "@type": "ListItem", "position": "3", "item": { "@id": "https://f1000research.com/articles/15-542", "name": "Knowledge and Attitudes Toward Healthcare Services Among a Particularly..." } } ] } Home Browse Knowledge and Attitudes Toward Healthcare Services Among a Particularly... ALL Metrics - Views Downloads Get PDF Get XML Cite How to cite this article Soman B, Mallya SD, Narayanan RS et al. 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 [version 1; peer review: 1 approved, 1 approved with reservations] . F1000Research 2026, 15 :542 ( https://doi.org/10.12688/f1000research.176835.1 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. Close Copy Citation Details Export Export Citation Sciwheel EndNote Ref. Manager Bibtex ProCite Sente EXPORT Select a format first Track Share ▬ ✚ Research Article 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 [version 1; peer review: 1 approved, 1 approved with reservations] Biju Soman https://orcid.org/0000-0002-7540-2755 1 * , Sneha D Mallya https://orcid.org/0000-0002-9407-2325 1 * , Rishi S Narayanan https://orcid.org/0009-0001-7973-3711 1 , [...] Vani Lakshmi R. 2 , Ashwini Kumar 1 , B. Unnikrishnan https://orcid.org/0000-0003-0892-8551 3 , Harpreet Kaur https://orcid.org/0000-0001-7143-8075 4 , Ranjitha S Shetty https://orcid.org/0000-0002-3210-2293 1 Biju Soman https://orcid.org/0000-0002-7540-2755 1 * , Sneha D Mallya https://orcid.org/0000-0002-9407-2325 1 * , [...] Rishi S Narayanan https://orcid.org/0009-0001-7973-3711 1 , Vani Lakshmi R. 2 , Ashwini Kumar 1 , B. Unnikrishnan https://orcid.org/0000-0003-0892-8551 3 , Harpreet Kaur https://orcid.org/0000-0001-7143-8075 4 , Ranjitha S Shetty https://orcid.org/0000-0002-3210-2293 1 * Equal contributors PUBLISHED 16 Apr 2026 Author details Author details 1 Department of Community Medicine, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India 2 Centre for Digital Health, Applied Research and Technology, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India 3 Department of Community Medicine, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India 4 Division of Epidemiology and Communicable Diseases, Ministry of Health and Family Welfare, Indian Council of Medical Research, New Delhi, Delhi, 110029, India Biju Soman Roles: Conceptualization, Data Curation, Formal Analysis, Investigation, Methodology, Writing – Original Draft Preparation, Writing – Review & Editing Sneha D Mallya Roles: Conceptualization, Data Curation, Formal Analysis, Investigation, Methodology, Project Administration, Resources, Supervision, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing Rishi S Narayanan Roles: Formal Analysis, Resources, Software, Writing – Review & Editing Vani Lakshmi R. Roles: Data Curation, Formal Analysis, Methodology, Resources, Software, Validation, Writing – Review & Editing Ashwini Kumar Roles: Methodology, Project Administration, Resources, Validation, Writing – Review & Editing B. Unnikrishnan Roles: Conceptualization, Data Curation, Methodology, Project Administration, Resources, Supervision, Validation, Visualization, Writing – Review & Editing Harpreet Kaur Roles: Methodology, Project Administration, Resources, Supervision, Validation, Visualization, Writing – Review & Editing Ranjitha S Shetty Roles: Conceptualization, Data Curation, Formal Analysis, Funding Acquisition, Investigation, Methodology, Project Administration, Resources, Supervision, Validation, Visualization, Writing – Review & Editing OPEN PEER REVIEW DETAILS REVIEWER STATUS This article is included in the Sociology of Health gateway. This article is included in the Manipal Academy of Higher Education gateway. Abstract 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 18–70 years) 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 < 0.05). 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. READ ALL READ LESS Keywords Indigenous Health Services, Tribal, Knowledge, Attitude, India, Traditional Medicine Corresponding Author(s) Ranjitha S Shetty ( [email protected] ) Close Corresponding author: Ranjitha S Shetty Competing interests: No competing interests were disclosed. Grant information: 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. Copyright: © 2026 Soman B et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. How to cite: Soman B, Mallya SD, Narayanan RS et al. 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 [version 1; peer review: 1 approved, 1 approved with reservations] . F1000Research 2026, 15 :542 ( https://doi.org/10.12688/f1000research.176835.1 ) First published: 16 Apr 2026, 15 :542 ( https://doi.org/10.12688/f1000research.176835.1 ) Latest published: 16 Apr 2026, 15 :542 ( https://doi.org/10.12688/f1000research.176835.1 ) Introduction Tribal communities in India are diverse and unique with each having its own distinct cultural and social characteristics. They comprise various ethno-linguistic groups, each with distinct beliefs and differing levels of economic, educational, and cultural development. 1 Approximately 8.6% of India’s population, is constituted by tribals with largest concentrations of Scheduled Tribes (ST) being found in states such as Andhra Pradesh, Assam, Jharkhand, Gujarat, Chhattisgarh, Maharashtra, Odisha, Rajasthan, and West Bengal. Almost 94.43 per cent of the total population in Mizoram and 94.79 per cent in Lakshadweep are Scheduled Tribes (STs). 2 Research studies focusing on indigenous populations have identified several significant health issues, including malaria, sexually transmitted infections (STIs), tuberculosis, nutritional deficiencies, and genetic disorders such as glucose-6-phosphate dehydrogenase (G6PD) deficiency and sickle cell anaemia. 3 , 4 In India, tribal healthcare is typically categorized under rural healthcare. However, it is a misconception to assume that the problems and needs of tribal populations mirror those of rural communities. 5 The unique geographical, environmental, social, and cultural contexts of tribal groups result in distinct healthcare requirements. These communities are profoundly affected by socio-cultural and economic factors, and their limited access to healthcare services, exacerbated by their widespread distribution, renders them particularly vulnerable within the framework of India’s National Strategic Plan. 6 , 7 Further, the tribal people in India have poorest health status contributed by complete absence of community participation in the planning, design and implementation of health services. There are about 42,48,978 tribal people in Karnataka, a southern coastal state in India, which accounts to 6.95% of the total population of the state. The ST population of the state is primarily rural (84.7%). Among the major STs, Koli Dhor have the highest (92.2%) rural population, followed by Gond (91.7%), Marati (90.8%) and Naika (85.1%). District-wise distribution of ST population shows that the tribal population is present in all 31 districts of Karnataka state with eight districts accounting for 52% of the tribal population of the state. There are two Particularly Vulnerable Tribal Groups (PVTG) in Karnataka, and they are Koraga and Jenukuruba tribes. 8 The problems and health issues of Koraga community are often overlooked, though the health issues of this tribal group are many. Magnitude of alcohol dependence was considerably more among Koraga tribe with a positive family history of alcoholism compared to other tribal groups and general population. 9 Prior published research findings reiterate that gender sensitive interventions and strengthening of the health systems should be emphasised in India, to improve health status and utilization of healthcare services by tribal communities. 10 Very few studies are done on the healthcare delivery system among tribal groups. Previous studies have demonstrated that prevailing health beliefs and practices among tribal communities significantly influence their access to and utilization of healthcare services. These findings underscore the urgent need to raise awareness and reduce barriers to healthcare utilization through targeted education. 11 – 14 There is limited research assessing the knowledge, attitudes, and practices related to the healthcare delivery system among tribal populations. Considering the paucity of research on this subject among this PVTG, the present community-based study was undertaken to assess the knowledge and attitudes of the Koraga community residing in coastal Karnataka towards healthcare services. 15 – 18 This research aligns with Sustainable Development Goals 3, 4 and 10 (good health and well-being, quality education and reduced inequalities). Materials and methods In Udupi district, located in southern part of India, the Koraga community is distributed across seven blocks. There are a total of 2653 Koraga households in Udupi district comprising a population of 8648 individuals. (Source: Integrated Tribal Development Project (ITDP) office, Udupi District). A community-based, cross-sectional survey was conducted among the Koraga tribe across all seven blocks of Udupi district from April 2021 to April 2022. Udupi, a coastal district in Karnataka, features diverse geographical terrain, including forests, hills, rivers, and extensive seashores. Many of the tribal families are concentrated in forested and remote areas, where access to mainstream society is limited. A sample size of 622 was estimated based on results of a pilot study showing 50% of the tribal population to have knowledge on healthcare services and its utilization, absolute precision of 5%, design effect of 1.5, at 5% level of significance and non-response of 10% by applying the finite population correction. The list of households and tribal hamlets residing in each of the seven blocks was obtained from ITDP office and multistage cluster sampling was used to identify the households. Each block was considered as a cluster and the number of households that need to be included was calculated based on probability proportional to size (PPS) sampling method. 19 Approximately 70 villages were selected randomly from all seven blocks, and a minimum of 20 households were selected from each village. Consenting family members aged 18–70 years were included in the survey. Those who were unwilling to participate in the survey were excluded ( Figure 1 ). The study was carried out, with necessary administrative and technical support from the Udupi district administration, ITDP, Udupi district, District Health and Family Welfare Department and Samagra Grameena Ashram, a non-governmental organization (NGO), functioning in the Udupi district, and tribal community gate keepers. Figure 1. STROBE Flow diagram. The STROBE flow diagram depicts the probability proportional to size (PPS) sampling method to select the households included in the study. The data was collected by the research survey team, including a research assistant and a Ph.D. scholar in health sciences who were trained in collecting data from the tribal community by the Principal Investigator (PI). Selected men and women volunteers from the tribal community as well as grassroot level health care workers namely, Accredited Social Health Activists (ASHA), catering to tribal population helped in data collection process by facilitating the introduction of survey team and briefing about the research project. Interviews were conducted at the households after explaining the purpose of survey and a detailed participant information sheet (PIS) was provided to the consented healthy male or female participants at their households. A written informed consent (IC) was obtained from the participants, and they were informed that their details would be kept confidential. All the ethical guidelines in line with declaration of Helsinki were followed during the conduct of the study. 20 The questionnaire used for the study consisted of two sections and was validated by experts in community medicine and public health and was pretested among ten tribal members and found to be reliable and feasible. The interviewer administered questionnaire included details on demographic particulars, and knowledge and attitude questions pertaining to the health care system and services across three domains including communicable diseases, reproductive health and mental health. The questionnaire consisted of a total of 35 questions: communicable diseases [knowledge:6; attitude:8], reproductive health [knowledge:5; attitude:5] and mental health [knowledge:6; attitude:5]. The knowledge questions were scored from 0 to 1, with a correct answer given 1 point and an incorrect answer being 0. The attitude questions, which were on a Likert scale, were given points from 0 to 1, with 0 for options suggesting an unfavorable attitude and 1 point for a favorable attitude. The range of scores for knowledge and attitude on communicable diseases was 0–6 and 0–8, respectively. Similarly, the knowledge and attitude scores for reproductive health were 0–5 and 0–5, respectively. Further, the knowledge and attitude scores for mental health were 0–6 and 0–5 respectively. The median scores were calculated for knowledge and attitude for all three domains. An individual was considered to have adequate knowledge and a favorable attitude for a given domain if the scores were above the median for the given domain. Each participant took about 20–25 minutes to answer the questions, which were asked in the local language Kannada and the responses were recorded in the data collection sheet by the researchers. Since the interviews were conducted by trained researchers and a structured questionnaire was used for data collection, there was no missing data. Ethics statement The study was initiated after obtaining approval from Kasturba Medical College Kasturba Hospital Institutional Ethics Committee (IEC No- 778/2019). This study was registered under CTRI, with registration number CTRI/2019/12/022385. Permission was obtained from the District Health and Family Welfare Department, Integrated Tribal Development Project (ITDP) Udupi district and District Administrative Authority, Udupi district. The purpose of the study and data collection plan was discussed with the tribal community leaders. Queries and clarifications sought by them were clarified promptly by the research team, and they were assured about the anonymity and confidentiality of the information obtained during data collection. Statistical analysis The data was entered and analyzed using Jamovi software (version 2.6.26). The categorical variables are presented as frequency and percentage. Univariate and multivariable logistic regression analysis was done to identify association between adequacy of knowledge and attitude towards communicable diseases, reproductive health and mental health and various background characteristics and unadjusted and adjusted odds ratio (UOR and AOR) was calculated and has been reported with 95% confidence interval. Variables which were significant on univariate analysis were included in the multivariable analysis. A p value <0.05 was considered statistically significant. Results The present community-based study included a total of 622 Koraga tribal individuals with a female preponderance (64.8%). Table 1 depicts the background characteristics of the study participants. Among the 622 study participants, 73.6% of the participants were aged ≤60 years. Most of the participants (29.9%) were from Kundapura block, and out of all the households in the study, 35.7% of them had more than four members in the family. However, 63.2% of the study participants were from a nuclear family. Almost half (45.8%) of the respondents had only primary level of education, while 33% were illiterate. About 68.8% of the participants had the availability of a public healthcare facility within five kilometres, and 58.8% of the study population depended on public transport to reach it. Majority of the respondents (93.1%) reported that ASHAs visit their homes regularly at least once a month. Table 1. Background characteristics of the study participants (n = 622). Characteristics Frequency n (%) Head of the household Males 219 (35.2) Females 403 (64.8) Age group (in years) 18–59 458 (73.6) >60 164 (26.4) Block Udupi 80 (12.9) Kaup 109 (17.5) Kundapura 186 (29.9) Karkala 67 (10.8) Brahmavara 80 (12.9) Byndoor 42 (6.8) Hebri 58 (9.3) Total number of family members 2 65 (10.5) 3 147 (23.6) 4 188 (30.2) >4 222 (35.7) Type of family Nuclear 393 (63.2) Joint 183 (29.4) Extended 46 (7.4) Religion Hindu 260 (41.8) Adidharma * 362 (58.2) Educational status Illiterate 205 (33.0) Primary school 285 (45.8) Secondary school 92 (14.8) Preuniversity college (PUC) and above 40 (6.4) Distance from the nearest healthcare facility (in kilometres) 10 74 (11.9) Mode of transport used to visit the healthcare facility Public transport 366 (58.8) Private vehicle 256 (41.2) Monthly home visits by ASHAs Yes 579 (93.1) No 43 (6.9) * Adidharma , is a distinct religion of the tribal community in India, who believe in nature spirits and supreme power of nature, and does not practice idol worship. Table 2 shows that more than half of respondents had inadequate knowledge (62.2%) and an unfavorable attitude (50.2%) towards prevention and management of communicable diseases, while it was found to be even higher for reproductive health (71.9% and 54.8%). However, 50% of them had adequate knowledge on mental health, while 60.5%, had an unfavorable attitude towards mental illness and its treatment, which was very high compared to the other two domains. The item-wise table is provided in extended data. ( https://figshare.com/s/e4d0b21a90efc9e46b78 ). Table 2. Domain-wise knowledge and attitude of the participants (n = 622). Knowledge domains Frequency (%) Communicable diseases Adequate 235 (37.8) Inadequate 387 (62.2) Reproductive health Adequate 175 (28.1) Inadequate 447 (71.9) Mental Health Adequate 311 (50.0) Inadequate 311 (50.0) Attitude domains Communicable diseases Favorable 310 (49.8) Unfavorable 312 (50.2) Reproductive health Favorable 281 (45.2) Unfavorable 340 (54.8) Mental health Favorable 246 (39.5) Unfavorable 376 (60.5) Table 3 depicts, on univariate analysis, all the factors except gender of the head of the household, total number of family members residing and type of family were found to be significantly associated with inadequate knowledge on communicable diseases (p<0.05). Further, on multivariable analysis, those with inadequate knowledge on communicable diseases were more likely to be aged above 60 years (AOR= 2.12; 95% CI 1.34-3.37), residents of Udupi (AOR=6.23, 95% CI 2.60-15.00), Kaup (AOR= 6.17, 95% CI 2.81-13.54), Kundapura (AOR=2.77, 95% CI 1.41- 5.43) and Karkala block (AOR= 2.74, 95% CI 1.27-5.88), from nuclear families (AOR= 2.27, 95% CI 1.04-4.94), following Adidharma religion (AOR= 1.75, 95% CI 1.14-2.67). Similarly, literacy level was also found to be a predictor for inadequate knowledge on communicable diseases with illiteracy (AOR=4.91, 95% CI 2.22-10.80), primary school (AOR=3.02, 95% CI 1.44-6.34) and secondary school educational status (AOR= 2.55, 95% CI 1.11-5.86), showing a significant association. Table 3. Association between knowledge and attitudes toward healthcare services for communicable diseases and the demographic variables of the study population (n = 622). Socio-demographic Characteristics Category Knowledge towards Healthcare Services for Communicable Diseases Adequate n = 235 No. (%) Inadequate n = 387 No. (%) UOR (95% CI) p value AOR (95% CI) p value Head of the household Male 69 (39.5) 150 (68.5) 0.66 (0.47–0.93) 0.017 1.37 (0.93–2.01) 0.11 Female 166 (41.2) 237 (58.8) 1 Age ≤60 years 199 (43.4) 259 (56.6) 1 >60 years 36 (22.0) 128 (78.0) 2.73 (1.81–4.13) <0.001 2.12 (1.33–3.37) <0.001* Block Udupi 16 (20.0) 64 (80.0) 8.21 (3.79–17.82) <0.001 6.23 (2.60–14.94) <0.001* Kaup 22 (20.2) 87 (79.8) 8.11 (3.95–16.69) <0.001 6.17 (2.80–13.55) <0.001* Kundapura 71 (38.2) 115 (61.8) 3.32 (1.79–6.20) <0.001 2.77 (1.41–5.43) 0.003 Karkala 27 (40.3) 40 (59.7) 3.04 (1.46–6.34) 0.003 2.73 (1.28–5.89) 0.010 Brahmavara 37 (46.3) 43 (53.8) 2.39 (1.18–4.81) 0.015 2.02 (0.95–4.32) 0.068 Byndoor 23 (54.8) 19 (45.2) 1.70 (0.75–3.84) 0.206 1.41 (0.59–3.40) 0.440 Hebri 39 (67.2) 19 (32.8) 1 Total family members Two 25 (38.5) 40 (61.5) 1 Three 57 (38.8) 90 (61.2) 0.99 (0.54–1.80) 0.965 Four 74 (39.4) 114 (60.6) 0.96 (0.54–1.72) 0.898 >Four 79 (35.6) 143 (64.4) 1.13 (0.64–2.00) 0.671 Type of Family Nuclear 159 (40.5) 234 (59.5) 1 Joint 66 (36.1) 117 (63.9) 1.20 (0.83–1.73) 0.315 1.01 (0.67–1.54) 0.934 Extended 10 (21.7) 36 (78.3) 2.45 (1.19–5.07) 0.016 2.27 (1.04–4.94) 0.039 Religion Hindu 128 (49.2) 132 (50.8) 1 Adidharma 107 (29.6) 255 (70.4) 2.31 (1.66–3.22) <0.001 1.74 (1.14–2.67) 0.010* Educational status Illiterate 59 (28.8) 146 (71.2) 0.67 (0.35–1.25) 0.209 4.91 (2.22–10.80) <0.001* Primary school 117 (41.1) 168 (58.9) 2.15 (1.01–4.23) 0.026 3.08 (1.43–6.34) 0.004 Secondary school 35 (38.0) 57 (62.0) 2.44 (1.14–5.22) 0.021 2.55 (1.11–5.86) 0.027 PUC and above 24 (60.0) 16 (40.0) 1 Socio-demographic Characteristics Category Attitude towards Healthcare Services for Communicable Diseases Favorable n = 310 No. (%) Unfavorable n = 312 No. (%) C OR (95% CI) p value AOR (95% CI) p value Head of the household Male 111 (50.7) 108 (49.3) 1.05 (0.76–1.46) 0.756 Female 199 (49.4) 204 (50.6) 1 Age ≤60 years 245 (53.5) 213 (46.5) 1 >60 years 65 (39.6) 99 (60.4) 1.75 (1.22–2.52) 0.002 1.27 (0.83–1.96) 0.273 Block Udupi 35 (43.8) 45 (56.3) 8.03 (3.38–19.12) <0.001 3.62 (1.41–9.33) 0.008* Kaup 32 (29.4) 77 (70.6) 15.03 (6.41–35.28) <0.001 8.80 (3.54–21.88) <0.001* Kundapura 108 (58.1) 78 (41.9) 4.51 (2.03–10.06) <0.001 3.16 (1.35–7.44) 0.008* Karkala 36 (53.7) 31 (46.3) 5.38 (2.21–3.07) <0.001 5.78 (2.29–14.59) <0.001* Brahmavara 36 (45.6) 44 (55.6) 7.63 (3.21–18.17) <0.001 4.95 (1.97–12.44) <0.001* Byndoor 13 (31.0) 29 (69.0) 13.94 (5.17–37.61) <0.001 11.87 (4.13–34.07) Four 109 (49.1) 113 (50.9) 1.01 (0.58–1.75) 0.985 Type of family Nuclear 208 (52.9) 185 (47.1) 1 Joint 80 (43.7) 103 (56.3) 1.45 (1.02–2.06) 0.040 1.22 (0.81–1.83) 0.351 Extended 22 (47.8) 24 (52.2) 1.23 (0.67–2.26) 0.513 1.16 (0.58–2.33) 0.672 Religion Hindu 178 (68.5) 82 (31.5) 1 Adidharma 132 (36.5) 230 (63.5) 3.78 (2.70–5.30) <0.001 4.06 (2.62–6.28) <0.001* Educational status Illiterate 77 (37.6) 128 (62.4) 2.03 (1.02–4.03) 0.042 2.91 (1.33–6.34) 0.007* Primary school 162 (56.8) 123 (43.2) 0.92 (0.48–1.81) 0.826 1.20 (0.58–2.50) 0.624 Secondary school 49 (53.3) 43 (46.7) 1.07 (0.51–2.26) 0.854 0.99 (0.44–2.24) 0.984 >10 years of schooling 22 (55.0) 18 (45.0) 1 Further, on univariate analysis, unfavorable attitude towards communicable diseases was significantly associated with age, block, type of family, religion and educational status (p<0.05). However, on multivariable analysis, respondents from Udupi (AOR= 3.63, 95% CI 1.41-9.34), Kaup (AOR= 8.80, 95% CI 3.54-21.88) Kundapura (AOR= 3.16, 95% CI 91.35-7.44), Karkala (AOR=5.78, 95% CI 2.29-14.59), Brahmavara ( AOR= 4.95, 95% CI 1.97-12.44) and Byndoor block (AOR= 11.87, 95% CI 4.13-34.07), were more likely to have unfavorable attitude as compared to those from Hebri block. Likewise, participants from joint families (AOR= 1.22, 95% CI 0.81-1.83), Adidharma religion (AOR= 4.06, 95% CI 2.63- 6.28) and those with low literacy (AOR= 2.91, 95% CI 1.33-6.34) also had a significant association with unfavorable attitude towards prevention and control of communicable diseases. Table 4 shows in the domain of knowledge regarding reproductive health care services, on univariate analysis, there was a significant association with demographic characteristics such as age, block and religion (p < 0.05). Further, multivariable logistic regression analysis showed that those with inadequate knowledge of reproductive health were more likely to be aged above 60 years (AOR = 2.75, 95% CI 1.69–4.48), residents of Kaup block (AOR = 2.59, 95% CI 1.11–6.06) and follow Adidharma religion (AOR = 2.76, 95% CI 1.79–4.26). The univariate analysis between demographic variables and attitude towards reproductive healthcare services showed that there was a significant association with all the demographic variables other than total number of family members and educational status (p < 0.05). On multivariable analysis, those above 60 years (AOR = 1.82, 95% CI 1.18–2.79), residents of Udupi (AOR = 11.22, 95% CI 4.06–30.10), Kaup (AOR = 15.03, 95% CI 5.75–39.29), Kundapura (AOR = 5.24, 95% CI 2.18–12.59), Karkala (AOR = 7.69, 95% CI 2.96–19.10) and Byndoor blocks (AOR = 17.99, 95% CI 6.05–53.54), joint family (AOR = 1.72, 95% CI 1.12–2.66) and Adidharma religion (AOR = 3.18, 95% CI 2.06–4.91) were predictors of unfavourable attitude towards reproductive healthcare services compared to those from Hebri block and Hindu religion. Table 4. Association between knowledge and attitude towards healthcare services on reproductive health with demographic variables of the study population (n = 622). Socio-demographic Characteristics Category Knowledge towards Reproductive Healthcare Services Adequate n = 175 No. (%) Inadequate n = 447 No. (%) C OR (95% CI) p value AOR (95% CI) p value Head of the household Male 48 (21.9) 171 (78.1) 0.61 (0.42–0.90) 0.011 1.371 (0.90–2.07) 0.133 Female 127 (31.5) 276 (68.5) 1 Age ≤60 years 150 (32.8) 308 (67.2) 1 >60 years 25 (15.2) 139 (84.8) 2.71 (1.70–4.33) <0.001 2.75 (1.69–4.48) <0.001* Block Udupi 16 (20.0) 64 (80.0) 2.44 (1.14–5.24) 0.022 0.97 (0.41–2.27) 0.937 Kapu 12 (11.0) 97 (89.0) 4.94 (2.21–1.00) <0.001 2.59 (1.10–6.06) 0.028* Kundapura 62 (33.3) 124 (66.7) 1.22 (0.66–2.25) 0.520 0.72 (0.34–1.40) 0.343 Karkala 21 (31.3) 46 (68.7) 1.33 (0.63–2.81) 0.440 1.31 (0.61–2.81) 0.488 Brahmavara 34 (42.5) 46 (57.5) 0.82 (0.41–1.65) 0.590 0.45 (0.23–1.05) 0.066 Byndoor 8 (19.0) 34 (81.0) 2.60 (1.01–6.62) 0.045 1.90 (0.72–5.02) 0.193 Hebri 22 (37.9) 36 (62.1) 1 Total family members Two 17 (26.2) 48 (73.8) 1 Three 43 (29.3) 104 (70.7) 0.86 (0.44–1.65) 0.644 Four 59 (31.4) 129 (68.6) 0.77 (0.41–1.46) 0.429 >Four 56 (25.2) 166 (74.8) 1.05 (0.56–1.97) 0.880 Type of family Nuclear 116 (29.5) 277 (70.5) 1 Joint 46 (25.1) 137 (74.9) 1.25 (0.83–1.86) 0.277 Extended 13 (28.3) 33 (71.7) 1.06 (0.54–2.09) 0.860 Religion Hindu 105 (40.4) 155 (59.6) 1 Adidharma 70 (19.3) 292 (80.7) 2.83 (1.97–4.05) <0.001 2.76 (1.79–4.26) 0.001* Educational status Illiterate 42 (20.5) 163 (79.5) 1.29 (0.59–2.86) 0.524 Primary school 101 (35.4) 184 (64.6) 0.60 (0.29–1.29) 0.196 Secondary school 22 (23.9) 70 (76.1) 1.06 (0.44–2.51) 0.893 PUC and above 10 (25.0) 30 (75.0) 1 Socio-demographic Characteristics Category Attitude towards Reproductive Healthcare Services Favorable n = 281 No. (%) Unfavorable n = 340 No. (%) C OR (95% CI) p value AOR (95% CI) p value Head of the household Male 80 (36.5) 139 (63.5) 0.58 (0.41–0.81) 0.001 1.41 (0.95–2.10) 0.086 Female 201 (50.0) 201 (50.0) 1 Age ≤60 years 225 (49.1) 233 (50.9) 1 >60 years 56 (34.4) 107 (65.6) 1.85 (1.27–2.68) 0.001 1.81 (1.18–2.79) 0.006* Block Udupi 18 (22.8) 61 (77.2) 24.69 (9.55–63.77) <0.001 11.21 (4.06–30.10) <0.001* Kaup 23 (21.1) 86 (78.9) 27.24 (10.91–67.96) <0.001 15.03 (5.71–39.29) <0.001* Kundapura 85 (45.7) 101 (54.3) 8.68 (3.73–20.07) <0.001 5.23 (2.18–12.59) <0.001* Karkala 35 (52.2) 32 (47.8) 6.66 (2.64–16.78) <0.001 7.69 (2.96–19.11) <0.001* Brahmavara 58 (72.5) 22 (27.5) 2.76 (1.09–7.00) 0.032 1.59 (0.59–4.24) 0.356 Byndoor 11 (26.2) 31 (73.8) 20.53 (7.20–58.52) <0.001 17.99 (6.05–53.54) Four 98 (44.1) 124 (55.9) 1.15 (0.66–2.01) 0.613 Type of family Nuclear 195 (49.7) 197 (50.3) 1 Joint 66 (36.1) 117 (63.9) 1.75 (1.22–2.52) 0.002 1.72 (1.16–2.66) 0.014* Extended 20 (43.5) 26 (56.5) 1.29 (0.70–2.38) 0.422 1.08 (0.54–2.16) 0.831 Religion Hindu 170 (65.4) 90 (34.6) 1 Adidharma 111 (30.7) 250 (69.3) 4.25 (3.03–5.97) <0.001 3.18 (2.06–4.91) <0.001* Educational status Illiterate 79 (38.5) 126 (61.5) 1.60 (0.81–3.15) 0.179 Primary school 146 (51.4) 138 (48.6) 0.94 (0.49–1.83) 0.868 Secondary school 36 (39.1) 56 (60.9) 1.56 (0.73–3.29) 0.247 PUC and above 20 (50.0) 20 (50.0) 1 Although on univariate analysis, all the variables except educational status were found to be significantly associated with knowledge on mental healthcare services (p < 0.05), the multivariable logistic regression analysis found that the predictors of inadequate knowledge towards mental healthcare services were residents living in Udupi (AOR = 3.86, 95% CI 1.52–9.81), Kaup (AOR = 11.37, 95% CI 4.61–28.07), Kundapura (AOR = 7.79, 95% CI 3.40–17.81), Karkala (AOR = 5.40, 95% CI 2.18–13.36) and Byndoor block (AOR = 6.26, 95% CI 2.32–16.88) and total four members in the family (AOR = 2.18, 95% CI 1.14–4.16.) Similarly, on the univariate analysis, gender of the head of households, age, block, type of family and religion were significantly associated with unfavorable attitude towards mental healthcare services (p < 0.05). Multivariable analysis showed that the variables such as age above 60 years (AOR = 1.93, 95% CI 1.23–3.03), being residents of Udupi (AOR = 3.02, 95% CI 1.24–7.36), Kaup (AOR = 29.71, 95% CI 10.50–84.10), Kundapura (AOR = 2.62, 95% CI 1.23–5.54),Karkala (AOR = 7.99, 95% CI 3.43–18.59) and Byndoor block (AOR = 43.84, 95% CI 11.13–172.59), and following Adidharma religion (AOR = 4.10, 95% CI 2.51–6.68) were significant predictors of unfavorable attitude towards mental healthcare services ( Table 5 ). Table 5. Association between knowledge and attitude towards healthcare services on mental health with demographic variables of the study population (n = 622). Socio-demographic Characteristics Category Knowledge towards Mental Healthcare Services Adequate n = 311 No.(%) Inadequate n = 311 No. (%) Crude OR (95% CI) p value AOR (95% CI) p value Head of the household Male 91 (41.6) 128 (58.4) 0.59 (0.42–0.82) 0.002 1.37 (0.94–1.98) 0.100 Female 220 (54.6) 183 (45.4) 1 Age ≤60 years 240 (52.4) 218 (47.6) 1 >60 years 71 (43.3) 93 (56.7) 1.44 (1.01–2.07) 0.045 1.39 (0.93–2.09) 0.108 Block Udupi 41 (51.2) 39 (48.8) 5.94 (2.50–14.13) <0.001 3.86 (1.51–9.81) 0.005* Kaup 29 (26.6) 80 (73.4) 17.24 (7.30–40.69) <0.001 11.37 (4.60–28.07) <0.001* Kundapura 73 (39.2) 113 (60.8) 9.68 (4.34–21.58) <0.001 7.79 (3.40–17.81) <0.001* Karkala 36 (53.7) 31 (46.3) 5.38 (2.21–13.07) <0.001 5.40 (2.18–13.36) <0.001* Brahmavara 63 (78.8) 17 (21.3) 1.69 (0.67–4.22) 0.265 1.36 (0.52–3.54) 0.523 Byndoor 19 (45.2) 23 (54.8) 7.57 (2.89–19.81) <0.001 6.26 (2.32–16.88) <0.001* Hebri 50 (86.2) 8 (13.8) 1 Total family members Two 44 (67.7) 21 (32.3) 1 Three 89 (60.5) 58 (39.5) 1.37 (0.73–2.53) 0.322 1.18 (0.61–2.30) 0.631 Four 85 (45.2) 103 (54.8) 2.54 (1.40–4.60) 0.002 2.18 (1.14–4.16) 0.018* >Four 93 (41.9) 129 (58.1) 2.91 (1.62–5.21) <0.001 2.03 (1.01–4.09) 0.047* Type of family Nuclear 213 (54.2) 180 (45.8) 1 Joint 80 (43.7) 103 (56.3) 1.52 (1.07–2.17) 0.019 1.09 (0.67–1.76) 0.737 Extended 18 (39.1) 28 (60.9) 1.84 (0.99–3.44) 0.055 1.02 (0.48–2.19) 0.955 Religion Hindu 155 (59.6) 105 (40.4) 1 Adidharma 156 (43.1) 206 (56.9) 1.95 (1.41–2.69) <0.001 1.50 (0.99–2.29) 0.058 Educational status Illiterate 98 (47.8) 107 (52.2) 1.64 (0.82–3.26) 0.161 Primary school 146 (51.2) 139 (48.8) 1.43 (0.73–2.80) 0.300 Secondary school 43 (46.7) 49 (53.3) 1.71 (0.81–3.63) 0.163 PUC and above 24 (60.0) 16 (40.0) 1 Socio-demographic Characteristics Category Attitude on Mental Healthcare Services Favourable n = 246 No. (%) Unfavourable n = 376 No. (%) UOR (95% CI) p value AOR (95% CI) p value Head of the household Male 74 (33.8) 145 (66.2) 0.69 (0.49–0.97) 0.030 1.07 (0.70–164) 0.740 Female 172 (42.7) 231 (57.3) 1 Age ≤60 years 198 (43.2) 260 (56.8) 1 >60 years 48 (29.3) 116 (70.7) 1.84 (1.25–2.70) 0.002 1.93 (1.23–3.03) 0.004* Block Udupi 25 (31.3) 55 (68.8) 8.43 (3.82–18.62) <0.001 3.02 (1.24–7.36) 0.015* Kaup 7 (6.4) 102 (93.6) 55.86 (20.65–151.08) <0.001 29.71 (10.50–84.10) <0.001* Kundapura 83 (44.6) 103 (55.4) 4.76 (2.37–9.56) <0.001 2.61 (1.23–5.54) 0.012* Karkala 24 (35.8) 43 (64.2) 6.87 (3.06–15.41) <0.001 7.99 (3.43–18.59) <0.001* Brahmavara 58 (72.5) 22 (27.5) 1.45 (0.65–3.25) 0.361 0.69 (0.29–1.67) 0.415 Byndoor 3 (7.1) 39 (92.9) 49.83 (13.11–189.39) <0.001 43.83 (11.13–172.59) Four 75 (33.8) 147 (66.2) 1.68 (0.96–2.95) 0.070 Type of family Nuclear 172 (43.8) 221 (56.2) 1 Joint 59 (32.2) 124 (67.8) 1.64 (1.13–2.36) 0.009 1.50 (0.95–2.36) 0.083 Extended 15 (32.6) 31 (67.4) 1.61 (0.84–3.07) 0.150 1.27 (0.57–2.79) 0.560 Religion Hindu 148 (56.9) 112 (43.1) 1 Adidharma 98 (27.1) 264 (72.9) 3.56 (2.54–4.99) <0.001 4.10 (2.51–6.68) <0.001* Educational status Illiterate 73 (35.6) 132 (64.4) 1.09 (0.54–2.19) 0.820 Primary school 125 (43.9) 160 (56.1) 0.77 (0.39–1.52) 0.448 Secondary school 33 (35.9) 59 (64.1) 1.07 (0.50–2.31) 0.858 PUC and above 15 (37.5) 25 (62.5) 1 Discussion The present study included 622 individuals belonging to the Koraga tribe living across seven blocks of the Udupi district. The study findings showed that the tribal population have poor knowledge (62.2%) and unfavourable attitude (50.2%) towards healthcare services on communicable diseases, and this aligns with previous reports that supports high prevalence of communicable diseases among various tribes across India. 20 – 22 Our findings are supported by an Australian study by Rheault et al., which showed that 59 per cent of the tribal population in the study area had low literacy rate which hindered their knowledge and reduced the access to healthcare services. 23 Approximately 93% of the tribal population in India resides in rural and remote areas, which significantly limits their access to formal education and schooling opportunities. 24 Our study also revealed notable gender disparities in knowledge and attitudes towards healthcare services for communicable diseases, with 68.5% of males and 58.8% of females demonstrating poor knowledge. Interestingly, attitudes were similarly unfavourable among both genders, with 49.3% of males and 50.6% of females reporting negative perceptions. Age emerged as a significant factor, with 78% of respondents aged over 60 years exhibiting poor knowledge, and 60.4% of the same age group had unfavourable attitudes, indicating a strong association between advancing age and limited awareness and receptiveness to healthcare services (p < 0.05). Geographic disparities were evident, with residents of Udupi and Kaup taluks exhibiting markedly higher proportions of poor knowledge (80%) and unfavourable attitudes (70.6%) toward healthcare services, both statistically significant (p < 0.05). Furthermore, individuals identifying with the Adidharma religion and those who were illiterate were significantly more likely to have both poor knowledge (<0.001) and unfavourable attitudes (<0.001) towards communicable disease-related healthcare services (p < 0.05), underscoring the influence of socio-cultural and educational factors on health perceptions. An Acquired Immuno Deficiency Syndrome (AIDS) awareness study conducted in Karnataka, a southern state of India by Eknath Naik et al. supports our findings in some respects. The study revealed that only 22% of adults had ever heard of AIDS, and just 18% knew about its modes of transmission. Furthermore, only 5% were aware of the link between STDs and AIDS. Notably, AIDS awareness among women was significantly lower than among men (14% vs. 30%), which contrasts with our findings, where females demonstrated better knowledge than males (41.2% vs. 39.5%). 25 However, a study conducted among a tribal community in Assam by Phukan presents contrasting findings which demonstrated a high level of awareness regarding malaria symptoms (97.3%), treatment options (94%), preventive measures (88%), and diagnostic methods (68%) among the respondents. Despite this, their knowledge about the availability of services from Fever Treatment Depots (FTDs) and Drug Distribution Centres (DDCs) was notably limited. 26 Our study is supported by research conducted in Maharashtra by Rajvanshi et al, which revealed poor knowledge and an unfavourable attitude towards malaria treatment among a tribal population. The study found that, 64.4% of respondents were illiterate, and only 20.6% were aware of the causative factors of malaria, despite 45% of household heads having received some form of health education from various sources. 27 Similarly, a study conducted among a tribal population in Maharashtra found that only 19% of participants were aware of the transmission routes of sexually transmitted diseases (STDs), and 30% relied on home remedies as a treatment option. 28 The variations in knowledge levels among tribal communities can be attributed to cultural distinctions and traditional practices, further influenced by multiple factors such as geographical terrain, remoteness from mainstream society, and the unique ancestral customs upheld by each group. 28 , 29 The findings of our research revealed that 71.9% of respondents had poor knowledge, and 54.8% exhibited an unfavourable attitude towards reproductive healthcare services. Notably, majority of the males (78.1%) and females (68.5%) demonstrated poor knowledge. Statistically significant associations (p < 0.05) were observed among participants aged above 60 years (84.8%), residents of Kaup taluk (89%), and individuals belonging to the Adidharma tribal group (80.7%), households with more than four members (74.8%), extended family structures (71.7%), and illiteracy (79.5%) were also identified as significant demographic factors associated with poor knowledge among the respondents. Similarly, attitude scores were also more likely to be unfavourable among males (63.5%), individuals aged above 60 years (65.5%), residents of Udupi taluk (77.2%), those living in joint families (63.9%), and members of the Adidharma religion (69.3%). These associations were statistically significant (p < 0.05). Factors such as large family size (35.7%) and low literacy (33.0%) may have contributed to an unfavourable attitude towards reproductive and child health. Our findings are consistent with the qualitative research done by Bharathi et al, in Uttarakhand which found that the Tharu tribe and the Buksa tribe had very poor knowledge and attitude towards the maternal and childcare provided by the healthcare system. 30 Another qualitative study from Bangladesh among Garo tribe also supports our findings, which elicited socio-economic factors, culture-based attitude and practices, family dynamics, husband’s knowledge and personal dispositions to play a significant role in the attitude towards reproductive healthcare services. The research found that most of these factors are unfavourable for the Garo tribe to access and avail reproductive healthcare services. Research evidence among tribal women in north India, also are consistent with our findings, that the favourable attitude is influenced by many demographic variables and educational status. The study showed that the utilization of antenatal services among ST women varied from about four per cent in Madhya Pradesh and Rajasthan to 10–14 per cent in Chhattisgarh and Odisha. Utilization was higher among those women with nine or more years of schooling (15–28%) and those women who visited health facility for pregnancy confirmation test (9–27%). 33 , 34 Similarly, a study conducted in the coastal Karnataka found that although 82.9 per cent of tribal women had heard of cervical cancer, only 2.3 per cent knew it could be detected early, and none had undergone screening, which could be attributed to lack of awareness and poor accessibility to healthcare services. 35 Another study in Madhya Pradesh reported significant lack of awareness about cervical cancer and its link to Human Papilloma Virus (HPV) infection among tribal women, leading to negative attitudes towards screening services. 36 Contrasting to our findings, a paper published from Canada reported that there is a positive attitude among the indigenous women towards reproductive healthcare services. 37 In contrast Aswathi et al, argues that improving knowledge and attitude can enhance the accessibility and utilization of reproductive healthcare services, with their results showing 74.2 per cent of study participants being aware that cervical cancer could be detected early by a screening test. Majority of respondents (89.2%) did not have awareness on risk factors for cervical cancer (p < 0.05). 38 Poor knowledge (50%) and unfavourable attitude (60.5%) towards mental health services among the Koraga community are consistent with studies from India among other tribal populations. Males had comparatively more knowledge (58.0%) than females (45.4%) and the knowledge was found to be adequate among respondents aged above 60 years (56.7%). Additionally, those from extended family (60.9%), Adidharma religion (56.9%), aged above 60 years (70.7%) and those with low literacy (52.2%) also showed poor knowledge regarding mental health services. Similarly, males (66.2%), females (57.3%), joint family (67.8%), Adidharma religion (72.9%, p < 0.05) and illiteracy (64.4%) were also having an unfavourable attitude. Significantly higher proportion of participants from Kaup (93.6%), Udupi (68.8%), Karkala (64.2%) and Kundapura blocks (55.4%), had (p < 0.05) unfavourable attitude. A systematic review by Bakhla et al. on mental health problems among tribes, showed that the prevalence of mental health disorders varied across the studies with depression ranging from three per cent to 43 per cent, anxiety up to eight per cent, mania from 0.04 per cent to 0.39 per cent, schizophrenia from 0.07 per cent to 0.52 per cent, intellectual disability from 0.1 per cent to 0.6 per cent, epilepsy from 0.2 per cent to 1.03 per cent, and dementia or cognitive impairment up to 42.92 per cent. A meta-analysis of 15 studies on depression among tribal population in India found that the pooled prevalence to be 14 per cent (with a confidence interval of 8% to 22%). 39 A mixed method study in Odisha found that the low educational level, Hindu religion, higher age, and female gender ( p < 0.05) were significantly associated with attitudes towards mental healthcare facilities among people in the remote and rural communities. It was also found that female respondents had more negative attitudes than male respondents. 40 Jena. S et al & Ali. T et al examined the attitudes and practices of tribal communities towards mental health in Jharkhand and other catchment areas. The results showed that over 60% of people believed in supernatural causes of mental illness and do not seek healthcare services. 41 , 42 Contrastingly Noronha et al, in her research found that the majority (80%) of the Koraga tribal participants had good knowledge regarding mental health, and 68% of them had a favourable attitude towards mentally ill individuals. It was found that 79.2% of the participants had a favourable attitude. 43 Our findings are supported by another study by Deb Roy A et al.which reiterates the importance of mental health education and literacy to enhance the knowledge and attitude of the population to improve the utilization of health care services. 44 Additionally, findings from recent ethnographic research conducted among the PVTG emphasised the need for the implementation of effective administrative policies and well-coordinated healthcare activities. Such measures would significantly increase the likelihood of successful outcomes by empowering these communities to adopt and effectively utilize the resources available to them, thereby improving their outlook and access to healthcare services. 45 Limitations The study was conducted among Koraga tribal community, the only PVTG in Udupi district and hence it lacks the scope for generalization of results to a larger population. Considering other PVTGs and conducting a comparative study across various states of India would be helpful to assess additional barriers to healthcare access. Notably, this study is unique in being the first to explore the knowledge and attitude towards healthcare services among the Koraga tribe of Karnataka. We have conducted this study considering possible bias related to the subjects, samples, (being tribal population) researchers, and methodology and by conducting this study in a very scientific and systematic manner, we have strived the best to eliminate the chances of biases. Suggestions for future research Studies can be focused on other PVTGs elsewhere in India with objectives of comparing the knowledge, attitude and practice on healthcare services which can be compared with general population also. The present research has highlighted several barriers which hinder the accessibility of healthcare services for tribal populations that can be overcome through coordinated education and health literacy among tribal populations. 46 – 49 Future research can utilize larger samples to make the results generalizable and such studies will be able to bring out hidden facts about tribal health which in turn might help the healthcare system to develop more fortified and structured programs for the improvement of tribal health, aligning with various Sustainable Development Goals. Qualitative studies can help to understand the underlying cultural, social, and systemic factors that influence healthcare-related knowledge, attitudes, and practices among this PVTG. Conclusion Although a range of healthcare services is available to tribal populations in India, their utilization remains suboptimal. The findings of this study indicate that the Koraga tribe exhibits limited knowledge and an overall unfavourable attitude toward healthcare services and their utilization. Specifically, the tribe demonstrated inadequate awareness and negative perceptions across three critical domains: communicable diseases, reproductive health, and mental health. While their knowledge and attitudes regarding communicable and reproductive health were found to be at a moderate level, their understanding of mental illness and related healthcare services was notably poor, accompanied by markedly negative attitudes. These deficits in knowledge and attitude appear to act as significant barriers to accessing and effectively utilizing both public and private healthcare services. The study also found that factors such as cultural and traditional health beliefs, geographic isolation and low educational attainment, were significantly associated with their unfavourable attitudes toward the healthcare system and services. The findings of this study provide important directions for future research PVTGs, especially concerning their cultural beliefs, existing practices, knowledge gaps, and potential interventions. These insights may assist healthcare administrators and policymakers in designing culturally sensitive health education initiatives and motivational programs aimed at improving healthcare access and utilization among tribal populations. Data protection issues This cross- sectional study was conducted among a Particularly Vulnerable Tribal Group (PVTG), and the knowledge questionnaire and attitude scale which were used in this research is shared in the extended data. Any further dataset such as score sheet can be available on request from the corresponding author, mentioning the specific reason for availing it. Ethical and consent statement Permission was obtained from the Institutional Ethics Committee (KMC-KH IEC) of Kasturba Medical College, Manipal, Manipal Academy of Higher Education. (IEC No: 778/2019) Approved on 19 November 2019). A written informed consent was received from all participants. This research was conducted in accordance with the Declaration of Helsinki. Data availability Underlying data Since the study was conducted among a socio-cultural and economically vulnerable group, and their stakeholders, the authors have taken precautions as per the guidelines by Declarations of Helsinki to protect the confidentiality and privacy of the participants and the data is provided based on that. The readers may contact the corresponding author for further information on this research on [email protected] Extended data 1. Figshare. Extended Data (Questionnaire, Participant information Sheet & Informed Consent). https://doi.org/10.6084/m9.figshare.31109209 51 This project contains the following underlying data: • Extended data on (a) Interviewer administered Knowledge Questionnaire and Attitude Scale (b) Participant Information Sheet (c) Informed Consent form (d) Knowledge and Attitude Score Sheet Data is available under the terms of the CC BY 4.0 . 2. Figshare. Extended Data on Knowledge and Attitude Scores. https://doi.org/10.6084/m9.figshare.31055596 52 This project contains the following underlying data: • Tables Data is available under the terms of the CC BY 4.0 . Reporting guidelines The guidelines for reporting this study are available in Figshare: STROBE Statement—Checklist of items that should be included in reports of cross-sectional studies . https://doi.org/10.6084/m9.figshare.30996508 50 The data are available under the terms of the Creative Commons Attribution 4.0 International license (CC-BY 4.0) . Acknowledgements We acknowledge the Indian Council of Medical Research (ICMR), New Delhi, for funding this research study (Grant ID: Tribal/121/2020-ECD-II) and the District Health Authority, Integrated Tribal Development Project (ITDP), Udupi district, and Samagra Grameena Ashram (NGO) for providing support for field activities. We also extend our sincere gratitude to all the participants who contributed to this research study. ChatGPT was used as a Large Language Model for language editing and structuring of text in this article. References 1. Debnath P, Debnath A, Chakrabarti K, et al. : Tribal communities, their quality of life and the differences: evidence from an Indian district. J Anthropol Surv India. 2024; 73 (2): 194–209. Publisher Full Text 2. Upadhyay RP, Misra P, Chellaiyan VG, et al. : Burden of diabetes mellitus and prediabetes in tribal population of India: a systematic review. Diabetes Res. Clin. Pract. 2013; 102 (1): 1–7. PubMed Abstract | Publisher Full Text 3. Bawdekar M, Ladusingh L: Contextual correlates of child malnutrition in rural Maharashtra. J. Biosoc. Sci. 2008; 40 (5): 771–786. PubMed Abstract | Publisher Full Text 4. Acharya SS: Health equity and tribal populations: challenges and way forward. Indian J. Med. Res. 2022; 156 (2): 179–181. PubMed Abstract | Publisher Full Text | Free Full Text 5. Ghule M, Raj A, Palaye P, et al. : Barriers to use of contraceptive methods among rural young married couples in Maharashtra, India: qualitative findings. Asian J Res Soc Sci Humanit. 2015; 5 (6): 18–33. Publisher Full Text 6. Ministry of Health and Family Welfare (MoHFW), Ministry of Tribal Affairs: Tribal health in India: bridging the gap and a roadmap for the future—executive summary and recommendations. New Delhi: Government of India; 2018. Reference Source 7. Ministry of Tribal Affairs: Statistical profile of scheduled tribes in India. New Delhi: Government of India; 2013. Reference Source 8. Roy S, Hegde HV, Bhattacharya D, et al. : Tribes in Karnataka: status of health research. Indian J. Med. Res. 2015; 141 (5): 673–687. PubMed Abstract | Publisher Full Text | Free Full Text 9. Mallya SD, Shreedhar S, Sudhakaran D, et al. : Health status of Koraga community: a pilot study among a particularly vulnerable tribal group of Udupi District, Karnataka, India. Indian J. Med. Res. 2022; 156 (2): 275–283. Publisher Full Text 10. Negi DP, Abdul Azeez EP: Diminishing traditional methods and inaccessible modern healthcare: the dilemma of tribal health in India. J Health Res. 2022; 36 (5): 867–877. Publisher Full Text 11. Soman B, Lathika AR, Unnikrishnan B, et al. : Tracing the disparity between healthcare policy-based infrastructure and health belief-led practices: a narrative review on indigenous populations of India. J. Racial Ethn. Health Disparities. 2024; 11 (6): 3572–3583. Publisher Full Text 12. Linda AI, Pal D, Murmu N, et al. : Health of tribal population in India: a glimpse of the current scenario. Curr Med Issues. 2024; 22 (2): 114–117. Publisher Full Text 13. Jain Y, Kataria R, Patil S, et al. : Burden and pattern of illnesses among the tribal communities in central India: a report from a community health programme. Indian J. Med. Res. 2015; 141 (5): 663–672. PubMed Abstract | Publisher Full Text | Free Full Text 14. Giri PP, Mohapatra B, Kar K: Prevalence of hypertension and the associated factors among Sabar and Munda tribes of Eastern India. J. Family Med. Prim. Care. 2022; 11 (9): 5065–5071. PubMed Abstract | Publisher Full Text | Free Full Text 15. George MS, Davey R, Mohanty I, et al. : “Everything is provided free, but they are still hesitant to access healthcare services”: why does the indigenous community in Attapadi, Kerala continue to experience poor access to healthcare?. Int. J. Equity Health. 2020; 19 (1): 105. PubMed Abstract | Publisher Full Text | Free Full Text 16. Sim F, Mackie P: Raising the profile of the inequalities in health of indigenous peoples. Public Health. 2019; 176 : 1. PubMed Abstract | Publisher Full Text 17. Subramanian SV, Davey Smith G, Subramanyam M: Indigenous health and socioeconomic status in India. PLoS Med. 2006; 3 (10): e421. Publisher Full Text 18. Chinnaiyan S, Palanisamy B, Sambasivam I: Understanding the trends of tribal research in India through bibliometric analysis. J. Family Med. Prim. Care. 2022; 11 (10): 5887–5893. PubMed Abstract | Publisher Full Text | Free Full Text 19. Elfil M, Negida A: Sampling methods in clinical research; an educational review. Emerg Tehran. 2017; 5 (1): e52. Publisher Full Text 20. Okafor IP, Oyewale DV, Ohazurike C, et al. : Role of traditional beliefs in the knowledge and perceptions of mental health and illness amongst rural-dwelling women in western Nigeria. Afr J Prim Health Care Fam Med. 2022; 14 (1): e1–e8. PubMed Abstract | Publisher Full Text | Free Full Text 21. Yin H, Wardenaar KJ, Xu G, et al. : Mental health stigma and mental health knowledge in Chinese population: a cross-sectional study. BMC Psychiatry. 2020; 20 (1): 323. PubMed Abstract | Publisher Full Text | Free Full Text 22. Jorm AF: Mental health literacy. Public knowledge and beliefs about mental disorders. Br. J. Psychiatry. 2000; 177 : 396–401. Publisher Full Text 23. Rheault H, Coyer F, Jones L, et al. : Health literacy in Indigenous people with chronic disease living in remote Australia. BMC Health Serv. Res. 2019; 19 (1): 523. PubMed Abstract | Publisher Full Text | Free Full Text 24. Department of Science and Technology: Annual report 2013–14. New Delhi: Ministry of Science and Technology, Government of India; 2014. Reference Source 25. Naik E, Karpur A, Taylor R, et al. : Rural Indian tribal communities: an emerging high-risk group for HIV/AIDS. BMC Int. Health Hum. Rights. 2005; 5 (1): 1. PubMed Abstract | Publisher Full Text | Free Full Text 26. Phukan P: Awareness and practices in relation to malaria in a tribal area in Kamrup District, Assam. Indian J. Public Health. 2009; 53 (4): 237–239. 27. Rajvanshi H, Saha KB, Sharma RK, et al. : Assessing community knowledge, attitude and practices to strengthen communication strategy for Malaria Elimination Demonstration Project in Mandla. Malar. J. 2021; 20 (1): 354. PubMed Abstract | Publisher Full Text | Free Full Text 28. Rao VG, Anvikar A, Savargaonkar D, et al. : Prevalence of sexually transmitted disease syndromes in tribal population of central India. J. Epidemiol. Community Health. 2009; 63 (10): 805–806. PubMed Abstract | Publisher Full Text 29. Waterworth P, Pescud M, Braham R, et al. : Factors influencing the health behaviour of Indigenous Australians: perspectives from support people. PLoS One. 2015; 10 (11): e0142323. PubMed Abstract | Publisher Full Text | Free Full Text 30. Bharti J, Singh H, Srivastava AS: Tharu and Buksa tribes’ attitudes toward child and maternal health and educational services in Uttarakhand: a qualitative study. J Mountain Res. 2023; 18 (2): 163–172. Publisher Full Text 31. Chowdhury SK: Uptake of antepartum care services in a matrilineal-matrilocal society: a study of Garo indigenous women in Bangladesh. BMC Pregnancy Childbirth. 2023; 23 (1): 75. PubMed Abstract | Publisher Full Text | Free Full Text 32. Khan MA, Islam MK, Siraj MA, et al. : Ethnomedicinal survey of various communities residing in Garo Hills of Durgapur, Bangladesh. J. Ethnobiol. Ethnomed. 2015; 11 : 44. Publisher Full Text 33. Adhikari T, Sahu D, Nair S, et al. : Factors associated with utilization of antenatal care services among tribal women: a study of selected states. Indian J. Med. Res. 2016; 144 (1): 58–66. PubMed Abstract | Publisher Full Text | Free Full Text 34. Nair S, Adhikari T, Juneja A, et al. : 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. Matern. Child Health J. 2021; 25 (5): 769–776. PubMed Abstract | Publisher Full Text 35. Ghosh S, Mallya SD, Shetty RS, et al. : Knowledge, attitude and practices towards cervical cancer and its screening among women from tribal population: a community-based study from Southern India. J. Racial Ethn. Health Disparities. 2021; 8 (1): 88–93. Publisher Full Text 36. Gupta B, Sridevi P: Knowledge, attitude and practices towards cervical cancer and its screening among women from tribal population of Anuppur District. J. Prev. Dent. 2025; 46 (1): 133–156. Publisher Full Text 37. Hayward A, Cidro J: Indigenous birth as ceremony and a human right. Health Hum. Rights. 2021; 23 (1): 213–224. PubMed Abstract 38. Aswathy S, Quereshi MA, Kurian B, et al. : Cervical cancer screening: current knowledge and practice among women in a rural population of Kerala, India. Indian J. Med. Res. 2012; 136 (2): 205–210. PubMed Abstract | Free Full Text 39. Bakhla AK, Nongpiur A, Kumari B, et al. : Psychiatry research and prevalence of psychiatric disorders among tribal populations of India: a systematic review and meta-analysis. Indian J. Psychiatry. 2025; 67 (2): 192–208. PubMed Abstract | Publisher Full Text | Free Full Text 40. Jena S, Sahoo KC, Samal M, et al. : Rural community attitude towards mental healthcare: a mixed-method study in Khurda district of Odisha, India. Middle East Curr. Psychiatry. 2020; 27 (1): 48. Publisher Full Text 41. Ali T, Deshmukh S, Kumar S, et al. : Assessment of supernatural attitude toward mental health among tribal and non-tribal populations. Ind. Psychiatry J. 2023; 32 (Suppl 1): S174–S178. PubMed Abstract | Publisher Full Text | Free Full Text 42. Hansda NM, Singh U, Kapse PP, et al. : Supernatural attitude and mental health practices among the tribal with special reference to Jharkhand. Indian J Psychiatric Soc Work. 2021; 12 (2): 90–95. Publisher Full Text 43. Noronha FS, Jose TT, George LS, et al. : Mental health literacy, attitude, and help seeking intention among a particularly vulnerable tribe. Clin Epidemiol Glob Health. 2024; 29 : 101706. Publisher Full Text 44. Deb Roy A, Das D, Mondal H: The tribal health system in India: challenges in healthcare delivery in comparison to the global healthcare systems. Cureus. 2023; 15 (6): e39867. PubMed Abstract | Publisher Full Text | Free Full Text 45. Soman B, Mallya SD, Kumar A, et al. : 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]. F1000Res. 2025; 14 : 589. Publisher Full Text 46. Thomas BE, Thiruvengadam K, Raghavi S, et al. : Understanding health care-seeking behaviour of the tribal population in India among those with presumptive TB symptoms. PLoS One. 2021; 16 (5): e0250971. Publisher Full Text 47. Kumar MM, Pathak VK, Ruikar M: Tribal population in India: a public health challenge and road to future. J. Family Med. Prim. Care. 2020; 9 (2): 508–512. PubMed Abstract | Publisher Full Text | Free Full Text 48. Nolan-Isles D, Macniven R, Hunter K, et al. : Enablers and barriers to accessing healthcare services for Aboriginal people in New South Wales, Australia. Int. J. Environ. Res. Public Health. 2021; 18 (6): 3014. PubMed Abstract | Publisher Full Text | Free Full Text 49. Artuso S, Cargo M, Brown A, et al. : Factors influencing health care utilisation among Aboriginal cardiac patients in central Australia: a qualitative study. BMC Health Serv. Res. 2013; 13 : 83. PubMed Abstract | Publisher Full Text | Free Full Text 50. Biju S, Mallya SD, Narayanan SR, et al. : STROBE statement for cross-sectional study. [dataset]. figshare. 2026 [cited 2026 Jan 21]. Reference Source 51. Biju S, Mallya SD, Narayanan SR, et al. : Supplementary data: Questionnaire, participant information sheet and informed consent. [dataset]. figshare. 2026 [cited 2026 Jan 21]. Reference Source 52. Biju S, Mallya SD, Narayanan SR, et al. : Extended data on knowledge and attitude scores. [dataset]. figshare. 2026 [cited 2026 Jan 21]. Reference Source Comments on this article Comments (0) Version 1 VERSION 1 PUBLISHED 16 Apr 2026 ADD YOUR COMMENT Comment Author details Author details 1 Department of Community Medicine, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India 2 Centre for Digital Health, Applied Research and Technology, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India 3 Department of Community Medicine, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India 4 Division of Epidemiology and Communicable Diseases, Ministry of Health and Family Welfare, Indian Council of Medical Research, New Delhi, Delhi, 110029, India Biju Soman Roles: Conceptualization, Data Curation, Formal Analysis, Investigation, Methodology, Writing – Original Draft Preparation, Writing – Review & Editing Sneha D Mallya Roles: Conceptualization, Data Curation, Formal Analysis, Investigation, Methodology, Project Administration, Resources, Supervision, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing Rishi S Narayanan Roles: Formal Analysis, Resources, Software, Writing – Review & Editing Vani Lakshmi R. Roles: Data Curation, Formal Analysis, Methodology, Resources, Software, Validation, Writing – Review & Editing Ashwini Kumar Roles: Methodology, Project Administration, Resources, Validation, Writing – Review & Editing B. Unnikrishnan Roles: Conceptualization, Data Curation, Methodology, Project Administration, Resources, Supervision, Validation, Visualization, Writing – Review & Editing Harpreet Kaur Roles: Methodology, Project Administration, Resources, Supervision, Validation, Visualization, Writing – Review & Editing Ranjitha S Shetty Roles: Conceptualization, Data Curation, Formal Analysis, Funding Acquisition, Investigation, Methodology, Project Administration, Resources, Supervision, Validation, Visualization, Writing – Review & Editing Competing interests No competing interests were disclosed. Grant information 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. Article Versions (1) version 1 Published: 16 Apr 2026, 15:542 https://doi.org/10.12688/f1000research.176835.1 Copyright © 2026 Soman B et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Download Export To Sciwheel Bibtex EndNote ProCite Ref. Manager (RIS) Sente metrics Views Downloads F1000Research - - PubMed Central info_outline Data from PMC are received and updated monthly. - - Citations open_in_new 0 open_in_new 0 open_in_new SEE MORE DETAILS CITE how to cite this article Soman B, Mallya SD, Narayanan RS et al. 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 [version 1; peer review: 1 approved, 1 approved with reservations] . F1000Research 2026, 15 :542 ( https://doi.org/10.12688/f1000research.176835.1 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS track receive updates on this article Track an article to receive email alerts on any updates to this article. TRACK THIS ARTICLE Share Open Peer Review Current Reviewer Status: ? Key to Reviewer Statuses VIEW HIDE Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Version 1 VERSION 1 PUBLISHED 16 Apr 2026 Views 0 Cite How to cite this report: Gothankar DJ. Reviewer Report For: 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 [version 1; peer review: 1 approved, 1 approved with reservations] . F1000Research 2026, 15 :542 ( https://doi.org/10.5256/f1000research.194947.r476278 ) The direct URL for this report is: https://f1000research.com/articles/15-542/v1#referee-response-476278 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 11 May 2026 Dr Jayashree Gothankar , Bharati Vidyapeeth Deemed University Medical College, Pune, India Approved VIEWS 0 https://doi.org/10.5256/f1000research.194947.r476278 The validation and pre-testing of research tools need to be written. 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 ... Continue reading READ ALL The validation and pre-testing of research tools need to be written. 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. Regarding the limitations, kindly elaborate on the statement “We have conducted this study considering possible bias related to the subjects, samples (being a tribal population), and researchers.” Is the work clearly and accurately presented and does it cite the current literature? Yes Is the study design appropriate and is the work technically sound? Yes Are sufficient details of methods and analysis provided to allow replication by others? Partly If applicable, is the statistical analysis and its interpretation appropriate? Partly Are all the source data underlying the results available to ensure full reproducibility? Yes Are the conclusions drawn adequately supported by the results? Yes Competing Interests: No competing interests were disclosed. Reviewer Expertise: Implementation research, public health, epidemiology I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Gothankar DJ. Reviewer Report For: 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 [version 1; peer review: 1 approved, 1 approved with reservations] . F1000Research 2026, 15 :542 ( https://doi.org/10.5256/f1000research.194947.r476278 ) The direct URL for this report is: https://f1000research.com/articles/15-542/v1#referee-response-476278 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Respond or Comment COMMENT ON THIS REPORT Views 0 Cite How to cite this report: Deb P()R. Reviewer Report For: 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 [version 1; peer review: 1 approved, 1 approved with reservations] . F1000Research 2026, 15 :542 ( https://doi.org/10.5256/f1000research.194947.r476269 ) The direct URL for this report is: https://f1000research.com/articles/15-542/v1#referee-response-476269 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 05 May 2026 Prof. (Dr.) Roumi Deb , Department of Anthropology, AISS, Amity University, Noida, Uttar Pradesh, India Approved with Reservations VIEWS 0 https://doi.org/10.5256/f1000research.194947.r476269 1. Summary of the article- This study is a community-based cross-sectional survey conducted among 622 adults from the Koraga tribe, a Particularly Vulnerable Tribal Group (PVTG) in Udupi district, Karnataka, India. The objective was to assess knowledge and attitudes ... Continue reading READ ALL 1. Summary of the article- This study is a community-based cross-sectional survey conducted among 622 adults from the Koraga tribe, a Particularly Vulnerable Tribal Group (PVTG) in Udupi district, Karnataka, India. The objective was to assess knowledge and attitudes toward healthcare services across three domains- communicable diseases, reproductive health, and mental health. Using multistage cluster sampling and structured interviews, the authors found that a large proportion of participants had poor knowledge (up to 71.9%) and unfavourable attitudes (up to 60.5%) toward healthcare services. Sociodemographic factors such as age, education, religion, and geographic location were significantly associated with knowledge and attitudes. The authors conclude that targeted health literacy interventions are needed to improve healthcare utilization among this population. 2. Comments linked to questions above- A. Clarity of presentation and use of literature - Partly The manuscript is generally well-structured (clear abstract, methods, results, discussion). Background section provides context on tribal health disparities. Relevant studies are cited to support findings and comparisons. Though, 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. Also, clearly articulate how this study adds new knowledge beyond existing evidence. B. Study design and technical soundness - Yes Appropriate cross-sectional design has been used for assessing knowledge and attitudes. Use of multistage cluster sampling with PPS is methodologically sound. Adequate sample size calculation and justification is provided. Ethical approval and informed consent procedures are well described. C. Methods and reproducibility - Partly Sampling method and study setting are described in detail. The questionnaire structure and scoring system are explained. Statistical methods are also outlined. However, 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’s alpha, validity metrics) and include bias mitigation strategies. D. Statistical analysis - Partly Use of logistic regression (univariate and multivariable) is appropriate. Reporting of AORs with 95% CIs is correct. However, 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–Lemeshow test) and confounding variables. E. Data availability and reproducibility - Yes Extended data is shared via Figshare. F. Conclusions supported by results - Yes Conclusions align with findings (poor knowledge and attitudes). Policy implications (health literacy interventions) are reasonable. 3. Essential Revisions (Must be addressed)- To ensure scientific soundness, the authors should: 3.1 Expand statistical reporting- Include model diagnostics and clarify confounding variables. 3.2 Improve methodological transparency- Provide validation details and bias control measures. 3.3 Strengthen literature review- Include recent studies and better synthesis. The study is important and methodologically sound, but requires minor revisions, particularly in statistical reporting and literature review, before it can be considered fully robust for indexing. Is the work clearly and accurately presented and does it cite the current literature? Partly Is the study design appropriate and is the work technically sound? Yes Are sufficient details of methods and analysis provided to allow replication by others? Partly If applicable, is the statistical analysis and its interpretation appropriate? Partly Are all the source data underlying the results available to ensure full reproducibility? Yes Are the conclusions drawn adequately supported by the results? Yes Competing Interests: No competing interests were disclosed. Reviewer Expertise: Public Health, Bio-social Anthropology, Demography, Population studies, Population Genetics, Reproductive health, Maternal and Child heath, studies on youth I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Deb P()R. Reviewer Report For: 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 [version 1; peer review: 1 approved, 1 approved with reservations] . F1000Research 2026, 15 :542 ( https://doi.org/10.5256/f1000research.194947.r476269 ) The direct URL for this report is: https://f1000research.com/articles/15-542/v1#referee-response-476269 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Respond or Comment COMMENT ON THIS REPORT Comments on this article Comments (0) Version 1 VERSION 1 PUBLISHED 16 Apr 2026 ADD YOUR COMMENT Comment keyboard_arrow_left keyboard_arrow_right Open Peer Review Reviewer Status info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Reviewer Reports Invited Reviewers 1 2 Version 1 16 Apr 26 read read Prof. (Dr.) Roumi Deb , AISS, Amity University, Noida, India Dr Jayashree Gothankar , Bharati Vidyapeeth Deemed University Medical College, Pune, India Comments on this article All Comments (0) Add a comment Sign up for content alerts Sign Up You are now signed up to receive this alert Browse by related subjects keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2026 Gothankar D. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 11 May 2026 | for Version 1 Dr Jayashree Gothankar , Bharati Vidyapeeth Deemed University Medical College, Pune, India 0 Views copyright © 2026 Gothankar D. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Approved info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions The validation and pre-testing of research tools need to be written. 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. Regarding the limitations, kindly elaborate on the statement “We have conducted this study considering possible bias related to the subjects, samples (being a tribal population), and researchers.” Is the work clearly and accurately presented and does it cite the current literature? Yes Is the study design appropriate and is the work technically sound? Yes Are sufficient details of methods and analysis provided to allow replication by others? Partly If applicable, is the statistical analysis and its interpretation appropriate? Partly Are all the source data underlying the results available to ensure full reproducibility? Yes Are the conclusions drawn adequately supported by the results? Yes Competing Interests No competing interests were disclosed. Reviewer Expertise Implementation research, public health, epidemiology I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. reply Respond to this report Responses (0) Gothankar DJ. Peer Review Report For: 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 [version 1; peer review: 1 approved, 1 approved with reservations] . F1000Research 2026, 15 :542 ( https://doi.org/10.5256/f1000research.194947.r476278) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/15-542/v1#referee-response-476278 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2026 Deb P. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 05 May 2026 | for Version 1 Prof. (Dr.) Roumi Deb , Department of Anthropology, AISS, Amity University, Noida, Uttar Pradesh, India 0 Views copyright © 2026 Deb P. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Approved With Reservations info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions 1. Summary of the article- This study is a community-based cross-sectional survey conducted among 622 adults from the Koraga tribe, a Particularly Vulnerable Tribal Group (PVTG) in Udupi district, Karnataka, India. The objective was to assess knowledge and attitudes toward healthcare services across three domains- communicable diseases, reproductive health, and mental health. Using multistage cluster sampling and structured interviews, the authors found that a large proportion of participants had poor knowledge (up to 71.9%) and unfavourable attitudes (up to 60.5%) toward healthcare services. Sociodemographic factors such as age, education, religion, and geographic location were significantly associated with knowledge and attitudes. The authors conclude that targeted health literacy interventions are needed to improve healthcare utilization among this population. 2. Comments linked to questions above- A. Clarity of presentation and use of literature - Partly The manuscript is generally well-structured (clear abstract, methods, results, discussion). Background section provides context on tribal health disparities. Relevant studies are cited to support findings and comparisons. Though, 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. Also, clearly articulate how this study adds new knowledge beyond existing evidence. B. Study design and technical soundness - Yes Appropriate cross-sectional design has been used for assessing knowledge and attitudes. Use of multistage cluster sampling with PPS is methodologically sound. Adequate sample size calculation and justification is provided. Ethical approval and informed consent procedures are well described. C. Methods and reproducibility - Partly Sampling method and study setting are described in detail. The questionnaire structure and scoring system are explained. Statistical methods are also outlined. However, 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’s alpha, validity metrics) and include bias mitigation strategies. D. Statistical analysis - Partly Use of logistic regression (univariate and multivariable) is appropriate. Reporting of AORs with 95% CIs is correct. However, 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–Lemeshow test) and confounding variables. E. Data availability and reproducibility - Yes Extended data is shared via Figshare. F. Conclusions supported by results - Yes Conclusions align with findings (poor knowledge and attitudes). Policy implications (health literacy interventions) are reasonable. 3. Essential Revisions (Must be addressed)- To ensure scientific soundness, the authors should: 3.1 Expand statistical reporting- Include model diagnostics and clarify confounding variables. 3.2 Improve methodological transparency- Provide validation details and bias control measures. 3.3 Strengthen literature review- Include recent studies and better synthesis. The study is important and methodologically sound, but requires minor revisions, particularly in statistical reporting and literature review, before it can be considered fully robust for indexing. Is the work clearly and accurately presented and does it cite the current literature? Partly Is the study design appropriate and is the work technically sound? Yes Are sufficient details of methods and analysis provided to allow replication by others? Partly If applicable, is the statistical analysis and its interpretation appropriate? Partly Are all the source data underlying the results available to ensure full reproducibility? Yes Are the conclusions drawn adequately supported by the results? Yes Competing Interests No competing interests were disclosed. Reviewer Expertise Public Health, Bio-social Anthropology, Demography, Population studies, Population Genetics, Reproductive health, Maternal and Child heath, studies on youth I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. reply Respond to this report Responses (0) Deb P()R. Peer Review Report For: 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 [version 1; peer review: 1 approved, 1 approved with reservations] . F1000Research 2026, 15 :542 ( https://doi.org/10.5256/f1000research.194947.r476269) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/15-542/v1#referee-response-476269 Alongside their report, reviewers assign a status to the article: Approved - the paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations - A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved - fundamental flaws in the paper seriously undermine the findings and conclusions Adjust parameters to alter display View on desktop for interactive features Includes Interactive Elements View on desktop for interactive features Competing Interests Policy Provide sufficient details of any financial or non-financial competing interests to enable users to assess whether your comments might lead a reasonable person to question your impartiality. Consider the following examples, but note that this is not an exhaustive list: Examples of 'Non-Financial Competing Interests' Within the past 4 years, you have held joint grants, published or collaborated with any of the authors of the selected paper. You have a close personal relationship (e.g. parent, spouse, sibling, or domestic partner) with any of the authors. You are a close professional associate of any of the authors (e.g. scientific mentor, recent student). You work at the same institute as any of the authors. You hope/expect to benefit (e.g. favour or employment) as a result of your submission. You are an Editor for the journal in which the article is published. Examples of 'Financial Competing Interests' You expect to receive, or in the past 4 years have received, any of the following from any commercial organisation that may gain financially from your submission: a salary, fees, funding, reimbursements. You expect to receive, or in the past 4 years have received, shared grant support or other funding with any of the authors. You hold, or are currently applying for, any patents or significant stocks/shares relating to the subject matter of the paper you are commenting on. Stay Updated Sign up for content alerts and receive a weekly or monthly email with all newly published articles Register with F1000Research Already registered? Sign in Not now, thanks close PLEASE NOTE If you are an AUTHOR of this article, please check that you signed in with the account associated with this article otherwise we cannot automatically identify your role as an author and your comment will be labelled as a “User Comment”. If you are a REVIEWER of this article, please check that you have signed in with the account associated with this article and then go to your account to submit your report, please do not post your review here. If you do not have access to your original account, please contact us . All commenters must hold a formal affiliation as per our Policies . The information that you give us will be displayed next to your comment. User comments must be in English, comprehensible and relevant to the article under discussion. We reserve the right to remove any comments that we consider to be inappropriate, offensive or otherwise in breach of the User Comment Terms and Conditions . Commenters must not use a comment for personal attacks. When criticisms of the article are based on unpublished data, the data should be made available. I accept the User Comment Terms and Conditions Please confirm that you accept the User Comment Terms and Conditions. Affiliation ✕ refresh Please enter your institution. Note: To add your institution or organisation, start typing the name and then select the correct name from the list. Where applicable, the name will appear in both the original language and in English. Do not paste in the name. If the name does not appear in the drop-down list, we will display the information you have entered. ✕ refresh Country/Region * USA UK Canada China France Germany Afghanistan Aland Islands Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory British Virgin Islands Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Cook Islands Costa Rica Cote d'Ivoire Croatia Cuba Cyprus Czech Republic Democratic Republic of the Congo Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands Faroe Islands Federated States of Micronesia Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard Island and Mcdonald Islands Holy See (Vatican City State) Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Kosovo (Serbia and Montenegro) Kuwait Kyrgyzstan Lao People's Democratic Republic Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macao Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Minor Outlying Islands of the United States Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island North Korea North Macedonia Northern Mariana Islands Norway Oman Pakistan Palau Palestinian Territory Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Reunion Romania Russian Federation Rwanda Saint Helena Saint Kitts and Nevis Saint Lucia Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Is South Korea South Sudan Spain Sri Lanka Sudan Suriname Svalbard and Jan Mayen Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand The Gambia The Netherlands Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu UK USA Uganda Ukraine United Arab Emirates United States Virgin Islands Uruguay Uzbekistan Vanuatu Venezuela Vietnam Wallis and Futuna West Bank and Gaza Strip Western Sahara Yemen Zambia Zimbabwe Please select your country/region. You must enter a comment. Competing Interests Please disclose any competing interests that might be construed to influence your judgment of the article's or peer review report's validity or importance. Competing Interests Policy Provide sufficient details of any financial or non-financial competing interests to enable users to assess whether your comments might lead a reasonable person to question your impartiality. Consider the following examples, but note that this is not an exhaustive list: Examples of 'Non-Financial Competing Interests' Within the past 4 years, you have held joint grants, published or collaborated with any of the authors of the selected paper. You have a close personal relationship (e.g. parent, spouse, sibling, or domestic partner) with any of the authors. You are a close professional associate of any of the authors (e.g. scientific mentor, recent student). You work at the same institute as any of the authors. You hope/expect to benefit (e.g. favour or employment) as a result of your submission. You are an Editor for the journal in which the article is published. Examples of 'Financial Competing Interests' You expect to receive, or in the past 4 years have received, any of the following from any commercial organisation that may gain financially from your submission: a salary, fees, funding, reimbursements. You expect to receive, or in the past 4 years have received, shared grant support or other funding with any of the authors. You hold, or are currently applying for, any patents or significant stocks/shares relating to the subject matter of the paper you are commenting on. Please state your competing interests The comment has been saved. An error has occurred. Please try again. Cancel Post var lTitle = "Knowledge and Attitudes Toward Healthcare...".replace("'", ''); var linkedInUrl = "http://www.linkedin.com/shareArticle?url=https://f1000research.com/articles/15-542/v1" + "&title=" + encodeURIComponent(lTitle) + "&summary=" + encodeURIComponent('Read the article by '); var deliciousUrl = "https://del.icio.us/post?url=https://f1000research.com/articles/15-542/v1&title=" + encodeURIComponent(lTitle); var redditUrl = "http://reddit.com/submit?url=https://f1000research.com/articles/15-542/v1" + "&title=" + encodeURIComponent(lTitle); linkedInUrl += encodeURIComponent('Soman B et al.'); var offsetTop = /chrome/i.test( navigator.userAgent ) ? 4 : -10; var addthis_config = { ui_offset_top: offsetTop, services_compact : "facebook,twitter,www.linkedin.com,www.mendeley.com,reddit.com", services_expanded : "facebook,twitter,www.linkedin.com,www.mendeley.com,reddit.com", services_custom : [ { name: "LinkedIn", url: linkedInUrl, icon:"/img/icon/at_linkedin.svg" }, { name: "Mendeley", url: "http://www.mendeley.com/import/?url=https://f1000research.com/articles/15-542/v1/mendeley", icon:"/img/icon/at_mendeley.svg" }, { name: "Reddit", url: redditUrl, icon:"/img/icon/at_reddit.svg" }, ] }; var addthis_share = { url: "https://f1000research.com/articles/15-542", templates : { twitter : "Knowledge and Attitudes Toward Healthcare Services Among a Particularly.... Soman B et al., published by " + "@F1000Research" + ", https://f1000research.com/articles/15-542/v1" } }; if (typeof(addthis) != "undefined"){ addthis.addEventListener('addthis.ready', checkCount); addthis.addEventListener('addthis.menu.share', checkCount); } $(".f1r-shares-twitter").attr("href", "https://twitter.com/intent/tweet?text=" + addthis_share.templates.twitter); $(".f1r-shares-facebook").attr("href", "https://www.facebook.com/sharer/sharer.php?u=" + addthis_share.url); $(".f1r-shares-linkedin").attr("href", addthis_config.services_custom[0].url); $(".f1r-shares-reddit").attr("href", addthis_config.services_custom[2].url); $(".f1r-shares-mendelay").attr("href", addthis_config.services_custom[1].url); function checkCount(){ setTimeout(function(){ $(".addthis_button_expanded").each(function(){ var count = $(this).text(); if (count !== "" && count != "0") $(this).removeClass("is-hidden"); else $(this).addClass("is-hidden"); }); }, 1000); } close How to cite this report {{reportCitation}} Cancel Copy Citation Details $(function(){R.ui.buttonDropdowns('.dropdown-for-downloads');}); $(function(){R.ui.toolbarDropdowns('.toolbar-dropdown-for-downloads');}); $.get("/articles/acj/176835/194947") new F1000.Clipboard(); new F1000.ThesaurusTermsDisplay("articles", "article", "194947"); $(document).ready(function() { $( "#frame1" ).on('load', function() { var mydiv = $(this).contents().find("div"); var h = mydiv.height(); console.log(h) }); var tooltipLivingFigure = jQuery(".interactive-living-figure-label .icon-more-info"), titleLivingFigure = tooltipLivingFigure.attr("title"); tooltipLivingFigure.simpletip({ fixed: true, position: ["-115", "30"], baseClass: 'small-tooltip', content:titleLivingFigure + " " }); tooltipLivingFigure.removeAttr("title"); $("body").on("click", ".cite-living-figure", function(e) { e.preventDefault(); var ref = $(this).attr("data-ref"); $(this).closest(".living-figure-list-container").find("#" + ref).fadeIn(200); }); $("body").on("click", ".close-cite-living-figure", function(e) { e.preventDefault(); $(this).closest(".popup-window-wrapper").fadeOut(200); }); $(document).on("mouseup", function(e) { var metricsContainer = $(".article-metrics-popover-wrapper"); if (!metricsContainer.is(e.target) && metricsContainer.has(e.target).length === 0) { $(".article-metrics-close-button").click(); } }); var articleId = $('#articleId').val(); if($("#main-article-count-box").attachArticleMetrics) { $("#main-article-count-box").attachArticleMetrics(articleId, { articleMetricsView: true }); } }); var figshareWidget = $(".new_figshare_widget"); if (figshareWidget.length > 0) { window.figshare.load("f1000", function(Widget) { // Select a tag/tags defined in your page. In this tag we will place the widget. _.map(figshareWidget, function(el){ var widget = new Widget({ articleId: $(el).attr("figshare_articleId") //height:300 // this is the height of the viewer part. [Default: 550] }); widget.initialize(); // initialize the widget widget.mount(el); // mount it in a tag that's on your page // this will save the widget on the global scope for later use from // your JS scripts. This line is optional. //window.widget = widget; }); }); } close Error Close Add Reset F1000.MICROSERVICES.AFFILIATION = ''; $(document).ready(function () { $('.js-affiliations-form').each((index, form) => { new AffiliationForm({ formId: form.id, institutionErrorSelector: '.comment-enter-institution', departmentErrorSelector: '.comment-enter-department', placeSelector: '.js-add-comment-place', stateSelector: '.js-add-comment-state', zipCodeSelector: '.js-add-comment-zipcode', countrySelector: '.js-add-comment-country', countryErrorSelector: '.comment-enter-country', }); }); }); $(document).ready(function () { var reportIds = { "479559": 0, "479558": 0, "479557": 0, "479556": 0, "479555": 0, "476271": 0, "476270": 0, "476269": 5, "479564": 0, "479563": 0, "479562": 0, "479561": 0, "479560": 0, "476278": 2, "476277": 0, "476276": 0, "476275": 0, "476274": 0, "476273": 0, "476272": 0, }; $(".referee-response-container,.js-referee-report").each(function(index, el) { var reportId = $(el).attr("data-reportid"), reportCount = reportIds[reportId] || 0; $(el).find(".comments-count-container,.js-referee-report-views").html(reportCount); }); var uuidInput = $("#article_uuid"), oldUUId = uuidInput.val(), newUUId = "ed4c9889-126c-4ad3-bf60-0bf8e4ac577c"; uuidInput.val(newUUId); $("a[href*='article_uuid=']").each(function(index, el) { var newHref = $(el).attr("href").replace(oldUUId, newUUId); $(el).attr("href", newHref); }); }); An innovative open access publishing platform offering rapid publication and open peer review, whilst supporting data deposition and sharing. Browse Gateways Collections How it Works Contact For Developers Cookie Notice Privacy Notice RSS Submit Your Research Follow us © 2012-2026 F1000 Research Ltd. ISSN 2046-1402 | Legal | Partner of Research4Life • CrossRef • ORCID • FAIRSharing R.templateTests.simpleTemplate = R.template(' $text $text $text $text $text '); R.templateTests.runTests(); var F1000platform = new F1000.Platform({ name: "f1000research", displayName: "F1000Research", hostName: "f1000research.com", id: "1", editorialEmail: "[email protected]", infoEmail: "[email protected]", usePmcStats: true }); $(function(){R.ui.dropdowns('.dropdown-for-authors, .dropdown-for-about, .dropdown-for-myresearch');}); // $(function(){R.ui.dropdowns('.dropdown-for-referees');}); $(document).ready(function () { if ($(".cookie-warning").is(":visible")) { $(".sticky").css("margin-bottom", "35px"); $(".devices").addClass("devices-and-cookie-warning"); } $(".cookie-warning .close-button").click(function (e) { $(".devices").removeClass("devices-and-cookie-warning"); $(".sticky").css("margin-bottom", "0"); }); $("#tweeter-feed .tweet-message").each(function (i, message) { var self = $(message); self.html(linkify(self.html())); }); $(".partner").on("mouseenter mouseleave", function() { $(this).find(".gray-scale, .colour").toggleClass("is-hidden"); }); }); Sign In Remember me Forgotten your password? Sign In Cancel Email or password not correct. Please try again Please wait... $(function(){ // Note: All the setup needs to run against a name attribute and *not* the id due the clonish // nature of facebox... $("a[id=googleSignInButton]").click(function(event){ event.preventDefault(); $("input[id=oAuthSystem]").val("GOOGLE"); $("form[id=oAuthForm]").submit(); }); $("a[id=facebookSignInButton]").click(function(event){ event.preventDefault(); $("input[id=oAuthSystem]").val("FACEBOOK"); $("form[id=oAuthForm]").submit(); }); $("a[id=orcidSignInButton]").click(function(event){ event.preventDefault(); $("input[id=oAuthSystem]").val("ORCID"); $("form[id=oAuthForm]").submit(); }); }); If you've forgotten your password, please enter your email address below and we'll send you instructions on how to reset your password. The email address should be the one you originally registered with F1000. Email address not valid, please try again You registered with F1000 via Google, so we cannot reset your password. To sign in, please click here . If you still need help with your Google account password, please click here . You registered with F1000 via Facebook, so we cannot reset your password. To sign in, please click here . If you still need help with your Facebook account password, please click here . Code not correct, please try again Reset password Cancel Email us for further assistance. Server error, please try again. If your email address is registered with us, we will email you instructions to reset your password. If you think you should have received this email but it has not arrived, please check your spam filters and/or contact for further assistance. Please wait... Register $(document).ready(function () { signIn.createSignInAsRow($("#sign-in-form-gfb-popup")); $(".target-field").each(function () { var uris = $(this).val().split("/"); if (uris.pop() === "login") { $(this).val(uris.toString().replace(",","/")); } }); });