Determinants of Antenatal care utilization among Particularly Vulnerable Tribal Groups in Eastern India: a mixed method study using the Andersen’s Behavioral model

Determinants of Antenatal care utilization among Particularly Vulnerable Tribal Groups in Eastern India: a mixed method study using the Andersen’s Behavioral model | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (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;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Determinants of Antenatal care utilization among Particularly Vulnerable Tribal Groups in Eastern India: a mixed method study using the Andersen’s Behavioral model Soumya Gouda, Elizabeth Abba, Arup Roy This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9117477/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 13 You are reading this latest preprint version Abstract Background Indigenous population or the Particularly Vulnerable Tribal Groups (PVTG) have rich socio-cultural traditions, subsistence-based livelihoods, yet they are marginalized and experience disparities in healthcare. Wellbeing of indigenous population has been a concern, but specific goal for such population has not been framed in the Sustainable Development Goals (SDG) whereas three goals namely SDG 2 (Zero Hunger), SDG 4(Quality education) and SDG 10 (Reduced Inequalities) have targets applied directly to the indigenous population. This empirical study aims to find the influence of livelihood and its determinants on antenatal care (ANC) among PVTG communities in Gajapati district of Odisha. It is emphasizing on SDG 3 which is Good Health and wellbeing. Methods The study used mixed methodology, quantitative was done through the survey questionnaire and qualitative was through the semi-structured interview. There is use of Binomial Regression and thematic analysis. Results The study has a total women respondent of 733 and the findings indicate that the majority of the respondents were below 30 years of age (79.7%). Government scheme awareness emerges as the strongest predictor and it is positive with significance p < 0.001. VHSND visit frequency is positively correlated with significance, p = 0.020. Income shows a negative correlation with significance, p = 0.054. Higher expenditure is associated with the Govt ANC as the p value is 0.042. Conclusion Across all models, Government scheme awareness remains consistently influential determinant of the Government ANC utilization with education and parity showing positive and strong result. The VHSND platforms are validated as the better methods of utilizing ANC. Such outreach platforms are required for reaching the hinterland and if the barriers mentioned such as loss of wage, travel issue if reduced would help in improving the ANC. PVTG tribal health antenatal care SDG livelihood determinants VHSND Full Text Additional Declarations No competing interests reported. Supplementary Files MainquestionnairerevisedEnglish.pdf Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 04 May, 2026 Reviews received at journal 03 May, 2026 Reviewers agreed at journal 01 May, 2026 Reviewers agreed at journal 30 Apr, 2026 Reviewers agreed at journal 28 Apr, 2026 Reviewers agreed at journal 23 Apr, 2026 Reviews received at journal 22 Apr, 2026 Reviewers agreed at journal 21 Apr, 2026 Reviewers invited by journal 21 Apr, 2026 Editor assigned by journal 20 Apr, 2026 Editor invited by journal 30 Mar, 2026 Submission checks completed at journal 30 Mar, 2026 First submitted to journal 30 Mar, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9117477","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":631127399,"identity":"1ef1bfbc-7523-4b7b-a7fa-70d2374b1883","order_by":0,"name":"Soumya Gouda","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA3klEQVRIiWNgGAWjYBAC+QYwZQPhMYJ4B8AINzCAyKYx8BCvBUIdRtWCFxiw95hu5qk5b28vkcAmzbuDQY7vRgLj4QI8WuR7zpjd5jl2O7FHIoHZmPcMg7HkjQSGwzPwWXMjB6iF7XYCj0QC42PeNobEDSAtPAS1/DtnD9TCcBiopZ44LbxtBxh7oLYkGBDSYnDmWNnNuX3JiT1nHjYbzj0jYTjzzMMGvFrk25u33Xjzzc6evT35mMTbHTbyfMeTD3/G6zAgYIIoAEeKBIyBHzD+IKhkFIyCUTAKRjQAAD3lT54S9rOmAAAAAElFTkSuQmCC","orcid":"","institution":"XIM University","correspondingAuthor":true,"prefix":"","firstName":"Soumya","middleName":"","lastName":"Gouda","suffix":""},{"id":631127400,"identity":"d395d889-896c-4a57-9bc7-ef7de44d74d2","order_by":1,"name":"Elizabeth Abba","email":"","orcid":"","institution":"XIM University","correspondingAuthor":false,"prefix":"","firstName":"Elizabeth","middleName":"","lastName":"Abba","suffix":""},{"id":631127401,"identity":"57eb00a1-658e-4dd5-b05e-01142ace9051","order_by":2,"name":"Arup Roy","email":"","orcid":"","institution":"XIM University","correspondingAuthor":false,"prefix":"","firstName":"Arup","middleName":"","lastName":"Roy","suffix":""}],"badges":[],"createdAt":"2026-03-13 18:38:54","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9117477/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9117477/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":108491906,"identity":"207c8dd3-f53c-403e-812c-a6a8ad03b038","added_by":"auto","created_at":"2026-05-05 09:56:08","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":758359,"visible":true,"origin":"","legend":"","description":"","filename":"DeterminantsofANCSoumyaGoudarevised29Mar.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9117477/v1_covered_fc3ffea4-9db1-40bd-88ba-8dab7f430f98.pdf"},{"id":108244464,"identity":"2946e5c4-46fd-4882-a145-9197c8ac9c11","added_by":"auto","created_at":"2026-04-30 22:40:45","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":94760,"visible":true,"origin":"","legend":"","description":"","filename":"MainquestionnairerevisedEnglish.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9117477/v1/c1979197c329f589a946f616.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Determinants of Antenatal care utilization among Particularly Vulnerable Tribal Groups in Eastern India: a mixed method study using the Andersen’s Behavioral model","fulltext":[],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":true,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":true,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-health-services-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bhsr","sideBox":"Learn more about [BMC Health Services Research](http://bmchealthservres.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/BHSR/default.aspx","title":"BMC Health Services Research","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"PVTG, tribal health, antenatal care, SDG, livelihood determinants, VHSND","lastPublishedDoi":"10.21203/rs.3.rs-9117477/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9117477/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eIndigenous population or the Particularly Vulnerable Tribal Groups (PVTG) have rich socio-cultural traditions, subsistence-based livelihoods, yet they are marginalized and experience disparities in healthcare. Wellbeing of indigenous population has been a concern, but specific goal for such population has not been framed in the Sustainable Development Goals (SDG) whereas three goals namely SDG 2 (Zero Hunger), SDG 4(Quality education) and SDG 10 (Reduced Inequalities) have targets applied directly to the indigenous population. This empirical study aims to find the influence of livelihood and its determinants on antenatal care (ANC) among PVTG communities in Gajapati district of Odisha. It is emphasizing on SDG 3 which is Good Health and wellbeing.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThe study used mixed methodology, quantitative was done through the survey questionnaire and qualitative was through the semi-structured interview. There is use of Binomial Regression and thematic analysis.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe study has a total women respondent of 733 and the findings indicate that the majority of the respondents were below 30 years of age (79.7%). Government scheme awareness emerges as the strongest predictor and it is positive with significance p\u0026thinsp;\u0026lt;\u0026thinsp;0.001. VHSND visit frequency is positively correlated with significance, p\u0026thinsp;=\u0026thinsp;0.020. Income shows a negative correlation with significance, p\u0026thinsp;=\u0026thinsp;0.054. Higher expenditure is associated with the Govt ANC as the p value is 0.042.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eAcross all models, Government scheme awareness remains consistently influential determinant of the Government ANC utilization with education and parity showing positive and strong result. The VHSND platforms are validated as the better methods of utilizing ANC. Such outreach platforms are required for reaching the hinterland and if the barriers mentioned such as loss of wage, travel issue if reduced would help in improving the ANC.\u003c/p\u003e","manuscriptTitle":"Determinants of Antenatal care utilization among Particularly Vulnerable Tribal Groups in Eastern India: a mixed method study using the Andersen’s Behavioral model","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-04-30 22:40:41","doi":"10.21203/rs.3.rs-9117477/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-05-04T09:16:52+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-03T17:34:21+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"40182472190570326062635496177177699266","date":"2026-05-01T04:53:44+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"166131511624601072710688064466109919759","date":"2026-04-30T11:23:23+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"47540045951911942849669935075632414633","date":"2026-04-28T04:24:42+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"208082742106693765317181337728225753125","date":"2026-04-24T01:40:56+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-23T01:55:14+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"155672070625963357860101111278101885790","date":"2026-04-21T17:07:55+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-04-21T16:47:28+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-04-20T09:20:07+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-03-30T14:05:50+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-03-30T09:16:50+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Health Services Research","date":"2026-03-30T09:05:23+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-health-services-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bhsr","sideBox":"Learn more about [BMC Health Services Research](http://bmchealthservres.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/BHSR/default.aspx","title":"BMC Health Services Research","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"378674aa-bfcf-413b-95e1-2b1cd933bf97","owner":[],"postedDate":"April 30th, 2026","published":true,"recentEditorialEvents":[{"type":"editorInvitedReview","content":"","date":"2026-05-04T09:16:52+00:00","index":77,"fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-03T17:34:21+00:00","index":76,"fulltext":""},{"type":"reviewerAgreed","content":"40182472190570326062635496177177699266","date":"2026-05-01T04:53:44+00:00","index":75,"fulltext":""},{"type":"reviewerAgreed","content":"166131511624601072710688064466109919759","date":"2026-04-30T11:23:23+00:00","index":73,"fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-04-30T22:40:41+00:00","versionOfRecord":[],"versionCreatedAt":"2026-04-30 22:40:41","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9117477","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9117477","identity":"rs-9117477","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}