Cocreating Change: Stakeholder Engagement in Advancing Equitable Cancer Screening in India

Cancer screening programs are complex interventions involving multiple target groups, health professionals, civil society, and policymakers. Such complexity requires careful analysis of how stakeholders at micro, meso, and macro levels can both influence and be influenced by interventions. The Access Cancer Care India (ACCI) implementation research project aims to identify and codesign context-specific, integrated strategies for early detection of common cancers in India. This paper outlines stakeholder engagement strategies within ACCI, hypothesizing that engaging diverse actors through structured workshops will generate feasible and acceptable interventions to reduce diagnostic delays and strengthen early detection of cancer.

Stakeholder mapping and influence assessment were conducted across macro (policymakers, program coordinators, Superintendents of district hospitals and oncology centers), meso (service providers, civil society, special interest groups, community health workers), and micro (community, patients) levels in Tamil Nadu, Kerala, and Rajasthan. Formative findings and potential interventions were shared in collaborative workshops where solutions were codesigned.

Diverse stakeholders actively participated across all sites. Key individual-level barriers included fear, stigma, and in Rajasthan, patriarchal norms limiting women's care-seeking. System-level barriers spanned limited diagnostic capacity, weak health care coordination, and financial constraints. Facilitators included community campaigns using lived experiences, empowerment through self-help groups, and capacity building of providers (Auxiliary Nurse Midwives and Mid-Level Service Providers, especially in Kerala). Tamil Nadu highlighted the potential of cervical cancer self-sampling. A recurring theme across states was the urgent need for clear referral and patient navigation systems.

Early, multilevel stakeholder engagement can surface critical barriers and codesign feasible, context-specific strategies to improve cancer detection. The ACCI model offers a replicable approach to reducing diagnostic delays and advancing equitable cancer care in low-resource settings.