"Barriers to Accessing Targeted Interventions among Key Populations in Jharkhand, India: A Mixed-Methods Study in Two
Ravi Ranjan Jha1, Ratnesh Sinha2, Jai Ranjan3
1Department of PSM, Shaheed Nirmal Mahto Medical College and Hospital Dhanbad, Dhanbad, Jharkhand, India.
Introduction:
This study investigates the barriers faced by key populations, men who have sex with men (MSM), transgender individuals (TGs), and female sex workers (FSWs), in two districts of Jharkhand in accessing healthcare services through targeted interventions (TIs). The objectives were to identify service delivery gaps, gain insights into participant experiences, and inform recommendations for improving healthcare access.
Methods:
A mixed-methods approach combining quantitative data collection was used. A total of 104 participants were surveyed by phone or in person, 30 of whom participated in FGDs. For qualitative data. The quantitative responses were scored on a five-point Likert scale for acceptability across the intervention's four dimensions: accessibility, approachability, availability, and appropriateness. SPSS was used for quantitative data analysis, whereas ATLAS.ti was used for qualitative data analysis. Statistical significance was set at P < 0.05.
Results:
Stigma, discrimination, lack of awareness and infrastructural challenges were the key thematic areas revealed. Discrimination, particularly for TGs, was greater. Scoring on a Likert scale revealed a high level of acceptability; however, only gender was found to be statistically significant (P < 0.05). MSMs reported fear of disclosure, whereas partner testing reluctance was commonly noted. Alcohol and drug abuse was noted to be significantly high.
Conclusion:
This study highlighted the need for culturally sensitive outreach, peer-based inclusion, and structural changes in health care settings. The findings provide actionable insights for policy makers to enhance inclusivity within national healthcare programs and address the unique challenges faced by key populations.
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