Awareness Gaps and Structural Barriers to NCD Prevention and Care-seeking: A Life- Course Qualitative Study in Eastern India

Background: The burden of non-communicable diseases (NCDs) has been steadily rising across all groups in India, posing a significant public health challenge. However, evidence on the knowledge, lifestyle and factors influencing care from marginalized populations in Eastern India remains limited. This study explored the knowledge, attitudes, lifestyle practices, and enablers and barriers to health-seeking behaviour among adults and adolescents in rural, tribal, deltaic, and hilly regions of West Bengal, Jharkhand, and Odisha. Methods: We conducted a cross-sectional, exploratory qualitative study across eight districts between October 27, 2025-November 25, 2025. Twenty-four focus group discussions (FGDs) were conducted with 160 adults (aged ≥ 30) and 101 adolescents (aged 11–19 years) in Bengali, Hindi, Nepali and Odiya languages. Data was analyzed using ATLAS.ti following an inductive thematic approach, framed within a Social-Ecological Model. Results: Across all regions, NCD awareness among adults was symptom-driven, with limited understanding of causes and risk factors. Adolescents developed an 'observational' awareness by witnessing parental illness. Routine preventive screenings were not considered important and health-seeking behaviour symptom-driven. Diets were carbohydrate-heavy shaped by food insecurity, with unhealthy foods consumed as survival strategies. Tobacco and alcohol use were widespread; with substance use culturally embedded in Jharkhand. Adolescents acknowledged their own unhealthy eating, inactivity, and peer substance use. Primary barriers to care included fear of medication dependency, reliance on informal providers, counselling gaps, financial constraints, geographic inaccessibility and service gaps. Facilitators included increasing awareness through individual counselling, social and behaviour change communication (SBCC) programs, outreach services and strengthening the volume and capacity of frontline workers. Conclusions: Addressing India’s NCD epidemic requires a life-course, community-centred, preventive approach that addresses the risk factors from adolescence to adults. Policy must strengthen primary healthcare, frontline health systems, social protection, and SBCC to overcome barriers, improve early detection and long-term NCD outcomes.