ABSTRACT Cultural competence is essential for ensuring equitable and effective health care systems for culturally diverse populations. In this commentary, we examine how cultural competence has been applied in public health interventions through evidence implementation projects conducted in West Bengal, India. The projects focus on childhood diarrheal disease management, type 2 diabetes screening, and antenatal nutrition care among Indigenous communities. Utilizing contextual inquiry and participatory observation, we highlight that aligning health services with local sociocultural norms, linguistic preferences, family decision-making structures, traditional health beliefs, and Indigenous knowledge systems enhances community engagement and service uptake. Training health workers in local dialects, aligning services with work schedules, and engaging informal care providers improved participation and adherence to care. This highlights a gap between global best practice guidelines and actual service delivery. Culturally competent approaches enhance trust and acceptability, and address systemic barriers among Indigenous communities. Spanish abstract: https://links.lww.com/IJEBH/A735
ABSTRACT Marginalized populations in West Bengal, India, including tribal communities, tea estate workers, and migrant laborers living in temporary settlements or urban slums, experience a disproportionate burden of disease and face persistent barriers to accessing quality health care. These challenges are shaped by structural inequities, geographic isolation, cultural differences, and reliance on informal health care providers. This commentary reflects on evaluation challenges encountered while implementing and assessing three health service initiatives—antenatal nutritional counseling, diabetes screening and management, and diarrhea treatment for children under 5 years—using the JBI seven-phase model for evidence implementation. The experiences highlight how contextual factors such as dispersed settlements, language diversity, cultural practices, seasonal disease patterns, and limited trust in formal health services complicate data collection and outcome assessment. Efforts to adapt implementation strategies, including culturally tailored communication tools, flexible outreach approaches, and engaging community health workers and informal providers, improved community participation and service acceptability but also introduced evaluation trade-offs. While observable improvements in provider adherence to protocols and community engagement were noted, short implementation timeframes and limited data systems constrained the ability to assess sustainability, equity impacts, and long-term outcomes. These experiences underscore the need for context-sensitive, participatory, and equity-focused evaluation approaches in low- and middle-income settings to ensure that evidence implementation efforts contribute meaningfully to reducing health disparities. Spanish abstract: https://links.lww.com/IJEBH/A700
ABSTRACT Background: Diarrheal disease remains the third leading cause of death among children under 5 globally, with 90% of deaths occurring in low- and middle-income countries. In India's tribal communities, this burden is compounded by poor sanitation, unsafe water, and limited access to health care. Mobile medical clinics (MMCs) are the primary health care contact for many indigenous populations, yet evidence-based diarrhea management is not consistently implemented in those clinics. Aim: This project aimed to improve the management of childhood diarrheal disease in MMCs serving tribal populations of North Bengal, India through the implementation of evidence-based practices. Methods: The project followed the JBI Evidence Implementation Framework, which is grounded in an audit and feedback process. A baseline audit was conducted of 60 treatment encounters using seven evidence-based audit criteria. This was followed by the identification of barriers to non-compliance, the implementation of targeted strategies, and a post-implementation audit to measure improvements. Health worker knowledge, attitudes, and behaviors were assessed via surveys. Results: Baseline compliance ranged from 0% to 59.71%; however, this improved across all domains after the implementation of strategies, including structured training, multilingual visual aids, emphasis on record-keeping, and demonstrations of best practice. Thus, promotion of rotavirus vaccination increased from 0% to 50.62%, advice on administering oral rehydration solution increased from 0% to 60.26%, maintaining distribution records and clinical data increased from 50% to 78.28%, and water, sanitation, hygiene (WASH) counseling in multiple local languages increased from 59.71% to 67.29%. Conclusions: Evidence-based diarrhea management can be meaningfully improved in resource-limited MMCs through multi-modal strategies incorporating education, locally relevant materials, and supported practice change. Sustaining improvements will require embedded supervision and supply chain support. Spanish abstract: https://links.lww.com/IJEBH/A699
ABSTRACT Introduction: Non-communicable diseases have become a major public health concern, with shifting trends in epidemiology among the tribal populations of India. Among them, type 2 diabetes is emerging as an epidemic, with an estimated prevalence of 19% in West Bengal. Due to inequities in health care access and utilization among tribal communities, seeking treatment for type 2 diabetes differs significantly from the general population. Objectives: This project aimed to improve the quality of diabetes screening and management services in mobile medical clinics in Nagrakata, Jalpaiguri Sadar, and Dhupguri, Jalpaiguri district, West Bengal, India, through the implementation of evidence-based recommendations. Methods: The project used a mixed methods approach, incorporating both quantitative and qualitative data collection and analysis, to evaluate the implementation of type 2 diabetes services in mobile medical clinics. It was guided by JBI's seven-phase approach to evidence implementation, incorporating audit and feedback, and a structured framework to identify barriers, enablers, and implementation strategies. Results: The project recorded increased compliance with the best practice recommendations across all the settings. The quality of screening practices was improved through strategies such as the dissemination of information, education, and communication materials; strengthening risk communication between health care professionals and community members; and the inclusion of risk assessment tools. Conclusions: This JBI evidence implementation project demonstrated that structured and context-specific strategies can meaningfully improve adherence to evidence-based diabetes screening practices in mobile medical clinics in underserved tribal populations. Significant improvements were observed in risk-based screening, patient education, communication of results, and use of standardized assessment tools. Spanish abstract: https://links.lww.com/IJEBH/A706
