From awareness to public health policy action: operational gaps in One Health implementation among frontline workers in Western India—A mixed method study

Background India has increasingly endorsed One Health at the policy level. However, evidence on its operationalization at the district level, particularly among frontline public-sector workers, remains limited. This study assessed the awareness, knowledge, attitudes, and practices (AKAP) related to One Health among frontline personnel in Gujarat, India. Methods A convergent mixed-methods study was conducted from January to June 2025 in Rajkot District, Gujarat. Quantitatively, 400 frontline workers from five departments (Health, AYUSH, Animal Husbandry, Food Safety, and Environment) were selected using proportionate stratified random sampling and interviewed using a validated AKAP questionnaire. Qualitatively, in-depth interviews were conducted with 25 purposively selected participants. Descriptive statistics, multivariable logistic regression, and exploratory factor analysis were performed for quantitative data, while thematic analysis was used for qualitative findings. Results Overall, 72% of participants were aware of the One Health concept, and 71% demonstrated positive attitudes toward its implementation. However, only 45% reported good One Health practices. Knowledge and attitude scores were significantly higher among Health and Animal Husbandry personnel compared with Food Safety and Environment sectors ( p < 0.001). Multivariable analysis identified high knowledge (aOR 2.8; 95% CI 1.9–4.2), positive attitude (aOR 2.3; 95% CI 1.6–3.4), prior One Health-specific training (aOR 3.1; 95% CI 2.0–4.9), and work experience >5 years (aOR 1.4; 95% CI 1.0–2.0) as independent predictors of good practice. Qualitative findings highlighted fragmented governance, limited interdepartmental coordination, lack of formal mandates, and absence of dedicated resources as major barriers to effective One Health implementation. Conclusions Despite high awareness and favorable attitudes, the translation of One Health principles into routine practice remains limited at the district level. Institutionalizing structured training, strengthening intersectoral governance, and prioritizing inclusion of environmental and food safety sectors are essential to operationalize One Health effectively in India and similar low- and middle-income settings.