Exploring Social Dynamics of Infectious Diseases of Poverty in Urban India: A Qualitative Grounded Theory Study

Poverty-related infectious diseases, such as tuberculosis, malaria, and neglected tropical diseases, disproportionately affect vulnerable populations in urban areas worldwide. Understanding the complex interactions between socioeconomic factors and health-seeking behaviours is crucial for addressing these public health concerns. Unplanned urbanization, poor built-environment characteristics, and social determinants increase susceptibility to health risks, including infectious diseases. However, there is comparatively limited understanding of how affected communities perceive and navigate these determinants in everyday life. This qualitative grounded theory study explored the social dynamics shaping perceptions of infectious diseases and health-seeking behaviours among urban slum dwellers across seven Indian states. Data was collected through seven focused group discussions and four in-depth interviews. Using grounded theory analysis, the study developed a conceptual system map of infectious disease-related health-seeking pathways and identified three interrelated domains shaping health behaviour: perceptions of the built environment, community understandings of infectious disease, and healthcare decision-making processes. Participants demonstrated awareness of environmental and sanitation-related disease risks but described persistent structural barriers, including inadequate infrastructure, financial constraints, mistrust in healthcare systems, and reliance on self-medication and informal care pathways. Comprehensive, community-centred strategies that involve residents in planning and implementation processes are critical for reducing the impact of poverty-related infectious diseases in urban India, alongside interventions addressing infrastructural deficiencies, healthcare affordability, and trust in public health services.