NCD-SCAN: A Digital Health Tool for Community-Based Non-Communicable Disease Risk Screening by Lady Health Workers in Pakistan.

Background: Non-communicable diseases (NCDs) account for the majority of premature mortality in low- and middle-income countries, yet early detection remains limited within Pakistan's primary healthcare system. Lady Health Workers (LHWs) represent a large, trusted, community-based workforce with potential to support digital NCD screening. This study assessed the feasibility, acceptability, and early implementation of NCD-SCAN, a mobile application integrating validated tools for cardiovascular, metabolic, cerebrovascular, lifestyle, and mental health risk assessment. Methods: We conducted a prospective mixed-methods implementation study in Karachi and Hyderabad, Pakistan, between June and August 2024. NCD-SCAN integrates validated instruments including RAPID, QVSFS, the Rose Angina Questionnaire, Global Adult Tobacco Survey items, the International Physical Activity Questionnaire, Refined Food Frequency Questionnaire, and the WHO-5 Well-Being Index. Formative qualitative data from 13 focus group discussions involving 128 LHWs informed application development. A separate cohort of 22 LHWs received standardized training and conducted household-based screenings. Quantitative data were analysed descriptively, while qualitative data from the formative phase and post-pilot feedback were analyzed thematically. Implementation determinants were examined using the Consolidated Framework for Implementation Research (CFIR). Results: LHWs screened 1,087 community members, with no reported data loss or technical failures. 77% of individuals were classified as medium or high risk for at least one NCD domain. High proportions of screen-positive results were observed for stroke symptoms (83.7%), poor mental well-being (64.4%), hypertension (46.3%), angina (32.8%), and diabetes risk (30.1%). LHWs reported strong community trust and perceived that the application enhanced their counselling capacity and professional credibility. Training and repeated use improved usability and confidence. Key facilitators included the application's multilingual design, integration into existing LHW workflows, and strong community engagement, while barriers included indirect costs, limited digital access, and weak referral linkages. Suggested improvements included physician-supported referral pathways and culturally adapted multimedia content. Conclusion: Community-based digital NCD screening through Pakistan's LHW programme is feasible and acceptable. The NCD-SCAN application supported structured risk assessment and frontline counselling; however, downstream impact will depend on strengthened referral pathways, service readiness, and financial protection mechanisms. These findings support further hybrid implementation-effectiveness evaluations to inform national digital NCD prevention strategies in low-resource settings.