The participants in this study represented a diverse range of stakeholders involved in the programmatic implementation and execution of medical deliveries in the states (Fig. 1). The study comprised 27 participants, including 17 males and 10 females, aged 24 to 58 years, with a mean age of 41 years (SD: ± 9.4). In Manipur, mainly Meitei language is used by the local population, whereas there were language barriers in Nagaland due to diverse linguistic landscape, leading to isolation and restricted social cohesion. However, in Manipur in Karang island, a village amidst security concerns, residents view new developments with skepticism, fearing connections to military operations or government interventions. This heightened sense of suspicion and caution exacerbates existing unease and uncertainty. A history of conflict and instability in the area, along with a deeply entrenched feeling of self-preservation, contributed to the predominant sense of dread about strangers, which complicated the research team’s interactions with the locals at first.

Through qualitative analysis, significant themes emerged, capturing diverse perspectives and lived experiences that offer insights into participants’ attitudes and beliefs towards drones, enhancing our understanding of this cutting-edge approach (themes are summarized in Table 2, Figure S3, and S4). Collected data show limited awareness regarding drones, regulations, and exposure: 57% of respondents are unaware of use of drones. Many respondents expressed that they have a limited or no previous experience with this technology (#1). Some respondents associate drones primarily with photography, events, weddings, and use in security and military contexts. They recognize drone usage in capturing visuals and being utilized for surveillance and related purposes (#2). Participants from both Manipur and Nagaland expressed concerns about the drone regulations in their respective states (#3).

Despite limited exposure, there is generally a positive curiosity expressed by respondents.

We observed positive reception and excitement surrounding the use of drone technology in healthcare, particularly for the delivery of medicines and vaccines to remote or inaccessible areas. Participants expressed openness to understanding and adapting to the use of drones in healthcare (#4) and enthusiasm about the innovative initiative and highlighted its potential benefits in improving medical infrastructure, providing timely and efficient healthcare services, and overcoming geographical challenges in regions like Northeast India (#5). The positive community response and the recognition of the potential impact of drone technology contributed to this overarching theme.

We asked participants about their perceptions regarding drone-based deliveries and grouped their responses into identified themes based on their views on this technology and the community’s reaction towards drone-based deliveries. Participants perceived the use of drones as they can improve healthcare accessibility to remote areas, overcome geographical challenges, and offer time efficiency and quick delivery. Healthcare workers highlighted it as a solution for delivering medical goods to remote and hard-to-reach areas (#6). They viewed drone technology as a solution for remote island villages and remote areas struggling to access medical facilities, thereby bridging the gap and providing essential healthcare services. The geographical challenges in hilly and remote regions, where traditional transportation methods are often impractical or time-consuming, drones were considered a solution to overcome the challenges such as bad roads, traffic jams, and inaccessible areas and ensure efficient delivery of vaccines and medical supplies as per the healthcare staff (#7). Many respondents highlighted the time-saving aspect of using drones. They emphasize that drones can transport vaccines on the same day, reducing the need to transport them one day prior (#8). Therefore, they expect drone-based delivery to enhance vaccination programs on designated days and handle leftover vaccines efficiently, especially in emergency situations and challenging weather conditions. Drones were praised for their reliability in delivering medical supplies and temperature loggers, ensuring timely and safe delivery, and for monitoring vaccine efficacy during transportation (#9). Respondents noted that drone deliveries are safe, quick, and do not cause damage to the vials (#10). Healthcare staff emphasized the idea of integrating drone technology with the ongoing conventional methods of Universal Immunization Programme (UIP) delivery (#11). This is particularly seen as beneficial for inaccessible areas like Karang Island in Manipur district. The suggestion was to gradually introduce drone technology alongside providing training to staff, creating a hybrid approach.

To assess the adaptability of healthcare workers using the probes, we identified the several themes regarding technical challenges, weather considerations, and landing locations. Several participants expressed concerns about understanding the technical aspects of drones. The primary hurdle lies in comprehending the intricacies of drone technology (#12). They perceived the technology as a potential challenge due to limited technical knowledge or language barriers. Without proficiency in English or Hindi, they were concerned about their limited contribution (#13). Many participants highlighted the need for awareness and support in comprehending the technicalities of drone operations (#14). Healthcare workers, including youth representatives, expressed valid concerns regarding potential safety issues associated with drone-based delivery, such as the risk of drones being attacked during deliveries and potential privacy issues. Healthcare staff emphasized that weather conditions, particularly heavy rain and high winds, pose potential obstacles to drone operations, including crashes, displacement, and faulty navigation, necessitating contingency plans for potential risks. Concerns were raised by healthcare staff about the distant location of drone take-off and landing sites, with suggestions to make them closer to health facilities. Logistics management, including time management and the coordination of supplies, is identified as a challenge.

Participants emphasized the importance of effective communication between healthcare personnel and drone operators for smooth operations, despite concerns about specialized manpower and experienced staff to handle technical challenges (#15). Participants expressed concerns about the additional workload associated with the drone-based delivery program (#16) and security concerns about drone use in remote areas, emphasizing the need to raise awareness and improve understanding of drone-based delivery systems (#17). Stakeholders identified confusion about COVID-19 infection, vaccination, and drone technology due to lack of awareness, rumors, and misinformation. However, community acceptance and understanding increased after investigators worked with them (#18).

The study revealed that healthcare workers perceive participation in a drone-based healthcare program as an opportunity to improve accessibility, especially in remote areas. To address hesitancy due to lack of technical understanding, we developed a comprehensive training module. The training was conducted in English and Hindi, with local language explanations provided when needed. This initiative empowered healthcare workers with the necessary knowledge and skills to contribute effectively to the program, bridging the technical understanding gap and enhancing its successful implementation and execution. We identified several themes regarding the training aspects.

Healthcare workers express their commitment to undergo training sessions to familiarize themselves with drone technology. This includes understanding the concept, practicing, and gaining the necessary skills for smooth operations (#19). Some healthcare workers initially expressed apprehensions or fears but express confidence that these concerns can be alleviated through proper training, demonstration, and practice (#20); and some expressed the technological savviness and ability to learn and adapt to new technologies (#21). There was a willingness to learn and overcome challenges, suggesting a positive attitude towards incorporating drone technology. Participants emphasized the need for coordination between healthcare workers, stakeholders, local administrators, community, and drone operators, including being available during operations and maintaining constant contact. Collaboration was seen as crucial for the successful integration of drone technology into healthcare practices (#22).