Perceptions of Asha Workers in the Hope Collaborative Care Mental Health Intervention in Rural South India: A Qualitative Analysis

Abstract

Background:Common mental disorders are responsible for a heavy disease burden in India and are often highly co-morbid with non-communicable diseases like diabetes and cardiovascular disease, which are increasing in prevalence across India as well. There is a severe lack of mental health resources in India, particularly in rural areas. Rural health care is often dependent on ASHA workers (Accredited Social Health Activists), high school-educated village women trained as community health workers. ASHA workers have been effectively involved in a variety of interventions, including a handful targeting mental illness, but perspectives of ASHA workers have been greatly overlooked.Methods:One-on-one qualitative interviews were conducted with 15 ASHA workers, all of whom completed the parent HOPE study, a collaborative-care randomized controlled trial that aims to integrate mental health care into existing primary care systems in rural Karnataka. The 15 ASHA workers in this substudy were asked questions about their role in HOPE, as well as their perspectives on patient health, mental illness, and the HOPE study.Results:ASHA workers mostly had positive interactions with patients, including encouraging them to attend sessions, helping to explain the topics and techniques, and checking in on the patients frequently. Occasionally ASHAs had negative relationships with patients. ASHA workers were able to identify key barriers to treatment and facilitators to treatment. ASHAs claimed that their knowledge about mental illness improved because of the HOPE study, though some gaps remained in their understanding of mental illness etiology and treatment. Overall, ASHA workers viewed the HOPE study as a necessary and effective intervention, and requested that it continue and expand.Conclusions: ASHA workers are important in establishing and maintaining relationships with patients that encourage attendance and participation, and the efforts of ASHAs often help in mitigating common barriers to treatment. Our results show that the beliefs and knowledge of ASHA workers can be changed in regards to mental illness, and ASHAs can become effective advocates for patients. The perspectives of ASHA workers need to be understood in order to understand the complexities of a rural health system that relies on their work, and most effectively help patients.

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