ASHA Workers Research Articles

A PRE-EXPERIMENTAL STUDY ON EFFECTIVENESS OF AWARENESS PROGRAM TOWARDS REDUCING STIGMA REGARDING MENTAL ILLNESS AMONG ASHA WORKERS AT SELECTED PHC OF SEPAHIJALA, TRIPURA

A pre-experimental study was conducted to assess the effectiveness of awareness program towards reducing stigma regarding mental illness among ASHA workers at selected PHC of Sepahijala, Tripura. A quantitative Pre-experimental research design was adopted by the researcher for conducting the study, and the Roys adaptation model was used as the framework. Data was collected from 30 ASHA workers after taking informed consent who were selected by non-probability purposive sampling technique through a self-structured stigma assessment scale. Obtained data was complied and analyzed according to objectives using frequency, percentage, mean, standard deviation, paired t test and chi square test. The findings of the study revealed that mean post test stigma score of ASHA workers were significantly higher than the mean pretest stigma score, which was significant at <0.05 level after exposure with awareness program. Therefore the awareness program was an effective method of imparting knowledge to ASHA workers.

Assess the Knowledge Regarding Antenatal and Postnatal Care among Asha Worker Working in Selected Area of Etawah

Background; ASHAs form the backbone of the NRHM and are meant to be selected by and be accountable to the village. They need to provide preventive, promotive and curative health facilities in the rural community.This study was conducted to assess the knowledge regarding antenatal and postnatal care among ASHA worker working in selected area of Etawah Kanpur U.P. The aim of the study was to assess the knowledge regarding antenatal and postnatal care among ASHA worker working in selected area of Etawah with view to develop and distribute information booklet to enhance their knowledge regarding. Objective 1. To assess the knowledge of ASHA worker regarding antenatal and postnatal care. 2.To determine the association between Demographic variable and knowledge score. Material and Method: for the present study Non experimental descriptive Cross-sectional Design was used for the study. purposive sampling was used to select 108 ASHA workers. Data were collected by structured knowledge questionnaire. Result: it showed that majority of the Participants 84 (90.72%) had Moderate knowledge, 18 (19.44) had adequate knowledge and 06 (6.48%) had Inadequate level of knowledge regarding pre and postnatal care among ASHA worker.

An observational study on menstrual hygiene practices among adolescents girls attending zilla parishad high school at Kommadi village in Visakhapatnam

Under RMNCH+A strategy, adolescent health program is relatively a new concept, particularly for female gender, and has been considered to be a continuum of health services up to adolescent age. The priority interventions among adolescent girls are, nutrition, Adolescent Friendly Health clinics (AFHCs), Counselling, Menstrual hygiene and preventive health checkups. Menstrual hygiene component has been taken for the present study among the adolescent girls in a Zilla Parishad High School aged 10 to 19 years. Rastriya Kishora Swastya Karyakram (RKSK) is broader one including both gender for distinct health services in India. : To study the association of various socio- economic and cultural practices influencing the usage of sanitary napkins by menstruating adolescent school girls. : Cross sectional study among menstruating adolescent girls in a Zilla Parishad High School at Kommadi village. 198 adolescent girls were randomly selected for study using semi structured questionnaire. Each menstruating girl is questioned categorically (yes/no) as per the structured questionnaire covering socio economic status, literacy of mother, awareness about ASHA etc. Appropriate statistical tests like frequencies, percentages and chi-square tests are applied to analyse and interpret the collected data.Socio-demographic factors of the target population in the community from where the adolescent girls attending zilla Parishad High school were subjected to study and found that 19(22%) adolescent girls having white ration card are using sanitary napkin. 46% of sanitary napkin users in our study are aware of using cloth available in the house during menstruation. 39 (52%) adolescent girls using sanitary napkin are aware of ASHA worker visiting their colony. One of the family members, either mother or elder sister being a member in Self Help Group in the colony is influencing the usage of sanitary napkin 46 (50.5%). Habit of Over-the-Counter drugs usage in the family has significantly (55%) influenced the adolescent school girls in using sanitary napkin. School drop-outs 51(62.9%) are also observed among sanitary napkin users during menstruation.: The usage of sanitary napkin replacing the traditional home-made cloth is highly essential for proper menstrual hygiene management among adolescent girls attending the school regularly without drop out. The role of ASHA workers and other paramedical staff in the community cannot be undermined.

Assessment of Knowledge, Attitude, and Practices (KAP) of Anganwadi Teachers and Asha Workers with Regard to Nutrition Education Intervention

Nutrition is one of the important aspects that deals with good health and wellbeing of people. Nutrition education helps to resolve the nutrition problems by imparting nutrition education and bring desirable changes in terms of Knowledge, Attitude and Practices (KAP). The existing study was conducted to know the knowledge, attitude, and practices of AWW and ASHA’s with regard to nutrition education for pregnant women and lactating mother. Data was gathered using pre-tested questionnaires with a sample size of 90 respondents chosen from three mandals (area) in the Guntur district. Random sampling procedure was used for selection of the respondents. The results of the study found that Anganwadi teachers and ASHA Workers had low to medium level of knowledge, poor attitude and poor practices during baseline test. After implementing intervention programme to the Anganwadi teachers and ASHA Workers for a period of one month a significant improvement in the Knowledge, Attitude and Practices was observed during Endline test (t=10.5; t=10.3). The above findings can be used to plan a digital material on nutrition education interventions which aiming at bringing change in the behavior of the respondents i.e., KAP and it can be used as ready reckoners during sudden epidemics.

Problems of Family Planning in India: Some Issues

Focusing on the magnitude of family planning in India, it is necessary to strengthen all its aspects through government programs, and training given by NGOs or ASHA workers to mothers and families. Family planning also deals with the reproductive healthcare of the mother as well as preventing her from different kinds of disease. It helps to improve the quality of life of the mother, child, and family as a whole.

Examining the relationship between motivation and incentives in the context of maternal health awareness: A study of Asha workers in Uttarakhand

Examining the relationship between motivation and incentives in the context of maternal health awareness: A study of Asha workers in Uttarakhand

Knowledge attitude and practices regarding pregnancy induced hypertension among ASHA workers – A possible link to reduce related adverse outcomes

Knowledge attitude and practices regarding pregnancy induced hypertension among ASHA workers – A possible link to reduce related adverse outcomes

Qualitative Study to Identify Strengths, Weakness, Opportunities, and Challenges of Family Adoption Programs among Students.

National Medical Commission (NMC) in their recent notification included Family Adoption Program (FAP) in the undergraduate curriculum to provide a learning opportunity towards community-based health care to Indian medical graduates. This study is carried out to explore and know strengths, weaknesses, opportunities, and challenges of FAP. FAP were used to gather data using Focus Group Discussion (FGD) and in-depth interviews of the stakeholders of the program. FGD of students was conducted. In-depth interviews of families, Sarpanch, Panchayat members, ASHA workers of the village, faculties, and Head of the Department of Community Medicine were conducted. Data analysis was done by using deductive-inductive content analysis method using computer software NVivo. Four main categories or themes were formed: strengths, weaknesses, opportunities, and challenges. Strengths include increased understanding about Community Medicine subject, beneficence to students, and community. Weakness includes difficulties in field with respect to time and availability and implementation of programs. Opportunities include early field exposure and FAP as a platform for primary healthcare. Challenges include competencies not aligned with phasewise curriculum and difficulties in adopting five families per student. The family adoption program needs to be adopted and implemented as a part of curriculum for MBBS students as there are many strengths and opportunities, while weaknesses and challenges need to be addressed.

Assessment of Urban ASHA workers: Unveiling Urban Dynamics

Background: The World Health Report highlighted the critical role of human resources in health systems, especially noting the human resource crisis in low-income countries due to various challenges such as migration and illness of health workers. The study aims to assess the performance of urban ASHA workers in Meerut and identify factors affecting their performance. Specific objectives include evaluating the delivery of essential services by ASHA workers and understanding the various individual, occupational, and environmental factors that influence their effectiveness. Methodology: The study was conducted with 40 ASHAs from the urban areas of Meerut. Data was collected through interviews using pretested schedules and performance assessments based on structured scales. Beneficiaries were also interviewed to gauge service delivery effectiveness. Chi-square and Fisher exact tests were used to analyze data and understand the association between various factors and ASHA performance. Results & Conclusion: The results were categorized into performance grades based on the ASHAs' scores, showing a distribution among different performance levels. Factors such as age, education, training frequency, occupation, and timely receipt of incentives were found to significantly affect the performance of ASHA workers. The study revealed that younger, better-educated, and regularly trained ASHAs with timely incentives showed better performance.

ASHA-led community-managed intervention programme to improve maternal and neonatal outcomes in pregnant women with pregnancy hypertension: A study protocol.

The objective is to use the available technology in conjunction with the peripheral health workers to identify the early warning signs of pregnancy-induced hypertension (PIH), provide appropriate referral services and closely monitor the patient thereafter with the aim of improving the prognosis of the condition. Quasi-experimental design. The research will be carried out in Udupi District Karnataka, India. The study will involve 250 pregnant women in total as well as 50 ASHA workers. All the participants will undergo a PIH knowledge assessment, which will be followed by a PIH risk assessment for expectant mothers. There will be an implementation of the community-managed intervention programme (CMIP). The creation of a mobile application, ongoing prenatal follow-up and training for ASHAs on mobile app usage are all part of the CMIP. The results for mothers and newborns will be monitored and to learn more about the efficacy of CMIP and the difficulties ASHA workers and expectant mothers encounter in identifying the early warning signals of PIH a focused group discussion will be held. A number of research on pregnancy-induced hypertension have demonstrated the necessity for community-based treatments to be developed in order to improve the outcomes for expectant mothers and newborns. These programmes assist in managing hypertension throughout pregnancy. Conversely, ASHA employees have had a favourable influence on community-level health outcome management. Currently, technology is being used extensively in healthcare and is receiving favourable reception. Thus, in an effort to improve maternal and newborn outcomes, this study attempts to incorporate mobile technologies in addition to ASHA workers and pregnant women. If the CMIP proves to be beneficial, it might be implemented nationwide, particularly in isolated regions, to monitor expectant mothers and avoid PIH-related concerns.

Mapping and vulnerability assessment in urban slums of Nainital and Udham Singh Nagar districts of Uttarakhand: A Cross-sectional Survey

Background: With increasing urbanization, number of urban slums is also rising. The health facilities and indicators in urban slums are poor as compared to other urban population. The present study presents an analysis of the health problems, utilization of health services and vulnerability of urban slums. Aims & Objectives: To map the slums in urban areas and assess the vulnerability of households. Methodology: The study was conducted in all urban slums of five cities of Nainital and Udham Singh Nagar districts namely Haldwani, Ramnagar, Rudrapur, Jaspur and Kashipur. Group discussions involving community members, ward surveys by ASHA workers and household level vulnerability assessment were done using standard format according to “Guidelines and Tools for Vulnerability Mapping and Assessment of Urban Health, 2017”. Results: Most urban slum dwellers are daily wage laborers with major population suffering mainly from diabetes, hypertension, respiratory infection. Lack of drugs and diagnostic facilities are the major concerns. Infrastructure needs strengthening in most of the slums. Around three fourth of population belonged to vulnerable group with remaining in highly vulnerable group. Conclusion: There are social problems in urban slums like illiteracy, lack of awareness, unemployment which worsen the health problems. So, a holistic approach is needed for the solution.

Mother Support Groups for Raising Awareness in the Community About Kangaroo Mother Care and Breastfeeding in the Era of COVID-19: Experiential Learning

Introduction This article explores the establishment and subsequent challenges faced by a Mother Support Group (MSG) initiated in Gujarat, India, focusing on promoting Kangaroo Mother Care (KMC) and exclusive breastfeeding, particularly amid the COVID-19 era. Methods The methodology involved adapting to COVID-19 restrictions, utilizing online platforms for training and webinars, and collaborating with ASHA workers for community outreach. The MSG members received training on breastfeeding and KMC, followed by practical demonstrations and community visits. Although initial efforts were promising, the group’s sustainability faltered when key stakeholders withdrew, revealing challenges in maintaining community-driven interventions. Results and discussion The article underscores the importance of sustained efforts in establishing and retaining parent support groups. The lack of comprehensive data collection limits the ability to evaluate specific outcomes, but we highlight the potential benefits of MSG, including improved breastfeeding practices and KMC adherence. We acknowledge the need for robust frameworks and standard operating procedures to enhance the sustainability of such initiatives, emphasizing the importance of community involvement and leadership in supporting disadvantaged newborns. Conclusion We draw attention to the complexities of sustaining grassroots initiatives and call for further research to develop effective models that address the unique needs of marginalized communities, particularly regarding the care of preterm newborns.

Assessment of knowledge of accredited social health activists regarding antenatal & neonatal care in a block of Haryana

Improving maternal & child health has been an essential tool for achieving health for all. The discourse on the Accredited Social Health Activist’s (ASHA’s) role centers around three typologies -as an activist, as a link worker or facilitator, and as a community level health care provider.To assess knowledge of ASHA workers regarding antenatal and neonatal care in a block of Haryana. The present cross-sectional, community-based study was conducted in block Barwala, district Hisar of Haryana. Universal sampling technique was used. A predesigned, pretested, semi-structured schedule was used to collect the information, which included details of socio-demographic profile of ASHA workers and questions about knowledge of antenatal & postnatal care. Appropriate statistical tests like frequencies and percentages test were applied to analyze the collected data.Only 6.9% ASHA workers told about benefits of early registration of pregnancy. Majority of ASHA workers had inadequate knowledge about identification of danger signs during pregnancy and infancy, duration of trimester. Majority of ASHA workers had adequate knowledge about breast-feeding practices however about half of ASHA workers had inadequate knowledge about duration of colostrum. Only about one third ASHA workers had adequate knowledge regarding weighing machine & colour zone used for identify malnutrition.: It is important to reorient ASHA workers at field level and supportive supervision also plays an important role.

IJCM_300A: Clinical medicine and Public health: Is the dichotomy justified? Epidemiological investigation of a Hepatitis A case admitted at a tertiary care hospital

Background: Outbreaks of Hepatitis A Virus (HAV) infection have been associated with poor sanitation, inadequate sewage disposal and contamination of food and water. Objective: To identify the epidemiological factors associated with a patient who presented with fever and vomiting and diagnosed with Hepatitis A. Methodology: 23-year-old, female patient was admitted in the general medicine department of a tertiary care hospital with complaints of fever and vomiting. IgM ELISA tests for Hepatitis A and Hepatitis E were positive. The patient’s mother had similar symptoms. Community Medicine department was informed about the patient. A team comprising of postgraduate students, MSW, ASHA worker and Anganwadi worker visited the patient’s house. Information including clinical history, source of drinking water, history of food and water intake from outside, sanitation and waste disposal methods of the house hold were collected. Stakeholders including the counsellor and members of the self-help group of the area were informed. House to house visit of all houses in 200 meters radius from patients’ house was done to look for more cases and to assess the environment sanitation. Results: The team identified that the source of drinking water of the patient’s family was a well which was not sanitary. A nearby house was identified with an open well with open sullage less than one meter away. Seven children of that household had fever and jaundice and were treated from a local hospital, one week prior. Stakeholders were also informed and both the wells were chlorinated and the families were educated about the importance of boiling water before consumption, proper disposal of sullage and waste disposal. Conclusion: Interdepartmental communication between clinical medicine and public health played an important role in identifying and eliminating the source of infection even when one patient was diagnosed and helped to prevent HAV outbreak.

IJCM_27A: To assess consumption of IFA in adolescent girls and pregnant women in selected health blocks of Himachal Pradesh.

Background: In India, anaemia is the most widespread nutritional deficiency disorder occurring primarily due to iron deficiency. Despite implementation of the Weekly Iron & Folic Acid Supplementation (WIFS) Programme under NRHM since 2013, the prevalence of anaemia is high among adolescents and pregnant women (PW) Objectives: To assess consumption of IFA in adolescent school going girls and pregnant women in selected health blocks of Himachal Pradesh. Methodology: It was a community-based study which was a part of project under WCD department of H.P. PW and school going adolescent girls of age 10-19 years from 9 Community development blocks were selected randomly using PPS. IFA consumption in last one year among adolescent girls and last 1 month among pregnant women was assessed by interviewing them. Results: Total participants among PW were 180 with mean age of 26.3±4.13, whereas 720 adolescents with mean age of 15.82±1.19 were enrolled in the study. Out of 180 PWs, 160(88.8%) received IFA where majority (156;97%) of them consumed IFA distributed by ASHA worker. On the other hand, majority of adolescent girls (484/720;67%) did not receive IFA, 196/236 (83%) who received IFA was distributed by ASHAs. Mean Hb level of PW was 11.7±1.47 whereas for adolescents was 12.73±4.85. Conclusion: It was observed that most of the pregnant women are utilizing government services, however the services are not being utilized by the school going adolescent girls as WIFS are not provided regularly.

IJCM_204A: A qualitative research to identify the barriers and facilitating factors in the utilization of healthcare services by a Particularly Vulnerable Tribal Group (PVTG) in Udupi District

Background: Udupi district hosts two major Particularly Vulnerable Tribal Groups (PVTG) namely Malaikudiya and Koraga. Koraga tribes are declining in number and deprived of availability of healthcare services and accessibility to healthcare facilities. There are a lot of barriers such as lack of awareness and social stigma amalgamate the existing conditions of Koraga tribes in Udupi district. Research studies pertaining to this problem has been seldom done. Objective: We aim to explore the barriers and facilitating factors in accessing healthcare services by a Particularly Vulnerable Tribal Group (PVTG) in Udupi district. Methodology: We conducted qualitative research through 8 in-depth interviews with AMOs from PHC and CHC, ITDP staff and NGO workers, and 3 focus group discussions with community health nurses, ASHA workers, and Koraga community leaders from Udupi district. We explored the major facilitators and barriers that influence the utilization of health care services by the PVTG. Results: On the beneficiaries’ point of view, lack of awareness, distance to health facilities, poor public transportation, perceived negative behavior of hospital staff, lack of infrastructure, unwelcoming neighbourhood approaches, and economic instability were the main barriers to utilizing healthcare facilities. On the stakeholders (providers) point of view, availability of healthcare facilities, government policies and schemes and NGO activities are the facilitating factors. Conclusion: Our study highlights the barriers to utilizing health facilities; these are not always driven by factors linked to the PVTG members’ socio- economic status but also depend significantly on the quality of the health services and other contextual factors. Although the government has made efforts to improve the rural healthcare system through national-level programs, our qualitative study shows that there are a number of barriers which lessens the effectiveness of the programs to enhance the utilization of healthcare facilities by the PVTG in the study area.

IJCM_30A: A mixed methods study to assess the contributory factors to anaemia among adolescent girls studying in tribal schools in a rural area of Maharashtra

Background: Anaemia is prevalent globally, notably in marginalized adolescent girls. NFHS-5 reports 59.1% anaemia in Indian adolescent girls. Tribal communities face unique health challenges due to their sociocultural dynamics. The national program for anaemia addresses this, but its implementation in contexts like tribal areas is unexplored. This study integrates quantitative and qualitative data for a thorough understanding of anaemia and its control in tribal settings. Objectives: 1. To estimate the prevalence of anaemia in tribal adolescent girls 2. To explore the awareness of anaemia in tribal adolescent girls 3. To understand the challenges in the implementation of an anaemia control program in a tribal setting Methodology: This 6-month mixed methods study assessed anaemia prevalence among adolescent girls in tribal schools. Using complete enumeration, a 200-sample size was determined, with obtained informed consent and assent. Adolescent girls were administered a questionnaire in their local language to collect information on their socio-demographic status and anaemia-related habits like diet and handwashing among others. Haemoglobin levels were measured using a digital haemoglobinometer. Focus Group Discussions with willing girls explored their understanding of anaemia, its causes and complications. Forced field analysis for ASHA and Anganwadi workers and certain Key Informant Interviews were conducted. Data was collected until saturation. Ethical approval with confidentiality was ensured. Results: The prevalence of anaemia was 70%, indicating a severe public health concern. Among these, 57.1% had mild, 34.3% had moderate, and 8.6% had severe anaemia. Anaemia in girls was statistically associated with specific food groups and habits. Low awareness of anaemia and operational issues in the control program were also identified. Conclusion: To enhance adolescent awareness of anaemia, efforts to improve their understanding of the condition and its impact are necessary. This research is vital for informing policymakers and health practitioners in refining interventions for this specific demographic in Maharashtra.

IJCM_328A: Operational Research on Capacity Building of Community Health Workers in Screening for Depression and Suicide risk

Background: The basic training for ASHA workers in Tamil Nadu include a module on Non-Communicable diseases with inadequate focus on Mental Health. As a part of the Community Based Assessment Checklist, ASHAs are trained in administration of Patient Health Questionnaire-2 to screen for depression. However, there is significant gap in the primary prevention of depression in the communities in terms of screening, basic counselling services and knowledge and attitude among community health workers Objective: This study aimed to assess the feasibility of capacity building of Community Health Workers in screening for depression and suicide risk and provision of Psychological First Aid Services Methodology: 117 Community Health Workers including ASHAs, AWWs, ANMs, WHVs, VHNs and UHNs were trained in WHO Psychological First Aid, PHQ-9 administration and WHO MhGAP 10 questions on suicide risk screening in Thiruvannamalai, Vellore and Tiruvallur District of Tamil Nadu Results: Of the 1371 individuals screened, 13.18% were positive for depression and 38% were positive for atleast one suicide risk. The most common suicide risk observed was chronic pain followed by extreme hopelessness. PHQ-9 and Suicide risk assessment was easy to administer among ANM, VHN and UHNs. However, ASHAs and Women Health Volunteers reported that PHQ-2/WHO Wellbeing Index was an easier tool to use in the field. Psychological First Aid training can be easily delivered by non-medical professionals to health workers. Conclusion: Community Health Workers can provide primary prevention in mental health by provision of Psychological First Aid to their community. Depression screening should be simplified by PHQ-2/WHO Well being index

Assessment of Physicochemical and Microbiological Qualities of Drinking Water in Ahmedabad Slum, India: A Cross-Sectional Study

ntroduction: The quality of drinking water is a public health concern, especially in urban slum areas. Drinking water quality and contamination are seriously threatened by the growing slum population and irregular water supply. Objective: To examine the physicochemical and microbiological quality of drinking water in the field practice area of one of the Tertiary-care hospital in Ahmedabad a part of PG teaching activity. Method: A cross-sectional study was carried out for water quality assessment using stratified random sampling. A total of 139 water samples were collected; samples were collected from different households in different areas of the Asarwa ward of Ahmedabad Corporation. From each ASHA worker’s area, according to population of that area, 6 to 10 samples were selected. The samples were analysed using standard methods and compared with WHO and BIS water quality standards. Results: TDS and alkalinity are above permissible levels in 42.4% and 46.7% samples respectively. pH, turbidity, conductivity, total hardness, and magnesium were found altered in a few samples. The mean free residual chlorine was 0.05 mg/L. Microbiological analysis of water samples revealed the presence of coliform in 5 (3.6%) samples. Conclusion: Except for total alkalinity and TDS, most physicochemical parameters of drinking water were acceptable. By storing water, a low level of free residual chlorine can be justified. A few samples (3.6%) with coliform bacteria indicate water contamination somewhere in the distribution system or at the consumer level.

A Study to Assess the effectiveness of Video Assisted Teaching Program regarding Cervical Cancer Screening and HPV Vaccination among ASHA workers at selected rural area of District Yamuna Nagar, Haryana

Background: The purpose of present study was to evaluate the effectiveness of video assisted teaching programme regarding cervical cancer screening and HPV vaccination in terms of knowledge among ASHA workers working at rural area of district Yamuna Nagar, Haryana. Quantitative research approach was used. One group pre-test and post-test design was adopted to attain current study objectives. 60 ASHA workers were selected by using purposive sampling method. Demographic profile was used to assess personal information of ASHA Workers. Pre-test was conducted to assess the existing level of knowledge regarding cervical cancer screening and HPV vaccination with the help of self-structured questionnaire followed by video assisted teaching program was implemented and after seven days a post test was taken. The study finding shows that knowledge score regarding cervical cancer screening and HPV vaccination of ASHA workers were improved after implemented the video assisted teaching program. The pre-test mean and standard deviation knowledge score were 12.18+3.41 and the post-test mean and standard deviation knowledge score were 24.52+1.84. The mean difference score was 12.34. The paired‘t’ test score was 14.423 for the degree of freedom 29 which was statistically significant at the ‘P’ value 0.001; however no significant association was found between post test level knowledge and demographic variable.