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Facilitating behavioral change: A comparative assessment of ASHA efficacy in rural Bihar.

作者信息

Burger Oskar, Hashmi Faiz, Dańko Maciej J, Akhauri Santosh, Chaudhuri Indrajit, Little Emily, Lunkenheimer Hannah G, Mondal Sudipta, Mor Nachiket, Saldanha Neela, Schooley Janine, Singh Palash, Johnson Tracy, Legare Cristine H

机构信息

Center for Applied Cognitive Science, The University of Texas at Austin, Austin, Texas, United States of America.

Max Planck Institute for Demographic Research, Rostock, Germany.

出版信息

PLOS Glob Public Health. 2022 Aug 17;2(8):e0000756. doi: 10.1371/journal.pgph.0000756. eCollection 2022.


DOI:10.1371/journal.pgph.0000756
PMID:36962814
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10021476/
Abstract

Community health worker (CHW) programs are essential for expanding health services to many areas of the world and improving uptake of recommended behaviors. One of these programs, called Accredited Social Health Activists (ASHA), was initiated by the government of India in 2005 and now has a workforce of about 1 million. ASHAs primarily focus on improving maternal and child health but also support other health initiatives. Evaluations of ASHA efficacy have found a range of results, from negative, to mixed, to positive. Clarity in forming a general impression of ASHA efficacy is hindered by the use of a wide range of evaluation criteria across studies, a lack of comparison to other sources of behavioral influence, and a focus on a small number of behaviors per study. We analyze survey data for 1,166 mothers from Bihar, India, to assess the influence of ASHAs and eight other health influencers on the uptake of 12 perinatal health behaviors. We find that ASHAs are highly effective at increasing the probability that women self-report having practiced biomedically-recommended behaviors. The ASHA's overall positive effect is larger than any of the nine health influencer categories in our study (covering public, private, and community sources), but their reach needs to be more widely extended to mothers who lack sufficient contact with ASHAs. We conclude that interactions between ASHAs and mothers positively impact the uptake of recommended perinatal health behaviors. ASHA training and program evaluation need to distinguish between individual-level and program-level factors in seeking ways to remove barriers that affect the reach of ASHA services.

摘要
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c88b/10021476/8129ac9decc7/pgph.0000756.g007.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c88b/10021476/5c9278d3a1a5/pgph.0000756.g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c88b/10021476/74d5944827dd/pgph.0000756.g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c88b/10021476/857bf7b95f49/pgph.0000756.g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c88b/10021476/300666a399e6/pgph.0000756.g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c88b/10021476/f3956e26e91e/pgph.0000756.g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c88b/10021476/9539c9255c5f/pgph.0000756.g006.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c88b/10021476/8129ac9decc7/pgph.0000756.g007.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c88b/10021476/5c9278d3a1a5/pgph.0000756.g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c88b/10021476/74d5944827dd/pgph.0000756.g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c88b/10021476/857bf7b95f49/pgph.0000756.g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c88b/10021476/300666a399e6/pgph.0000756.g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c88b/10021476/f3956e26e91e/pgph.0000756.g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c88b/10021476/9539c9255c5f/pgph.0000756.g006.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c88b/10021476/8129ac9decc7/pgph.0000756.g007.jpg

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Facilitating behavioral change: A comparative assessment of ASHA efficacy in rural Bihar.

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[2]
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[3]
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引用本文的文献

[1]
Developing community-based surveillance systems for vaccine-preventable diseases: lessons learned from Indonesia.

Glob Health Action. 2025-12

[2]
From counsel to consumption: examining sociocultural influences on perinatal nutrition in rural India.

Front Nutr. 2025-8-7

[3]
Community health workers' counseling is based on a deficit model of behavior change.

PLOS Glob Public Health. 2025-7-23

[4]
Association between coordinated counseling from both ASHA and Anganwadi Workers and maternal health outcomes: A cross-sectional study from Madhya Pradesh and Bihar, India.

PLOS Glob Public Health. 2024-11-13

[5]
Association between the use of Accredited Social Health Activist (ASHA) services and uptake of institutional deliveries in India.

PLOS Glob Public Health. 2024-1-16

[6]
Leverage the power of ritual to improve community health worker efficacy and public health outcomes: Lessons from Bihar, India.

Lancet Reg Health Southeast Asia. 2022-5-5

[7]
Evolution of community health workers: the fourth stage.

Front Public Health. 2023

本文引用的文献

[1]
Tradition, taste and taboo: the gastroecology of maternal perinatal diet.

BMJ Nutr Prev Health. 2021-7-5

[2]
The association between early in marriage fertility pressure from in-laws' and family planning behaviors, among married adolescent girls in Bihar and Uttar Pradesh, India.

Reprod Health. 2021-3-9

[3]
When women eat last: Discrimination at home and women's mental health.

PLoS One. 2021

[4]
Interplaying role of healthcare activist and homemaker: a mixed-methods exploration of the workload of community health workers (Accredited Social Health Activists) in India.

Hum Resour Health. 2021-1-6

[5]
Bringing Greater Precision to Interactions Between Community Health Workers and Households to Improve Maternal and Newborn Health Outcomes in India.

Glob Health Sci Pract. 2020-9-30

[6]
Counseling Is a Relationship Not Just a Skill: Re-conceptualizing Health Behavior Change Communication by India's Accredited Social Health Activists.

Glob Health Sci Pract. 2020-9-30

[7]
Predictors of the diets consumed by adolescent girls, pregnant women and mothers with children under age two years in rural eastern India.

J Biosoc Sci. 2021-9

[8]
Community Health Workers as Influential Health System Actors and not "Just Another Pair Of Hands".

Int J Health Policy Manag. 2021-8-1

[9]
Perinatal risk and the cultural ecology of health in Bihar, India.

Philos Trans R Soc Lond B Biol Sci. 2020-8-17

[10]
The community health worker as service extender, cultural broker and social change agent: a critical interpretive synthesis of roles, intent and accountability.

BMJ Glob Health. 2020-6

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