Goldwater Micah B, Hashmi Faiz A, Mondal Sudipta, Legare Cristine H
School of Psychology, The University of Sydney, Sydney, New South Wales, Australia.
The Center for Applied Cognitive Science, The University of Texas at Austin, Austin, Texas, United States of America.
PLOS Glob Public Health. 2025 Jul 23;5(7):e0004167. doi: 10.1371/journal.pgph.0004167. eCollection 2025.
In 2005, India launched the Accredited Social Health Activist (ASHA) program, which has augmented access to medical services and health education in marginalized rural communities. Despite notable progress in health delivery, uptake of medical services remains below target levels. The current research asked ASHAs and their clients why people reject medical advice and what the ASHAs could do to convince them otherwise. Our results identify a consistent mismatch between reasons to reject advice versus how to persuade clients to follow the advice. Two reasons were primarily cited for rejecting the uptake of medical services: insufficient or inaccurate understanding of the medical benefits of these services and the dynamics of the social situation, such as pressure from family members. In contrast, the predominant solutions addressed these knowledge gaps; ASHAs and their clients felt that highlighting the health advantages would be the most effective persuasion technique. ASHAs and their clients infrequently mentioned strategies addressing societal dynamics and norms. This mismatch between barriers to uptake and solutions suggests that the ASHA program inadvertently operates with a "deficit model" of decision-making and persuasion. The deficit model is the belief that the way to convince people to comply with health recommendations is to address their knowledge deficit by educating them on the medical benefits. The current research suggests that ASHAs should be trained in the science of belief revision and behavior change, which requires directly addressing the concerns and motivations of others, not just providing information.
2005年，印度启动了“经认证的社会健康活动家”（ASHA）项目，该项目增加了边缘化农村社区获得医疗服务和健康教育的机会。尽管在医疗服务提供方面取得了显著进展，但医疗服务的利用率仍低于目标水平。当前的研究询问了ASHA及其服务对象，人们拒绝医疗建议的原因以及ASHA可以采取什么措施来说服他们接受建议。我们的研究结果表明，在拒绝建议的原因与如何说服服务对象接受建议之间存在持续的不匹配。人们拒绝接受医疗服务主要有两个原因：对这些服务的医疗益处以及社会状况动态（如来自家庭成员的压力）理解不足或不准确。相比之下，主要的解决办法是填补这些知识空白；ASHA及其服务对象认为，强调健康益处将是最有效的说服技巧。ASHA及其服务对象很少提及解决社会动态和规范的策略。接受服务的障碍与解决办法之间的这种不匹配表明，ASHA项目无意中采用了一种“缺陷模型”的决策和说服方式。缺陷模型是指这样一种信念，即说服人们遵守健康建议的方法是通过向他们传授医疗益处来解决他们的知识缺陷。当前的研究表明，应该对ASHA进行信念修正和行为改变科学方面的培训，这需要直接解决他人的担忧和动机，而不仅仅是提供信息。
