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

Autor:	Burger O; Center for Applied Cognitive Science, The University of Texas at Austin, Austin, Texas, United States of America., Hashmi F; Center for Applied Cognitive Science, The University of Texas at Austin, Austin, Texas, United States of America., Dańko MJ; Max Planck Institute for Demographic Research, Rostock, Germany., Akhauri S; Project Concern International, Patna, India., Chaudhuri I; Project Concern International, Delhi, India., Little E; Nurturely, Bend, Oregon, United States of America., Lunkenheimer HG; Center for Applied Cognitive Science, The University of Texas at Austin, Austin, Texas, United States of America., Mondal S; Project Concern International, Delhi, India., Mor N; Banyan Academy of Leadership in Mental Health at Kanchipuram, Chennai, Tamil Nadu, India., Saldanha N; Yale Research Initiative on Innovation and Scale, New Haven, Connecticut, United States of America., Schooley J; Project Concern International, San Diego, California, United States of America., Singh P; SCOPE, Helsinki, Finland., Johnson T; Bill & Melinda Gates Foundation, Seattle, Washington, United States of America., Legare CH; Center for Applied Cognitive Science, The University of Texas at Austin, Austin, Texas, United States of America.
Jazyk:	angličtina
Zdroj:	PLOS global public health [PLOS Glob Public Health] 2022 Aug 17; Vol. 2 (8), pp. e0000756. Date of Electronic Publication: 2022 Aug 17 (Print Publication: 2022).
DOI:	10.1371/journal.pgph.0000756
Abstrakt:	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. Competing Interests: The authors declare that no competing interests exist for this manuscript. (Copyright: © 2022 Burger et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)
Databáze:	MEDLINE
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