Evaluation of a Positive Psychological Intervention to Reduce Work Stress among Rural Community Health Workers in India: Results from a Randomized Pilot Study

Efforts to reduce work stress among frontline health workers in India, namely the rural Accredited Social Health Activists or 'ASHAs' (resident women, lay health workers) have predominantly emphasized on 'extrinsic' variables (e.g., financial incentives, or enhanced supervision), with little consideration of 'intrinsic' factors like the wellbeing of ASHAs themselves or building their abilities in managing work stress. 'Character-strengths' based positive psychological interventions have shown improvements in work wellbeing and engagement, but these findings have been largely observed in the Global North, with no experimental studies in India. This study is a pilot randomized controlled trial where rural ASHAs were allocated to receive regular supervision by their supervisors appointed by the health system (control arm), or a character-strengths based coaching intervention in addition to regular supervision (intervention arm). The intervention included a residential workshop and follow-on weekly individual telephonic coaching support. We aimed to examine the preliminary effectiveness of the intervention on happiness of ASHAs using the Authentic Happiness Inventory (primary outcome). At 3-month follow-up, ASHAs in the intervention arm showed higher total happiness scores (n = 30, Mean = 83.6; SD = 13.32) than ASHAs in the control arm (n = 31, Mean = 76.32; SD = 13.16), with a significant between-arm difference (Cohen's d: 0.55). Secondary outcomes (e.g., burnout, motivation) showed non-significant between-arm differences at follow-up. We conducted telephone-interviews of ASHAs to gather their experiences of the intervention and used thematic analysis to assess its feasibility and acceptability. This study critically contributes to inform the ways by which rural frontline workers can use character-strengths to improve work wellbeing in low-resource settings.