"We are everyone's ASHAs but who's there for us?" a qualitative exploration of perceptions of work stress and coping among rural frontline workers in Madhya Pradesh, India

被引：3

作者：

Shrivastava, Ritu ^{[1
]}

Sharma, Lochan ^{[1
]}

Jolly, Mehak ^{[1
]}

Ahuja, Romi ^{[1
]}

Sharma, Radhika ^{[1
]}

Naslund, John A. ^{[2
]}

Agrawal, Jyotsna ^{[3
]}

Shidhaye, Rahul ^{[4
]}

Mehrotra, Seema ^{[3
]}

Hollon, Steve D. ^{[5
]}

Patel, Vikram ^{[2
]}

Tugnawat, Deepak ^{[1
]}

Kumar, Ananth ^{[6
]}

Bhan, Anant ^{[1
]}

Bondre, Ameya P. ^{[1
]}

机构：

[1] Sangath, 106,Good Shepherd Colony,Kolar Rd, Bhopal 462042, Madhya Pradesh, India

[2] Harvard Med Sch, Dept Global Hlth & Social Med, 25 Shattuck St, Boston, MA 02115 USA

[3] Natl Inst Mental Hlth & Neurosci, Hosur Rd,Lakkasandra,Wilson Garden, Bengaluru 560029, Karnataka, India

[4] Pravara Inst Med Sci, Ahmednagar 413736, Maharashtra, India

[5] Vanderbilt Univ, Brentwood, TN 37027 USA

[6] Natl Inst Hlth & Family Welf Campus, Natl Hlth Syst Resource Ctr, Baba Gang Nath Marg,Block F, New Delhi 110067, India

来源：

SOCIAL SCIENCE & MEDICINE | 2023年 / 336卷

关键词：

Community health workers; Burnout; ASHAs; LMIC; Qualitative; Focus groups; Grounded theory approach; COMMUNITY-HEALTH WORKERS; PEER SUPPORT; BURNOUT;

D O I：

10.1016/j.socscimed.2023.116234

中图分类号：

R1 [预防医学、卫生学];

学科分类号：

1004 ; 120402 ;

摘要：

Objective: More than a million female village-level lay providers called 'Accredited Social Health Activists (ASHAs)', who deliver primary care, face high levels of stress due to work demands and low compensation, within the context of poverty and gender inequality. Evidence on ASHAs has focused on workplace challenges from a system perspective, without sufficient probing into individual-level stress. This study aims to gain perspectives into the experiences of work stress, the related health symptoms, and the responses to stress among ASHAs in India. Methods: Focus group discussions (FGDs) conducted with ASHAs in Sehore district, Madhya Pradesh, were audiorecorded and transcribed. Grounded theory was used to generate themes under the various domains of ASHAs' work and domestic life. We identified pathways between the conditions that trigger stressful events, experiences of these events, resulting perceptions, effects on health and wellbeing, and approaches used by ASHAs to respond to stress. Results: Six FGDs with 59 ASHAs generated the following themes: (a) Facility: Workload, undue pressures, unstructured work; ASHAs' relationships with seniors (e.g., feelings of being disrespected, blamed, or targeted), and low access to physical and administrative resources; (b) Home: Feelings of guilt for putting less time for family/ child care; disrespect by the elderly for a poorly incentivised job; (c) Community: Low acceptance by the villagers; caste- and gender-bias; difficult community-level relationships (emotional labour, fear/stigma towards her services); (d) Somatic and psychological symptoms: headache, exhaustion, depressive symptoms (to cite a few); and (e) Responses to stress: Motivation (support from peers, family, a sense of identity/pride, incentives), Individual strengths (e.g., social responsibility), and spiritual recourse mechanisms. Conclusions: This study will inform the development of a strengths-based coaching intervention to address work stress among ASHAs. The findings are relevant to building the evidence on alleviation of work stress among female frontline cadres in low-resource settings globally.

引用

页数：11