Development of a character-strengths based coaching program for rural community health workers to address their work stress in Madhya Pradesh, India

While rural ‘Accredited Social Health Activists (ASHAs)’ delivering primary care at the village-level in India experience high levels of work stress and burnout, little is known about the potential of positive psychology interventions in helping them respond to stressful situations. We aim to describe a systematic approach to designing and developing a ‘character-strengths based’ coaching program for rural ASHAs to help reduce their work-stress and improve their delivery of routine primary care. The development of the coaching program involved: (1) formative work, (2) blueprint development, (3) content development, (4) content-testing, and focus groups discussions to evaluate the feasibility and acceptability of the intervention, specifically the coaching workshop. This was followed by thematic qualitative analysis of ASHA perspectives/feedback to inform further modifications to the workshop. Intervention development occurred over 11 months, and the final coaching material consisted of a ‘content manual’ (for ASHAs) with four modules including character-strengths based ‘strategies’ to address challenges/stressors arising at health facilities, village communities and homes. Coaching material also included a workshop ‘facilitator’s manual’ having session-wise detailed instructions, a list of ‘energizers’ and plans for the coaching workshop. Consistent efforts were made to tailor the case-examples and workshop activities (e.g., roleplays, videos and reflections or discussion-based activities) to the local culture and context. This study illustrates a step-wise approach to contextually adapt the evidence-based character-strengths intervention approaches with iterative feedback from stakeholders (ASHAs), to develop a face-to-face coaching program aiming to reduce work stress, tailored to the context of a rural low-resource setting.