Perceptions of Accredited Social Health Activists on Depression: A Qualitative Study from Karnataka, India

Mental health orientation among ASHAs: A study from Karnataka State, India

Introduction

The high mental health treatment gap in India, necessitates mental health service delivery through the primary health care system. Accredited Social Health Activists (ASHAs) as frontline community health workers are a key member of the primary health care team. The ASHAs training needs related to mental health, require to be determined in order to accordingly tailor capacity-building programs. In this context, the present study aims to examine the ASHAs mental health orientation utilizing a factorially validated Indian tool.

Methods

In this cross-sectional study, 91 ASHAs from a taluk of Bengaluru Urban District, responded to the self-administered Orientation towards Mental Illness (OMI) scale. Data were analysed using descriptive statistics viz. frequencies, percentages, means, and standard deviations.

Results

The ASHAs reported an overall unfavourable mental health orientation and the specific OMI factors on which unfavourable orientation was observed were Psychosocial stress, Non-restrained behaviour, Weak cognitive control, Fidgety behaviour, Bizarre behaviour, Psychosocial manipulation, and Hypo-functioning.

Conclusion

The findings of the study suggest that capacity-building programs for ASHAs will need to first examine their orientation to mental health and collaboratively address an unfavourable orientation when present, as it would have a bearing on ASHAs mental health service delivery in the community.

Use of Data to Understand the Social Determinants of Depression in Two Middle-Income Countries: the 3-D Commission

Depression accounts for a large share of the global disease burden, with an estimated 264 million people globally suffering from depression. Despite being one of the most common kinds of mental health (MH) disorders, much about depression remains unknown. There are limited data about depression, in terms of its occurrence, distribution, and wider social determinants. This work examined the use of novel data sources for assessing the scope and social determinants of depression, with a view to informing the reduction of the global burden of depression.This study focused on new and traditional sources of data on depression and its social determinants in two middle-income countries (LMICs), namely, Brazil and India. We identified data sources using a combination of a targeted PubMed search, Google search, expert consultations, and snowball sampling of the relevant literature published between October 2010 and September 2020. Our search focused on data sources on the following HEALTHY subset of determinants: healthcare (H), education (E), access to healthy choices (A), labor/employment (L), transportation (T), housing (H), and income (Y).Despite the emergence of a variety of data sources, their use in the study of depression and its HEALTHY determinants in India and Brazil are still limited. Survey-based data are still the most widely used source. In instances where new data sources are used, the most commonly used data sources include social media (twitter data in particular), geographic information systems/global positioning systems (GIS/GPS), mobile phone, and satellite imagery. Often, the new data sources are used in conjunction with traditional sources of data. In Brazil, the limited use of new data sources to study depression and its HEALTHY determinants may be linked to (a) the government's outsized role in coordinating healthcare delivery and controlling the data system, thus limiting innovation that may be expected from the private sector; (b) the government routinely collecting data on depression and other MH disorders (and therefore, does not see the need for other data sources); and (c) insufficient prioritization of MH as a whole. In India, the limited use of new data sources to study depression and its HEALTHY determinants could be a function of (a) the lack of appropriate regulation and incentives to encourage data sharing by and within the private sector, (b) absence of purposeful data collection at subnational levels, and (c) inadequate prioritization of MH. There is a continuing gap in the collection and analysis of data on depression, possibly reflecting the limited priority accorded to mental health as a whole. The relatively limited use of data to inform our understanding of the HEALTHY determinants of depression suggests a substantial need for support of independent research using new data sources. Finally, there is a need to revisit the universal health coverage (UHC) frameworks, as these frameworks currently do not include depression and other mental health-related indicators so as to enable tracking of progress (or lack thereof) on such indicators.

Potential for a comprehensive stroke education: Assessing awareness about stroke among community health workers - A qualitative study from Urban Bangalore, Karnataka, India

Context:

The incidence of stroke is evolving to be a major public health issue in recent years. The situation is aggravated by the limited public awareness about its risk factors and treatment procedures. It is important to explore the level of awareness of the Accredited Social Health Activists (ASHAs) about stroke as they work in the community as part of the public healthcare delivery systems.

Aims:

The aim of this study was to explore the awareness about stroke among the ASHAs through a qualitative study.

Settings and Design:

The study was conducted in the institution using a cross-sectional qualitative approach.

Methods and Material:

A focus group discussion with 12 ASHAs from Bengaluru district of Karnataka was conducted.

Statistical Analysis Used:

Data were analyzed manually through direct content analysis.

Results:

It was revealed that the ASHAs did not have adequate general awareness about stroke, its causes, and related treatment procedures. The ASHAs overgeneralized the causes to lifestyle factors, such as smoking, drinking, and so on.

Conclusions:

The study showed the level of awareness of stroke among the ASHAs is inadequate at present, and they would benefit from systematic sensitisation programmes. Limited awareness could lead to failure to identify the early warning signs and appropriate, timely help. A need of a comprehensive educational program to increase their awareness is emphasized.