’[We] learned how to speak with love’: a qualitative exploration of accredited social health activist (ASHA) community health worker experiences of the Mobile Academy refresher training in Rajasthan, India

Abstract

IntroductionMobile Academy is a mobile-based training course for India’s accredited social health activist (ASHA) community health workers (CHW). The course, which ASHAs access by dialling a number from their phones, totals 4 hours of audio content. It consists of 11 chapters, each with their own quiz, and provides a cumulative pass or fail score at the end. This qualitative study of Mobile Academy explores how the programme was accessed and experienced by CHWs, and how they perceive it to have influenced their work.MethodsWe conducted in-depth interviews (n=25) and focus group discussions (n=5) with ASHAs and other health system actors. Open-ended questions explored ASHA perspectives on Mobile Academy, the course’s perceived influence on ASHAs and preferences for future training programmes. After applying a priori codes to the transcripts, we identified emergent themes and grouped them according to our CHW mLearning framework.ResultsASHAs reported enjoying Mobile Academy, specifically praising its friendly tone and the ability to repeat content. They, and higher level health systems actors, conceived it to primarily be a test not a training. ASHAs reported that they found the quizzes easy but generally did not consider the course overly simplistic. ASHAs considered Mobile Academy’s content to be a useful knowledge refresher but said its primary benefit was in modelling a positive communications approach, which inspired them to adopt a kinder, more ‘loving’ communication style when speaking to beneficiaries. ASHAs and health system actors wanted follow-on mLearning courses that would continue to compliment but not replace face-to-face training.ConclusionThis mLearning programme for CHWs in India was well received by ASHAs across a wide range of education levels and experience. Dial-in audio training has the potential to reinforce topical knowledge and showcase positive ways to communicate.

Using behavioural design and theories of change to integrate communication solutions into health systems in India: evolution, evidence and learnings from practice

“…An independent qualitative assessment of Mobile Academy found that the service bolstered FLHWs’ RMNCH knowledge and provided them with positive ways to communicate with families. 13 An independent analysis of system-generated call record data found that over four in five FLHWs (81%) who started Mobile Academy completed the IVR training, and only 1% did not ‘pass’ (i.e. accurately answer at least half the quiz questions) 14 suggesting the service was effective.…”

Lessons learnt from applying a human-centred design process to develop one of the largest mobile health communication programmes in the world

“…17 18 Mobile Academy has been identified as an effective tool for refreshing FHLWs' knowledge, as well as a mechanism for modelling a more effective style of interpersonal communications. 19 Although Mobile Kunji was not scaled by the national government because it was thought that FLHWs would soon have personal smartphones, research indicated that it was associated with improvements in a range of health outcomes. 20 These results suggest that HCD processes, when effectively applied, can be invaluable in creating impactful digital solutions that resonate with communities and have a strong potential for scale, sustainability and health system integration.…”

Critical policy capacity factors in the implementation of the community health worker program in India

“…Another initiative undertaken by the central government is the mobile phone-based interactive voice-based training program for the ASHAs. However, it also underlines the requirement of financial incentives to reimburse for their time spent on training (Scott et al, 2022).…”

“…Besides these developments on health policy and CHWs in LMICs and India, an analytical effort that employs the PCF and seeks to understand how distinct policy capacities relate to each other has not been made yet. Prashanth et al, 2014;Scott et al, 2019;Sodhi et al, 2016;Srivastava et al, 2016 Operational capacities Improvement in the functioning of state and non-state actors Support to the frontline policy implementers Kim et al, 2017;Nambiar & Sheikh, 2016;Scott et al, 2022 Saprii et al, 2015;Wahid et al, 2020 Note. Adapted from Wu et al (2015).…”