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. 2023 Dec 15:4:100230.
doi: 10.1016/j.ssmmh.2023.100230. Epub 2023 Jun 17.

Stress Alleviation Methods for community-Based Health ActiVists (SAMBHAV): Development of a digital program for stress reduction for community health workers in rural India

Ritu Shrivastava  1 , Abhishek Singh  1 , Azaz Khan  1 , Shivangi Choubey  1 , Juliana Restivo Haney  2 , Eirini Karyotaki  3 , Deepak Tugnawat  1 , Anant Bhan  1 , John A Naslund  4
Affiliations

Stress Alleviation Methods for community-Based Health ActiVists (SAMBHAV): Development of a digital program for stress reduction for community health workers in rural India

Ritu Shrivastava et al. SSM Ment Health. .

Abstract

Background: Community health workers (CHWs) face high levels of stress (both professional and personal) and risk of burnout, highlighting the need for efforts to promote their mental health and well-being. This study seeks to develop a digital stress reduction program for CHWs in rural India.

Methods: A stepwise design process was employed to adapt and digitize the evidence-based World Health Organization's Self-Help Plus (SH+) intervention for addressing psychological distress among CHWs in Madhya Pradesh, India. This involved participatory design workshops with CHWs to ensure that the digital stress reduction intervention would be relevant for their needs and the local culture and context. Small groups of CHWs reviewed the adapted program content, allowing the research team to make refinements such as simplifying language, tailoring content to the local setting, and ensuring that program materials are both interesting and relevant. Simultaneously, the research team digitized the content, leveraging a combination of video and graphical content, and uploaded it to the Sangath Learning Management System, a digital platform accessible on a smartphone app.

Results: In total, 18 CHWs contributed to the adaptation of the SH+ content and digital intervention development. Participants commented on finding some terms difficult to follow and recommended simplifying the language and providing detailed explanations. Participants offered positive feedback on the adapted content, expressing that they found the examples covered in the material both relatable and relevant to their own personal experiences at home and in the workplace. By combining participants' insights and comments with feedback from content experts, it was possible to finalize a digital Hindi version of the SH+ intervention for CHWs in rural India.

Conclusions: This study is timely given the continued detrimental impacts of the COVID-19 pandemic, and offers a promising and potentially scalable digital program to alleviate psychological distress among frontline health workers.

Keywords: ASHA; Burnout; Community health worker; Digital technology; Mental health; Self-help plus; Stress.

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Conflict of interest statement

Declaration of competing interest The authors declare no competing interests.

Figures

Fig. 1.
Fig. 1.
Overview of the stepwise approach to development of the digital program for stress reduction for community health workers in rural India.
Fig. 2.
Fig. 2.
Sample video content from the digital SH+ intervention adapted for ASHAs in rural India.
Fig. 3.
Fig. 3.
Sample graphics from the digital SH+ intervention adapted for ASHAs in rural India.
Fig. 4.
Fig. 4.
Sample content from the SAMBHAV program manual adapted from the WHO SH+ manual for use with ASHAs in rural India.
See this image and copyright information in PMC

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