A Character‑Strengths Based Coaching Program to Reduce Work Stress of Rural Community Health Workers in Madhya Pradesh, India: Protocol for a Single-Blind Randomized Controlled Trial

Abstract

Background: There is scarce knowledge on the use of structured positive psychology interventions for reducing work-stress and improving wellbeing of rural community health workers in India, particularly the Accredited Social Health Activists (ASHAs) who are village-level (resident, female, incentivised) lay health workers. This trial will test the effectiveness of a ‘character-strengths’ based coaching intervention compared to routine supervision on wellbeing (‘authentic happiness’) of ASHAs.Methods: This protocol is for a single-blind, parallel group randomized controlled trial comparing the effectiveness of a five-day residential workshop focusing on the use of character-strengths and subsequent 8- to 10-week remote telephonic coaching (weekly) to individually support ASHAs to improve their wellbeing, against routine health system support. The arms are intervention added to routine ASHA supervision (weekly, by the ASHA supervisor) and routine supervision alone (control arm). The target sample comprises 330 rural ASHAs in Madhya Pradesh, India. The primary outcome of mean Authentic Happiness Inventory (AHI) scores will be compared between arms at 3-month follow-up. Secondary outcomes will include an assessment of ASHA’s self-reported affect, self-efficacy, flourishing, burnout, motivation, physical health symptoms, quality of life, self-expressed character-strengths, and routine work performance indicators, and the consequent patient-level outcomes [e.g., service satisfaction and depression remission rates after receiving brief psychological treatment by trained ASHAs]. We will also evaluate the costs of developing and delivering the intervention.Discussion: This trial will determine whether a character-strengths based coaching intervention is an effective and scalable approach for reducing work-stress and improving wellbeing of rural ASHAs in low-resource settings.

Note:
Trial Registration Details: NCT06013488.

Funding Information: This work was supported by the Templeton World Charity Foundation, Nassau, Bahamas (Grant number: TWCF0635).

Declaration of Interests: The authors declare that there are no known conflicts of interest associated with this publication and there has been no significant financial support for this work that could have influenced its outcome.

Ethics Approval Statement: Institutional (ethics) Review Board at Sangath, India approved all study procedures. All participants provided written informed consent for the pilot study activities.

Keywords: character strengths, community health workers, work stress, randomized controlled trial, positive psychology