F1000Research F1000Research 2046-1402 F1000 Research Limited London, UK 10.12688/f1000research.146186.1 Study Protocol Articles An evaluation of job satisfaction levels among ASHA workers at the Raipur PHC, Nagpur

[version 1; peer review: 1 approved]

 Bisane Priti Conceptualization Investigation Methodology Resources Writing – Original Draft Preparation https://orcid.org/0009-0000-6717-3828 a 1 Inkane Swapnil Conceptualization Methodology Resources Supervision Visualization Writing – Original Draft Preparation 1 G. Choudhari Sonali Conceptualization Methodology Supervision Validation Writing – Review & Editing 2 G. Mendhe Harshal Conceptualization Formal Analysis Methodology Supervision Visualization Writing – Original Draft Preparation Writing – Review & Editing 1 Community Medicine, Datta Meghe Medical College, Nagpur, Maharashtra, 440019, India Community Medicine, Jawaharlal Nehru Medical College, School of Epidemiology and Public Health, Datta Meghe Institute of Higher Education and Research (DU), Wardha, Maharashtra, 442001, India pritibisane19022000@gmail.com

No competing interests were disclosed.

 30 4 2024 2024 13 428 12 4 2024 Copyright: © 2024 Bisane P et al. 2024 This is an open access article distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Background

ASHA (Accredited Social Health Activists) are an essential connection between the community and health care providers, these guidelines were established by The Ministry of Health and Family Welfare, Government of India. An ASHA worker’s level of job satisfaction is influenced by societal, cultural, and economic factors. An ASHA worker who does not receive a sufficient salary will find it difficult to support their family. The ASHA employee is not at all satisfied with this issue. In earlier research investigations, ASHAs voiced unhappiness with the incentives and expectations of greater or regular income.

 Objectives

To assess the job satisfaction of the ASHA workers in the selected area of Nagpur, Maharashtra and find the association between levels of job satisfaction with selected variables.

 Methods

The sample for the study will be conducted by using Multistage Random sampling techniques. Data will be collected by using semi- questionnaires. All responses from the questionnaires will be collated in a Microsoft Excel file, encoded, and processed using chi squared test and SPSS version 26.

 ASHA workers job satisfaction health worker workload The author(s) declared that no grants were involved in supporting this work. Introduction

In 2005, a new initiative to improve health care in India was carried out by the Ministry of Health and Family Welfare, Government of India when it introduced Accredited Social Health Activists (ASHA) workers under its National Health Mission NHM. 1 , 2 One of the important elements of the National Rural Health Mission is the provision of a trained female community health activist, ASHA workers are chosen from the identical village and caring for an average population of 1000. In hilly and tribal areas, on the other hand, it is possible to adapt this rule in order to take account of specific circumstances. ASHA will be the first stop for any health-related needs of underprivileged populations, particularly women and children who are having challenges for accessing health care. 3

NHM is the government’s primary programme for achieving the Millennium Development Goals, which include MMR, IMR, the control of particular diseases, improving the nutritional status of mothers and children, and enhancing the accessibility, availability, and acceptability of health facilities, particularly in rural areas. 1

The main challenges are workload, lengthy working hours, fatigue in training and much time spent under the shade of a hot sun. They also stated that they had been ill due to their work on all national health programmes. The afternoon field visit walk has been described as being extremely stressful and exhausting by some ASHA employees, who also claimed that the excessive workload had affected their dedication and level of productivity. 2

“In this study, we will fill a gap in existing knowledge by examining and identifying factors that contribute to ASHA employees’ job satisfaction with Raipur PHC Nagpur, which has been relatively unknown until now.” The study’s findings will be beneficial in identifying the gap in ASHAs’ work satisfaction.

 Aim and objectives Aim

The study aims to gauge job satisfaction levels among A.S.H.A. workers and examine potential associations between job satisfaction and specific demographic variables.

 Objective

To assess the workload of ASHA workers in Raipur PHC Nagpur, including their responsibilities, caseload, and work hours.

To measure the job satisfaction levels of ASHA workers in Raipur PHC Nagpur.

Research questions

What are the levels of job satisfaction among ASHA workers, and are there any significant associations between job satisfaction and specific demographic variables in this study?

 Hypothesis

The rate of job satisfaction among ASHA employees will significantly correlate with the chosen demographic factors.

 Methods

Study design

Study design: An observational cross-sectional descriptive study.

Study settings: The study will be conducted at the Raipur PHC, Hingna Taluka, Nagpur. Hingna Taluka consists has 4 Primary Health Centres, namely Adegaon, Kanholibara, Raipur, and Takalghat, of which Raipur village was selected using simple random sampling. Raipur PHC targets close to 30000 population. The data from the study participants will be collected for a period of 2 months after obtaining approval from the Institutional Ethics Committee.

Study participants: ASHA workers working under Raipur PHC, Hingna and will include all the urban and rural ASHA workers who are working for a minimum of period of 1 year and are willing to give written informed consent. Remaining ASHA workers will be excluded from the study.

Variables: Sociodemographic attributes of ASHA workers, Daily tasks, caseload, working hours, and job satisfaction levels.

Data sources: A semi-structured validated questionnaire will be administered to ASHA workers in Raipur PHC to collect details about their sociodemographic profile, workload, and job satisfaction. Data pertaining to each variable of study will be collected using semi-structured questionnaire.

Bias: To address recall bias, the questionnaire did not include any questions pertaining to their employment history or work experiences.

Study size

The findings of a study done in the Tahsil Samudrapur reported that 72% of ASHA workers felt satisfied while working in Nagpur’s rural and urban areas. 4 Considering that estimates as the basis, the sample size for the present study will be calculated as N = ( 4 × P × Q ) / ( L × L )

[Where, P-72; Q- 28, L (allowable error) – 9] N = ( 4 × 72 × 28 ) / ( 9 × 9 ) = 98

Assuming a 10% non-response rate, the final sample size is 107.

Quantitative variables: Age, Education, Work experience

Statistical methods: Data will be entered in Microsoft Excel and analysis will be carried out using descriptive (frequency and percentages) and inferential statistics (Chi-square test to study the association between sociodemographic attributes and job satisfaction), at a p value of <0.05. Microsoft Excel will be used for statistical analysis. https://www.ibm.com/support/pages/spss-statistics-220-available-download

Ethical considerations

Informed consent: Every participant will be asked for their written informed consent.

Privacy and confidentiality: Personal information will be kept private, and strict confidentiality will be maintained.

Minimizing harm: Measures will be implemented to minimize potential harm or distress to participants during the study, primarily focusing on prioritizing their well-being. Participants will be ensured that the findings of the study will not have any impact on their professional careers.

Fairness and equity: The research will take steps to prevent bias and discrimination in participant selection, data analysis, and reporting to uphold fairness and equity.

Ethical review: Ethical approval for this study (SMHRC/IEC/2023/1603) was provided by the ethical committee of Shalinitai Meghe Hospital and Research Centre, Wanadongri (Nagpur) on 12/April/2023.

Study status

Data collection will be done in the month of April and May 2024.

 Discussion Literature review

One of the essential measures of the national rural health mission in India’s success is ASHA. Delivering the provided healthcare services to the people in rural India has taken all of their heart and soul. The primary concerns of ASHA employees are those relating to working conditions, job satisfaction, and rewards. 2

ASHA is a female villager who has completed at least the eighth grade; however, this requirement may not be enforced in tribal regions. She is trained for 23 days over the course of a year and undergoes ongoing refresher training. 5 There are currently more than a million ASHAs (1,047,324) serving everyone in the country, excluding Goa. There is about one ASHA among 879 people living in rural areas, with a wide range of interstate variations. 3 As multitaskers, ASHAs played a significant role in bridging the gap between the public and the healthcare system by assuming the “social activist” responsibilities of health educators and facilitators of healthcare services. They have been shown to positively impact family planning, prenatal care, postpartum care, and healthcare-seeking behaviour. 5

In addition to healthcare costs, work satisfaction strongly impacts quality, efficiency and effectiveness in healthcare workers. Professional satisfaction in health professionals is directly linked to absences from work, human relations and organizational arrangements, which also impact patients and the healthcare system as a whole. 6 A survey on job satisfaction is regularly carried out in several countries, and if the data obtained are monitored, it may be possible to find that work organization still needs to be complied with.

The employment satisfaction of the ASHA workers is, in fact, a matter of economics, social conditions and culture. There will be problems for those ASHA workers who need more pay. This issue leaves the (ASHA) feeling far from satisfied. 6

Roles and responsibilities of ASHA

ASHA is an activist who aims to raise awareness on health and social determinants in a way that encourages the community to consider local health plans and encourage beneficiaries to use available healthcare services by the state. At this level, ASHA can also offer a minimal package of curative care where appropriate and practical and must promptly refer patients. 7

They also have responsibility for Counselling (breastfeeding, complementary feeding, immunization, birth preparedness, safe delivery, Family Planning, breastfeeding),Escort for institutional delivery, Antenatal care, Postnatal care, Immunization, Family planning Detection, referral, confirmation, registration of cases (malaria, TB, leprosy, RTI/STI Survey of health and related events, Mobilize community and facilitate in accessing health and health-related services Organization of VHND, promotion of household toilets Depot holder of drugs such as ORS, condoms, oral pills, chloroquine, disposable delivery kit (DDK), IFA and chloroquine. 8

Challenges faced by ASHA workers

Job satisfaction among ASHA workers is influenced by a multitude of challenges they encounter, including.

Low compensation

R. Bhatnagar et al.’s 9 study found that approximately 50% of ASHAs in the blocks it examined served a population of between 1000 and 1500 people. Every ASHA member routinely attends neighbourhood meetings and cooperates closely with the neighbourhood. Less incentives compared to their job were frequently cited as the source of dissatisfaction, particularly for ASHAs operating in tribal regions.

Workload

Kawade A et al., 10 study conducted on 67 ASHAs from the two PHCs were studied. ASHAs worked up to 20 hours a week in their village of residence, providing services to about 800-1200 people despite a workload that left them harried and exhausted.

Lack of training and skill development

Guha I et al.’s 11 study claimed that no additional education had been given, only basic training during the first stage of their time in uniform. A few people said their training was successful, but modification training was necessary. A few people also mentioned the need for training due to their need for more awareness of various national programs.

Limitations – The study has a limitation: the findings may not be broadly applicable to all ASHA workers, the reliance on self-reported data introduces the potential for response bias, impacting the accuracy of job satisfaction assessments, and the finding may lack universal applicability beyond the unique circumstances of Raipur PHC.

 Ethic and consent

Ethical approval for this study (SMHRC/IEC/2023/1603) was provided by the ethical committee of Shalinitai Meghe Hospital and Research Centre, Wanadongri (Nagpur) on 12/April/2023.

Informed consent: Every participant will be asked for their written informed consent.

 Data availability

No data is associated with this article.

 References Kori S Bhatia M Mishra A : A Cross-sectional Assessment of Knowledge of ASHA Workers. J. Krishna Inst. Med. Sci. Univ. 2015;4(4):57–63. Bidari R Ray S : Job satisfaction of Accredited Social Health Activist (ASHA). Eur. J. Mol. Clin. Med. 2020;7(11):20–26. National Health Mission: ASHA Update July 2019. [cited 2023 Sep 16]. Reference Source Taksande VD Ashtankar PA Bansod CR : To Assess the Job-Related Difficulties and Dissatisfaction of Asha Workers in Selected Rural Area. J. Evolution Med. Dent. Sci. 2021;10(2):98–101. 10.14260/jemds/2021/20 Agarwal S Curtis SL Angeles G : The impact of India’s accredited social health activist (ASHA) program on the utilization of maternity services: A nationally representative longitudinal modelling study. Hum. Resour. Health. 2019;17(1):68. 31426801 10.1186/s12960-019-0402-4 PMC6701148 Visser MRM Smets EMA Oort FJ : Stress, satisfaction and burnout among Dutch medical specialists. CMAJ. 2003;168(3):271–275. 12566331 Mishra A : The role of the Accredited Social Health Activists in effective health care delivery: evidence from a study in South Orissa. BMC Proc. 2012;6(S1):P1. 10.1186/1753-6561-6-S1-P1 Scott K George AS Ved RR : Taking stock of 10 years of published research on the ASHA programme: examining India’s national community health worker programme from a health systems perspective. Health Res. Policy Sys. 2019;17(1):29. 30909926 10.1186/s12961-019-0427-0 PMC6434894 Bhatnagar R Singh K Bir T : An assessment of performance based incentive system for ASHA Sahyogini in Udaipur, Rajasthan. Indian J. Public Health. 2009;53(3):166–170. 20108882 Kawade A Gore M Lele P : Interplaying role of healthcare activist and homemaker: a mixed-methods exploration of the workload of community health workers (Accredited Social Health Activists) in India. Hum. Resour. Health. 2021;19:7. 33407518 10.1186/s12960-020-00546-z PMC7789492 Guha I Raut A Maliye C : Qualitative Assessment of Accredited Social Health Activists (ASHA) Regarding their roles and responsibilities and factors influencing their performance in selected villages of Wardha. Int. J. Adv. Med. Health Res. 2018;5:21. 10.4103/IJAMR.IJAMR_55_17 10.5256/f1000research.160236.r287138 Reviewer response for version 1 Adamopoulos Ioannis Pantelis 1 Referee https://orcid.org/0000-0002-4942-7123 Department of Environmental Hygiene and Public Health Inspections, Hellenic Republic Region of Attica, Athens, Greece

Competing interests: No competing interests were disclosed.

 16 9 2024 Copyright: © 2024 Adamopoulos IP 2024 This is an open access peer review report distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. recommendation approve

DEAR AUTHORS CONGRATULATIONS FOR THIS IMPORTANT AND FINE WORK !!

 It has the correct specifications, and approves :

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Contribution to the literature:  the uniqueness and importance of this work in terms of research topics, its methodologies, and outcomes, this article enhances the scholarship in the subject. Ideas are presented  clear, concise, and complete manner. Manuscript is free from any repetitions, irrelevant information, or unjustified generalizations. Theoretical framework is explicitly stated. All claims are backed up with evidence and references. Research problems’ position and significance in existing literature is emphasized. Chosen methodology is suitable for the problem. Study’s findings are well presented with sufficient discussions and comparisons to existing literature. Objective and convincing measures exist to support the validity and reliability of the methodology and results. Relevant literature is properly cited for the An evaluation of job satisfaction levels among ASHA workers at the Raipur PHC, Nagpur. And finally have completed the aims and scope of F1000 Research.

I suggest: Please Accept the article as it is.

WITH REGARDS

The Reviewer

Is the study design appropriate for the research question?

Yes

Is the rationale for, and objectives of, the study clearly described?

Yes

Are sufficient details of the methods provided to allow replication by others?

Yes

Are the datasets clearly presented in a useable and accessible format?

Yes

Reviewer Expertise:

OCCUPATIONAL SAFETY AND HEALTH

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard.