Assessing the knowledge, attitudes and practices of ASHA workers towards the Ayushman Bhava Initiative in Western Gujarat: a mixed-methods study

Vaibhav Shrivastav; Yogesh Murugan; Nirmalkumar Shaileshbhai Patel

doi:10.18203/2394-6040.ijcmph20263600

Authors

Vaibhav Shrivastav Department of Community Medicine, M.P. Shah Government Medical College, Jamnagar, Gujarat, India
Yogesh Murugan Department of Community Medicine, M.P. Shah Government Medical College, Jamnagar, Gujarat, India
Nirmalkumar Shaileshbhai Patel Department of Community Medicine, M.P. Shah Government Medical College, Jamnagar, Gujarat, India

DOI:

https://doi.org/10.18203/2394-6040.ijcmph20263600

Keywords:

Ayushman bhava, ASHAs, Knowledge, Attitudes, Practices, Mixed-methods study

Abstract

Background: The Ayushman Bhav initiative, launched by India's government, represents a pioneering approach to holistic healthcare delivery. This study evaluated the knowledge, attitudes, and practices (KAP) of Accredited Social Health Activists (ASHAs) regarding this initiative in Western Gujarat.

Methods: A mixed-methods study engaged 170 ASHA workers through structured questionnaires and 12 focus group discussions (8 participants each). The questionnaire assessed socio-demographic characteristics and KAP dimensions; logistic regression examined associations between socio-demographic factors and knowledge levels. Qualitative data underwent thematic analysis.

Results: Fifty-seven percent of ASHAs accurately understood the initiative's core aim, though specific knowledge gaps persisted; 51.2% had overall good knowledge. Attitudes were generally favourable, with 95.3% believing the initiative could improve patient care and 97% valuing communication. Self-reported practice was high across all domains, including information-sharing (95%) and active listening (84.7%). Higher education (AOR 3.79, 95% CI 1.49-9.63 for graduates), longer work experience, and higher income were significantly associated with good knowledge. Qualitative analysis identified three themes: Transformative potential versus implementation Reality, reflecting ASHAs' view of the initiative as paradigm-shifting despite ground-level challenges; structural tensions, highlighting resource-responsibility mismatches and knowledge-practice gaps; and evolution of Professional Identity, describing ASHAs' shift from health workers to community advocates.

Conclusions: The study reveals moderate knowledge, strongly positive attitudes, and high self-reported practice among ASHAs. These findings support targeted capacity-building, community engagement strategies, and policy interventions to bridge knowledge gaps and strengthen implementation of Ayushman Bhava through ASHAs.

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