Publication:

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

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.