Through this project, Sangath, a mental health nonprofit in India, will conduct a randomized controlled trial to test the effectiveness of coaching ASHAs, village-level primary healthcare workers, in providing depression treatment through its ESSENCE program, run by project director Anant Bhan.

While India accounts for roughly 50 million of the global 258 million people living with depression, mental health treatments have not been adequately integrated with routine primary care facilities in the country. Moreover, there is a dire lack of community-level primary depression care providers in rural India.

Recognizing that ASHAs are India’s best hope for successful depression treatment in rural areas, the ESSENCE program has recently trained roughly 340 ASHAs in a brief psychological treatment for depression. However, ASHAs face high levels of stress due to work demands, low compensation, and the larger context of poverty and gender inequality. Delivering mental health services can thus add a significant additional emotional burden to an already taxing workload.

Through the current project, Sangath aims to develop and implement a character-based coaching program for ASHAs to assist them in negotiating mental-health challenges in routine work situations. The project will contribute significantly to the limited body of research that currently exists in character-strength intervention studies, in particular because it is rooted in the Indian cultural context, incorporating Indian psychology concepts and models derived from spiritual texts.

The team will assess the effectiveness of this coaching on ASHAs’ well-being, motivation, and work performance through a two-arm randomized controlled study, as well as measure the effect of the intervention on patient-level engagement and satisfaction as well as patient health outcomes. They hypothesize that ASHAs who receive this coaching program in addition to routine supervision by their facilitators will perform better than those who receive routine supervision alone.

Project outcomes will include academic articles, workshops on intervention development and trial results, conference presentations, and a critical intervention coaching manual for key stakeholders. Perhaps most significant, this coaching will enable the enrolled ASHAs to provide mental health care to an exponentially higher number of patients. The team hopes to later collaborate with the Indian government to pilot and expand the intervention coaching program with frontline workers in various contexts of India.