B.4 ASHA-Only Conflict Vignettes

These vignettes described a conflict a fictional ASHA was experiencing. The questions asked the ASHA respondents how the character in the vignette should resolve the conflict, and asked ASHAs about their own experiences with conflicts like the one in the story. For these vignettes, because there were no experimental manipulations and only a single kind of respondent, we did conduct GLMMs analyses. Here, we quantify and describe the results. Each vignette describes a different potential conflict that ASHAs may experience.

B.4.1 Conflict between recommendation and own history.

Table B.81: Should you be honest about your past?
Yes, be honest that you did not do the recommended practice yourself Lie, say you did it in your past Only recommend what you’ve done
0.85 0.15 0.00
Table B.82: Explanations about being honest
Explanation for yes: Norms/Knowledge/Times have changed Explanation for yes: Do better than I did
0.68 0.74
Table B.83: Frequency of different recommended practice that ASHAs did not do themselves
Family planning clinic visits/check-ups/institutional delivery Colostrum/ breastfeeding lifestyle (nutrition, work) infant care (around navel) Vaccines/IFA tablets/medicine
0.48 0.16 0.44 0.08 0.03 0.19

B.4.2 Conflict between maternal duties and ASHA duties.

Table B.84: What to prioritize
Prioritize ASHA duties Prioritize mother duties Just do everything somehow Proposed some kind of shortcut e.g., deliver ASHA services via mobile phone
0.66 0.11 0.23 0.06
Table B.85: Who can get help from
Get help from family Get help from community members Get help from other health care workers e.g., ANM other ASHA
0.97 0.19 0.29
Table B.86: Consequences
Minorshort term consequence for ASHAs child eg is hungry misses some school More severe consequence for child could be health or education related but perhaps with longer term consequences Minor consequence for mother her child Major consequence for mother her child Social consequence husband is upset
0.20 0.16 0.00 0.00 0.01
Table B.87: Talk about how to handle with other ASHAs
Yes, take help Take help, share profit No
0.83 0.03 0.14
Table B.88: How often
Happens (unspecified how often) Frequently Sometimes Rare but happens Never
0.03 0.16 0.26 0.15 0.10
Table B.89: How to deal with conflict and why
ASHAs Child/Maternal Duties First ASHA duties first (family care for child) ASHA duties first (money) ASHA duties first (responsibility) ASHA duties first (unspecified)
0.10 0.16 0.19 0.46 0.01

B.4.3 Beneficiary not respecting ASHA nor her recommendations

Table B.90: How to handle the beneficiary not respecting ASHA recommendations
Persist in trying to convince Explain health benefits Financial/cost factors Social reasons Ask family to help Ask community member to help Ask another ASHA or health care worker to help No solution/give up
0.54 0.37 0.03 0.03 0.10 0.15 0.34 0.04
Table B.91: How often
Frequent Sometimes Rare but happens Never
0.36 0.12 0.39 0.12
Table B.92: Why
Something wrong with mother eg illiterate Something wrong with ASHA bad at job ASHA just does it for money Other social reasons eg caste
0.35 0.48 0.15 0.23

B.4.4 Beneficiary disagrees about best practices.

Table B.93: What is explained
Explain health risks/benefits Financial incentives Documentation, other benefits of engaging with health care system
0.84 0.63 0.19
Table B.94: Who to get help from
Enlist help of family Enlist help of community members Enlist help of ASHAs/health care workers Enlist help of other (non-specified)
0.26 0.07 0.22 0.01
Table B.95: How often in your experience
Frequent Sometimes Rare but happens Never Other
0.33 0.10 0.46 0.06 0.04
Table B.96: What to do after beneficiary disregards recommendation
Continue to try to convince mother Monitor child’s health directly Compare old rituals vs. new practices
0.85 0.21 0.48

B.4.5 An ASHA does work on another ASHAs territory

Table B.96: What should the ASHA do
Talk to other ASHA Talk to Beneficiary Report to supervisor/authority
0.58 0.25 0.60
Table B.96: How have you handled this
Talk to other ASHA Talk to Beneficiary Report to supervisor/authority
0.46 0.12 0.38
Table B.97: How common is this for ASHAs to do this generally: frequency
Frequent Rare but happens Never
0.41 0.56 0.02
Table B.98: How common is this for ASHAs to do this generally: why
It is to help the other ASHA It is to help themselves at other ASHA’s expense Because they do not know not to Other
0.10 0.25 0.05 0.03
Table B.99: Have you done it: frequency
Frequent Rare but happens Never
0.05 0.54 0.41
Table B.100: Have you done it: why
It is to help the other ASHA For my own benefit Other
0.40 0.08 0.03

B.4.7 Doctor is rude to ASHA

Table B.106: Does it affect ASHA-mother relationship?
No effect Negative Effect Positive effect
0.12 0.88 0.00
Table B.107: Does mother lose respect for ASHA?
Lose respect Does not lose respect More respect
0.63 0.34 0.03
Table B.108: Why was the doctor rude?
ASHAs fault Beneficiary’s fault Doctor’s fault Nurse’s fault Friction between Nurse and ASHA To ensure adherence to recommended practice
0.90 0.02 0.05 0.02 0.02 0.02
Table B.109: How should ASHA deal with this?
Apologize to doctor Say to doctor to not yell in front of beneficiary Blame beneficiary ASHA persist with beneficiary ASHA does better job in future Reassure beneficiary Get help from nurse/ANC Ask beneficiary to give her a good review to the nurse
0.32 0.05 0.11 0.22 0.52 0.02 0.05 0.02
Table B.110: How common is this generally?
Frequent Rare but happens Never
0.46 0.52 0.01
Table B.109: How common is this for you?
Frequent Rare but happens Never
0.03 0.33 0.63
Table B.109: How do you deal?
Confront doctor/stand up for themself Apologise to doctor/submit Get help/consolation from another Work to regain respect Make a complaint Blame beneficiary
0.11 0.27 0.06 0.16 0.02 0.03
Table B.109: Do you/ASHAs get sufficient respect?
Yes, enough respect No, not enough respect Not enough incentives/delayed
0.67 0.32 0.06

B.4.8 ASHA has too many duties simultaneously

Table B.111: How to deal with too many responsibilities: vaccinate & clinic births?
Prioritize vaccine Prioritize birth Just do it all Enlist help of family Enlist help of community members Enlist help of other health care workers Other solutions for efficiency e.g. use of mobile phones, gathering mothers together
0.43 0.48 0.16 0.27 0.03 0.33 0.36
Table B.112: Consequences of prioritizing vaccine over clinic births
Pregnant woman problems/death Neonate problems/death Home delivery No birth certificate Miss financial incentive No problems Enlist another health worker
0.60 0.54 0.65 0.10 0.23 0.08 0.12
Table B.113: Consequences of prioritizing clinic births over vaccine
No or minor consequence (vaccine) Major consequence (vaccine) Enlist help of health care workers Any new interesting things? ASHA will be scolded Lose financial incentive Enlist family ASHA possibly fired
0.30 0.63 0.26 0.00 0.05 0.05 0.05 0.02
Table B.114: How often do paid and unpaid duties conflict in general?
Frequent Rare but happens Never
0.06 0.87 0.06
Table B.115: Common duties that conflict with others
Vaccination Delivery/checkup Care meeting Polio Leprosy survey Home tour ASHA day
0.66 0.70 0.10 0.28 0.07 0.00 0.10
Table B.116: How often do paid and unpaid duties conflict for you?
Frequent Rare but happens Never
0.04 0.82 0.10
Table B.117: What do you get done when there are such conflicts

Hospital visit (e.g. for birth) House/beneficiary visit (e.g. vaccination) | ASHA training :—–:|:—–:

Table B.118: How do you deal with this?
Enlist others family help Enlist help of other health care workers Skip one of the tasks Prioritize one Work according to the hospital
0.38 0.54 0.04 0.07 0.01