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.4.6 Doctor is rude to beneficiary for not doing recommended practice

Table B.101: How should ASHA deal with doctor being rude to mother?

Tell mother it is for her own good/Doctor is right	Tell mother doctor was wrong to yell	Tell the doctor not to yell	Comfort mother in another way	Enlist another’s help	Tell mother she has made a mistake but comfort her	Tell mother ASHA was scolded because of her	Explain financial incentives
0.85	0.03	0.00	0.05	0.06	0.06	0.02	0.02

Table B.102: How common is this generally: frequency

Frequent	Rare but happens	Never
0.46	0.37	0.16

Table B.103: How common is this generally: result

When it happens: it affects their desire to return to hospital	When it happens: it has little effect on mother
0.53	0.16

Table B.104: How common is this for you: frequency

Frequent	Rare but happens	Never
0.02	0.42	0.52

Table B.105: How common is this for you: how to deal with it

Talk to/soothe mother	Reprimand/talk with nurse	Tell mother it is for her own good/ encourage submissiveness	Explain health benefits	Explain financial benefits	Novel solutions offered (for Q4 mainly)	Complain about the doctor	Talk with doctor
0.08	0.05	0.32	0.11	0.03	0.00	0.03	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