The association between social support through contacts with Accredited Social Health Activists (ASHAs) and antenatal an
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ORIGINAL PAPER
The association between social support through contacts with Accredited Social Health Activists (ASHAs) and antenatal anxiety among women in Mysore, India: a cross‑sectional study Nivedita L. Bhushan1 · Karl Krupp2,3 · Poornima Jaykrishna2 · Kavitha Ravi2 · Anisa Khan2 · Rahul Shidhaye4 · Sandra Kiplagat5 · Vijaya Srinivas2 · Purnima Madhivanan2,3,6 Received: 17 October 2019 / Accepted: 28 February 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose In India, antenatal anxiety prevalence estimates range from 6 to 48%. Social support is strongly associated with mental wellbeing, yet most studies have examined the impact of support from partners and family members rather than peers, community members, or health care providers. This study explores the supportive role of Accredited Social Health Activists (ASHA) contacts for antenatal anxiety. Methods Data were analyzed from the Saving Children, Improving Lives project, a quasi-experimental study conducted among rural, pregnant women in India. Regression models were used to estimate adjusted prevalence ratios (aPRs) and 95% confidence intervals for the relationship frequency of ASHA contacts and antenatal anxiety. Antenatal anxiety was measured using a subscale of the Edinburgh Postnatal Depression Scale. Results The sample consisted of 480 pregnant women. Reported antenatal anxiety prevalence was 27% (95% CI 23%, 31%). Participants who were more frequently visited by ASHAs at home (aPR: 0.90; 95% CI 0.76, 0.98) and more frequently accompanied by ASHAs to their antenatal care visits (aPR: 0.86, 95% CI 0.78, 0.95) were less likely to report antenatal anxiety. ASHA home visits were protective for the most vulnerable women (primigravida and those experiencing domestic violence) and ASHA accompaniment to antenatal care visits was equally protective for all women. Conclusions ASHAs are valued for their contribution towards maternal health education and linking women of reproductive age to healthcare services. Our findings additionally suggest the important role ASHAs play in providing social support to pregnant women, particularly those who are most vulnerable to experiencing antenatal anxiety. Keywords Antenatal anxiety · Social support · Community health workers
* Nivedita L. Bhushan [email protected]
Purnima Madhivanan [email protected]
Karl Krupp [email protected]
1
Poornima Jaykrishna [email protected]
Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
2
Kavitha Ravi [email protected]
Public Health Research Institute of India, Mysore, Karnataka, India
3
Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
Rahul Shidhaye [email protected]
4
Pravara Institute of Medical Sciences, Loni, Maharashtra, India
Sandra Kiplagat [email protected]
5
Florida International University, Miami, FL, USA
6
Divis
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