Driving and restraining forces influencing the performance of Accredited Social Health Activist workers of a primary health center in India: A force field analysis

作者：Gaurav R. Naik, Anuradha K. Shah, J. Prakash, Vijaykumar Singh · 发表于：Indian Journal of Community and Family Medicine · 年份：2025 · DOI：10.4103/ijcfm.ijcfm_35_25

Accredited Social Health Activists (ASHAs) are frontline health workers crucial to India’s rural healthcare system. Their performance is shaped by multiple facilitating and inhibiting factors. This study applied Force Field Analysis (FFA) to systematically identify these factors. A qualitative study was conducted at a primary health center in rural Maharashtra, India. Two focus group discussions, each with 12–13 ASHA workers, were carried out using a semi-structured guide based on the FFA framework. Discussions were conducted in the local language, recorded, and thematically analyzed. Driving and restraining forces were identified, prioritized, and visually represented through FFA diagrams. Six driving forces and ten restraining forces were identified. Strong community trust, peer support, training opportunities, and financial/logistical incentives emerged as motivating factors. Conversely, inadequate remuneration, excessive workload, lack of refresher training, negative community attitudes, and poor transport facilities acted as significant barriers. The balance of these opposing forces determined ASHAs’ effectiveness in rural health service delivery. FFA provided structured insights into the dynamic forces influencing ASHAs’ performance. Policymakers should strengthen enabling factors such as community engagement and skill enhancement while addressing systemic barriers such as financial insecurity and workload. These findings are applicable to similar f...