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Background <p>Maternal mortality remains a major public health concern in low-resource settings. Birth preparedness and complication readiness (BPCR) is an established strategy to improve timely care-seeking and reduce preventable maternal and neonatal complications. Utilizing Accredited Social Health Activists (ASHAs) to deliver BPCR interventions may strengthen community-level implementation; however, evidence on feasibility and acceptability is limited.</p> Objective <p>To assess the feasibility and acceptability of an ASHA training strategy for community-level delivery of BPCR interventions in North Karnataka, India.</p> Methods <p>A quasi-experimental pre–post interventional study was conducted among 100 ASHAs from two Primary Health Centres (PHCs) and one Community Health Centre (CHC). All eligible ASHAs who provided informed consent were included using complete enumeration sampling. Baseline BPCR-related knowledge and practice data were collected through face-to-face interviews. ASHAs then received structured BPCR training delivered through a Birth Planner—a pictorial educational pamphlet—over three interactive sessions at 3-, 6-, and 12-month intervals. Post-intervention assessment was conducted using the same questionnaire. Pre- and post-intervention scores were compared using paired t-tests, and effect sizes were estimated using Cohen’s dz.</p> Results <p>Mean baseline knowledge scores for pregnancy, labour and childbirth, and postpartum danger signs were 31.55, 27.11, and 27.27, respectively, increasing to 73.45, 53.22, and 59.27 following the intervention. Self-reported practice scores for birth preparedness improved from 49.33 at baseline to 99.67 post-intervention. All improvements were statistically significant (<i>p</i> &lt; 0.001) with large to very large effect sizes (Cohen’s dz ≥ 1.31), indicating feasibility and high acceptance of BPCR implementation through structured ASHA training.</p> Conclusions <p>Structured BPCR training using a simple, pictorial Birth Planner was feasible and acceptable among ASHAs in a rural district of North Karnataka, resulting in significant improvements in self-reported BPCR knowledge and practices. These findings, while limited by the pre–post design and single-district context, support ASHA-led BPCR integration within the National Health Mission. Future multi-site controlled studies are warranted to assess generalizability and long-term impact on maternal and neonatal health outcomes.</p>

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From policy to practice: feasibility and acceptability of training ASHAs to deliver birth preparedness and complication readiness in North Karnataka, India: a pre–post study

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年7月4日

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  • Annapurna Kari,
  • Mubashir Angolkar

摘要

Background

Maternal mortality remains a major public health concern in low-resource settings. Birth preparedness and complication readiness (BPCR) is an established strategy to improve timely care-seeking and reduce preventable maternal and neonatal complications. Utilizing Accredited Social Health Activists (ASHAs) to deliver BPCR interventions may strengthen community-level implementation; however, evidence on feasibility and acceptability is limited.

Objective

To assess the feasibility and acceptability of an ASHA training strategy for community-level delivery of BPCR interventions in North Karnataka, India.

Methods

A quasi-experimental pre–post interventional study was conducted among 100 ASHAs from two Primary Health Centres (PHCs) and one Community Health Centre (CHC). All eligible ASHAs who provided informed consent were included using complete enumeration sampling. Baseline BPCR-related knowledge and practice data were collected through face-to-face interviews. ASHAs then received structured BPCR training delivered through a Birth Planner—a pictorial educational pamphlet—over three interactive sessions at 3-, 6-, and 12-month intervals. Post-intervention assessment was conducted using the same questionnaire. Pre- and post-intervention scores were compared using paired t-tests, and effect sizes were estimated using Cohen’s dz.

Results

Mean baseline knowledge scores for pregnancy, labour and childbirth, and postpartum danger signs were 31.55, 27.11, and 27.27, respectively, increasing to 73.45, 53.22, and 59.27 following the intervention. Self-reported practice scores for birth preparedness improved from 49.33 at baseline to 99.67 post-intervention. All improvements were statistically significant (p < 0.001) with large to very large effect sizes (Cohen’s dz ≥ 1.31), indicating feasibility and high acceptance of BPCR implementation through structured ASHA training.

Conclusions

Structured BPCR training using a simple, pictorial Birth Planner was feasible and acceptable among ASHAs in a rural district of North Karnataka, resulting in significant improvements in self-reported BPCR knowledge and practices. These findings, while limited by the pre–post design and single-district context, support ASHA-led BPCR integration within the National Health Mission. Future multi-site controlled studies are warranted to assess generalizability and long-term impact on maternal and neonatal health outcomes.