Empowering accredited social health activist (ASHA) workers to support community mental health in Karnataka State of India: A systematic review
Johnson-Pradeep Ruben, Supriya Shivashankar, Ramakrishna Goud Bhooma Goud, Aishwarya G.V, Rajani Parthasarathy, Srinivasa G.A, Girish Kumar, Prem Kumar Mony, Sumithra Selvam, Krishnamachari Srinivasan, Pulkit Verma, Neha Dahiya, Ashoo GroverBackground and objectives
Accredited social health activists (ASHAs) play a key role in community mental health services in Karnataka; however, evidence on training interventions has not been systematically reviewed. We aimed to systematically synthesise evidence on mental health training interventions for ASHAs in Karnataka, focusing on provider competencies and service delivery outcomes.
Methods
Systematic search of databases, trial registries, and grey literature (October 2025–January 2026) included studies published between 2000 and 2025. Eligible studies involved ASHAs in Karnataka and evaluated mental health training interventions with outcomes related to provider competencies or service delivery. Due to heterogeneity, findings were synthesised narratively using SWiM guidelines for quantitative studies and GRADE-CERQual for qualitative. The risk of bias was assessed using RoB 2, ROBINS-I (v2), MMAT, and CASP.
Results
Of 648 records screened, 13 studies comprising 567 ASHAs met the inclusion criteria. Narrative synthesis showed improved provider competencies and service delivery outcomes from quantitative studies, while qualitative studies revealed moderate confidence. Overall, risk of bias was judged as ‘low to some concerns’. Digital and hybrid models showed more sustained gains than standalone in-person training. Selected service delivery outcomes, including screening coverage, home visits and supervisory engagement, improved with structured support. However, the evidence was limited by pre-post designs, small sample size, reliance on self-reported outcomes, and heterogeneity in interventions and outcome measures.
Interpretation and conclusion
Structured training may improve ASHAs’ mental health provider competencies and service delivery. Digital and hybrid models are promising, but evidence remains limited, highlighting the need for rigorous studies with standardised outcomes and long-term follow up.