All 150 interviews were successfully completed. Table shows the sociodemographic characteristics of the sample. Table presents a summary of SRQ, SPJ and OSI scores. In SRQ, a cut-off score of 8 or more was taken to indicate the presence of mental distress. Based on this cut-off, 26% of respondents had mental distress. Taking a score of 40–50 (1 sd) on the SPJ as a cut off revealed that 14% of the respondent LHWs were experiencing high job pressure, while taking > 51 (2 sd) as the cut-off point showed that an additional 5% had a very high job pressure, resulting in a cumulative figure of 19% of respondents having significant job pressure.
Socio-demographic variables (N = 150)
Summary table of SRQ, SPJ and OSI scores
Comparison was made with respect to different socio-economic variables given in Table . Three variables had a statistically significant effect on the LHW resulting in job stress. These included having to travel 2 km or more every day to perform her job, living a distance of 3 km or more away from the BHU, and having a family income of PKR 4,000 per month or less. Age, marital status, number of children, and living in joint or nuclear family had no impact on the psychological state and did not appear to be a factor for increased job pressure.
Factors leading to increased job pressure were also explored. Overall, the absence of career advancement was a source of moderate to very high pressure in 53% of the respondents (Table ) while working with opposite sex was causing moderate to very high pressure in 23% of respondents. Being undervalued by the department was having a similar effect on 23% of the respondent LHWs while 29% of them felt moderate to high pressure because of the things not under their direct control.
Sources of pressure in job for LHWs (item-level responses on SPJ)
Occupational Stress Indicator (OSI) was used as a measure of job satisfaction among the respondents and the mean OSI for the group was 33.96 (Table ). On a scale of 1–5, the level of job satisfaction and factors responsible were also explored. Overall, 56% of the respondents expressed very little to moderate job satisfaction. 79% reported very little to moderate satisfaction with amount of salary, 39% of the respondents reported low satisfaction with the professional skills they had while 65% had a low level of inspiration in terms of professional development (Table ).
The researchers also asked an open-ended question about the main problem the LHW faced while performing her job. Problems that were reported with high frequency (20% or more) have been shown in Figure . The most common problem reported was dealing with administrative inefficiency such as irregular supply of medicines and vaccines (70%) and not getting their salary on time. Inadequate salary was the next biggest problems reported by over 60% of the respondents. Other problems included difficulty motivating mothers and families to get their children immunized and take preventive measures, difficulty in communicating on family planning issues, non cooperative attitudes of community and inadequate information, education, communication (IEC) materials and other job aids.
Most common problems reported by the LHWs.