Peer-reviewed article

Perspectives of Anganwadi workers on early childhood mental health: A qualitative study from rural Karnataka and hilly Uttarakhand.

Nandhini A, Govindan R, Kumar CN, Kaushik K, Rajendra KM et al. · 20 Jul 2026

Abstract

Background Anganwadi workers (AWWs) are central to India's integrated child development services (ICDS) and play an important role in early childhood care and development (ECCD). However, limited evidence exists regarding how AWWs understand and respond to early childhood mental health concerns across diverse rural settings. This study explored AWWs' perspectives on early childhood mental health, including barriers, existing practices, and training needs. Methods A qualitative descriptive design informed by Sandelowski's approach was employed. Five focus group discussions (FGDs) were conducted with 35 AWWs from Belur taluk, Karnataka (n = 22), and Munsyari block, Uttarakhand (n = 13). Discussions were audio-recorded, transcribed verbatim, and analyzed inductively using Braun and Clarke's thematic analysis approach. Coding was independently undertaken by two researchers using ATLAS.ti version 9.0. Results Five interrelated themes emerged: understanding child mental health; community participation and parenting practices; innovations and training needs; operational challenges affecting psychosocial engagement; and delivery of nutrition and health services within community contexts. AWWs demonstrated strong motivation and contextual understanding of children's developmental and emotional needs; however, recognition of less visible emotional and regulatory concerns remained limited. Parenting stress, migration, economic hardship, administrative workload, geographical barriers, and limited referral pathways constrained early identification and psychosocial engagement. Participants expressed a preference for practical, skills-based training and simple referral guidance integrated within routine ICDS activities. Conclusion AWWs occupy an important position within rural early childhood care systems. The findings suggest that practical, context-responsive training and clearer referral pathways may strengthen the early identification and support of children with developmental and emotional concerns in rural settings.