"We Are Tired of Explaining": Communication Practice and AI Roleplay Training for Community Health Workers in Rural India

Abstract

Community health workers (CHWs) in the Global South increasingly encounter AI-powered tools, yet the counseling work central to their role remains largely unsupported. We study communication practices among Accredited Social Health Activists (ASHAs) in rural Rajasthan, India, through simulated family-planning calls, semi-structured interviews, and an LLM chatbot roleplay design-probe with 20 participants. In calls, ASHAs often responded to social or material concerns by shifting to health-risk information, denying concerns, promising unspecified help, or listing medical solutions with limited explanation. A smaller set of responses instead engaged concerns, sought permission before involving family members, or left decisions with beneficiaries. We interpret these patterns through Motivational Interviewing, emphasizing restraint from correcting, persuading, or over-solving. Drawing across observed calls, interviews, and probe reactions, we derive design considerations for AI roleplay training: keep AI in a rehearsal role, provide descriptive rather than prescriptive feedback, and evaluate counseling process rather than agreement with prescribed responses.