Asakti-Anasakti as mediator of emotional labor strategies & burnout: a study on ASHA workers.

Pandey, Jatin ; Singh, Manjari

In this study the authors borrow the concept of anasakti (non-attachment) and asakti (attachment) from the Indian philosophy of Anasakti Yoga to explain the relation between two emotional labor strategies of surface and deep level acting and burnout for accredited social health activists (ASHA workers or ASHAs).Emotional labor and burnout are widely associated with jobs that involve high customer interaction. Community health workers when interact with people have similar work requirements. Asakti-Anasakti are regarded as bi-polar emotional states wherein an individual high in asakti forms emotional attachments more quickly as compared to a person who is high in anasakti. Results from 116 ASHA workers bring forth that Asakti-Anasakti mediates the relationship between emotional labor strategies and burnout.

Introduction

The quality of the health care services delivered by community health care workers depends on the interaction between the caregiver and the caretaker similar to the service delivery in case of frontline employees and customers (Berry, Zeithaml & Parasuraman, 1985; Zeithaml, Bitner & Gremler, 2006). Customer is present at the time of service creation and delivery, this is in contrast to a product rich setting where a customer might not be present at the production site (Berry et al., 1985). In service setting the emotions displayed by employees have implications for customer satisfaction (Tan, Foo& Kwek, 2004) and in successful service delivery, therefore, emotions become an important factor in the health care service delivery.

Healthcare workers are in close proximity of people for delivering healthcareservices; this makes their job rich in "people work" and therefore emotionally taxing through the performance of emotional labor (Maslach & Jackson, 1984). This close proximity also warrants them to display and/or suppress specific emotions that are desired for successful service delivery (Ashforth & Humphrey, 1993; Smollan, 2006). This tussle between felt and projected emotions gives rise to emotional labor which is communicated by the strategies of surface level acting and deep level acting (Brotheridge & Lee, 2003). The emotional state of these health workers decides which strategies would be used by them and, thus, will be associated with outcomes like burnout.

Scholars have tried to find the relevance of Indian philosophical thought in the domain of management e.g. congruence of Nyaya Sutras to modem theories of management (Pandey & Singh, 2015a) and application of Sankhya philosophy in managerial decision making (Pandey, Gupta & Naqvi, 2016).We look into classical Indian texts for concepts and constructs that could refine this relation. Asakti and anasakti are two emotional determinants drawn from classical Indian philosophy of Anasakti Yoga (Gandhi, 1946). Asakti can be loosely translated as attachment and anasakti as non-attachment. We propose that asakti or anasakti levels in an individual mediate the relation between emotional labor strategies and burnout.

Emotional Labor

Emotional labor is the "process of regulating both feelings and expressions for the organizational goals" (Grandey, 2003: 97). It has also been referred to as "the process by which workers are expected to manage their feelings in accordance with organizationally defined rules and guidelines" (Wharton, 2009:147). Care and concern that a nurse shows to patients and a doctor's interaction with critical patients are examples of emotional labor in action. A bad mood, bitter experience, personal loss, etc. should not ideally affect their behavior with patients but, human emotions take its toll when there is a tussle between perceived and projected emotions. This tussle gives rise to the effort on their part to display desired emotions which can be seen as emotional labor. Like a sculptor needs physical effort to carve a stone similarly a community health worker needs psychological effort to carve a positive image in the minds of the beneficiary.

ASHA Workers & Emotional Labor

Accredited social health activists (ASHAs or ASHA workers as they are called in India) are community health workers instituted by the Government of India's Ministry of Health and Family Welfare as a part of the National Rural Health Mission. ASHA workers are indeed augmentation to the existing human resources of healthcare workers to reach villages (Paul et al., 2011; Reddy et al., 2011). By 31st March 2015, there were approximately 9,04,195 ASHA workers (National Rural Health Mission, 2014). Selected from their villages and accountable to their village they are women who are trained to work as an interface between the community and the public health system. Their major job roles are counselling women before, during and after delivery on health practices and precautions and care of the young child(About Accredited Social Health Activist (ASHA), 2014).

In the case of ASHA workers, the goal of the organization is the betterment of people who are being served by these workers. The beneficiaries of the health care services are either children or people who are unwell; therefore, there is an expectation of the display of appropriate emotions and the suppression of inappropriate emotional displays (Smollan, 2006). Certain emotions that are expected from community health workers like concern, empathy, etc. are vital, but suppression of others like anger, irritation, etc. are also essential in the interaction with sick people (Groth, Hennig-Thurau, & Walsh, 2009).

Emotional Labor Strategies

When emotional labor is expressed through deep acting employees change their inner felt emotions to the ones that are required in the job whereas in the case of surface acting inner feelings are not disturbed (Grandey, 2003; Hochschild, 1983). In the service script surface acting is more concerned with management of the visible aspects of emotion like expression, tone etc. whereas in deep acting, employees try to identify with the role (Zapf, Vogt, Seifert, Mertini & Isic, 1999). Empathy towards sick by an ASHA worker indicates deep acting whereas just sympathy expressed through words indicate surface acting.

Burnout

Hochschild (1983) suggested that burnout is one of the outcomes associated with the performance of emotional labor. It has become very popular and well-known metaphor for human service workers like nurses (Kristensen, Borritz, Villadsen, & Christensen, 2005). Recent studies broaden this horizon to include other groups like managers, students, etc. who are exposed to chronic stress (Rholetter, 2013). Erickson and Ritter (2001) found that emotional labor acted as a predictor of burnout. Researchers have used the meta-analytic technique to estimate a positive relation between emotional labor and burnout(Bono & Vey, 2005). These studies bring to light the importance of this construct. Deep acting lead to fusion of self and work role which leads to increment in the risk of burnout (Wharton, 1999).However, surface acting does not entail fusion of self with work role therefore would not result in burnout.

Emotional State& Emotional Labor

In case of service delivery, the emotional state of the service provider (ASHA in our case) would have an enormous impact on the strategy employed for putting in emotional labor. A study on leadership, emotional labor and personality indicates that employees' openness to experience weakens the relationship of deep acting to other work-related outcomes (Wu & Hu, 2013). Neuroticism was associated more with surface acting, and less with both deep acting and job feedback whereas job feedback fully mediated the relationship between neuroticism and deep acting (Hong et al., 2012). We see that the individual's psychological make-up is made through her/ his emotional states and this emotional state is a major interface when a person interacts with others. We, therefore, propose a link between emotional states arising out of asakti-anasakti and emotional labor strategies.

Asakti-Anasakti: Theoretical Framework

Anasakti is a Sanskrit word which when loosely translated to English would mean non-attachment and asakti would mean attachment. Western psychology encompasses attachment to have a positive connotation (Sahdra, Shaver & Brown, 2010) but in the Indian context a deeper analysis brings in traits like non-attachment, equipoise, selfless duty orientation, and effort in the absence of concern for the outcome into the personal who is high on anasakti (Banth & Talwar, 2012). Similarly non-attachment does not include ignorance, cruelty and indifference (Ghosh, 2005). Indian spiritual tradition consider anasakti as a personality variable (Shaw, 1995) . Also the relative stability of the reflected characteristics that can be measured in terms of set of attributes of these variables gives support for as akti-anasakti as personality variables (Pande & Naidu, 1992). We consider asakti and anasakti as emotional states that arise out of the personality make-up of the individual.

[FIGURE 1 OMITTED]

Asakti-anasakti are regarded as bipolar points of an emotional continuum (fig. 1). The characteristics change as one moves from one end of the continuum to the other, mainly there exist a mixture of the two poles in ambivalent behavior (Bhushan, 1996). Higher anasakti in a person makes her/him accept situations without giving them negative reaction. Anasakti reflects the constant state of mind that observes the nature of events and remains unaffected (Banth & Talwar, 2012), it is free from attachment as well as aversion i.e. it transcends both of these states. It is not a state where desire or goals do not exist (Agrawal & Jaiswal, 2013), and the individual is not able to perform his/her job. The job is performed without the employee getting fixated to the job process. In case of frontline employees, the plight of the customer will not induce similar deep level emotions in the service personnel but it would not inhibit from her/him to do her/his job as well. Anasakti dominated person shows benevolence and broadmindedness whereas asakti dominated individual is attracted towards people and objects with expectations which often results in frustration and mental problems (Bhushan & Jha, 2005).

Researchers have identified the characteristics of anasakti as emotional equipoise in the face of success or failure, a relatively weak concern for obtaining extrinsic rewards, and an intense effort to achieve excellence (Banth & Talwar, 2012), emphasis on duty, absence of hedonistic compulsions, attention control, present orientation, lack of social approval/ comparison, non-attachment of material possession (Naidu & Pande, 1990). High asakti can be identified with emotional states of type A personality and positively correlated with insecurity, depression, anxiety and hostility (Tripathi, Naidu, & Biswas, 1993). In a nutshell anasakti deals with acceptance of ups and downs of life without psychological dependency on any situation or outcome, it is the key to happiness (Agrawal & Jaiswal, 2013).

[FIGURE 2 OMITTED]

Test for asakti-anasakti (TAA) is used to measure an individual's asakti and anasakti levels in our study. A person scoring high in this test is said to be more asakta or attached whereas a lower score indicates anasakti or non-attachment. An attached individual i.e. higher on asakti will form bonds more easily with customers and use deep level acting to perform emotional labor whereas an individual higher on anasakti will display emotional labor through surface level acting and not get emotionally involved with customers. Based on the discussion on emotional labor strategies and asakti-anasakti framework we propose the following:

Hypothesis 1: TAA scores will mediate the relation between surface acting and burnout

Hypothesis 2: TAA scores will mediate the relation between deep acting and burnout.

The proposed model is given in fig.2.

Method Research Design & Participants

Initially, we conducted interviews to see if the jobs of ASHA workers involved emotional labor. We found that their work did entail emotional labor when they counselled people and especially when they dealt with pregnant women. Many times the work these women do which is, in fact, emotional work is unrewarded and unrecognized because of its association with the domestic sphere of work, in effect women disappear from view as emotional laborers (Bolton, 2009).We then designed a survey instrument and personally administered the instrument to 125 women Asha workers in villages in difficult geography (Ghanshala, Pant & Pandey, 2013; Pandey & Singh, 2015b) of Almora district of Uttarakhand, India. Since the respondents were Hindi speaking we needed the questionnaire to be in Hindi. Test of Asakti-Anasakti is originally in Hindi and was used as such. The items for surface and deep acting were translated to Hindi by a bilingual, a back translation of these measures in English was done, and it was found to be similar. After slight changes in language, the Hindi questionnaire was given to two experts for content validity and to 5 ASHA to interpret the items for face validity.

We received 116 (92.8% response rate) usable questionnaires back that were used in the analysis. ASHA stands for Accredited Social Health Activist. These women are involved in the promotion of community health services in rural India. Their work entails close connection with people and counselling them on health issues. This involves close contact with people and emotional commitment from the end of ASHA workers. The mean age of the sample was 32.17 years with a standard deviation of 7 years. All of them were married. 92(79.31%) of them had completed high school or less, 21(18.1%) had completed intermediate, 3(.03%) had a agraduate degree.

Measures

Established scales were used in the study with slight modification and translation. Asakti-Anasakti was measured through the test of Asakti-Anasakti (Bhushan & Jha, 2005). Test of Asakti-Anasakti (TAA) measures attachment-non-attachment as bipolar personality disposition. It has 40 items having high DP out of which 10 are negative (e.g. "I am contended in all situations", "I like hearing my praises"). The scale is anchored on 4 points (1 = Never, 4 = Always).This test has shown to possess high reliability and predictive and construct validity. Cronbach's Alpha was 0.95

Surface level and deep level acting was measured by the eight-item measure of surface level and deep level acting developed by Grandey (2003). The stimuli statement for this section read: "In order to do your job effectively, how much do you do the following behaviors?" Surface acting was measured through five items (e.g. "Fake a good mood", "Just pretend to have the emotions I need to display for my job") whereas deep acting was measured through three items (e.g. "Work hard to feel the emotions that I need to show to others").Cronbach's Alpha for surface acting was 0.88 and for deep acting it was 0.79.

The measure of burnout was the contextualized version of the Copenhagen Burnout Inventory (CBI). We used the work related burnout measure from the inventory. Work related dimension has been defined as "the degree of physical and psychological fatigue and exhaustion that is perceived by the person as related to his/her work"(Kristensen et al., 2005: 197). Work related dimension of burnout had seven items (e.g. "is your work emotionally exhausting?" "Do you feel that every working hour is tiring for you?") Cronbach's Alpha was 0.90.

Analysis

To test the mediation effect regression analysis was conducted using the Baron and Kenny's (1986) approach. Three regressions are done to test each mediation. First, the independent variable (surface acting/ deep acting) should predict the mediator (TAA scores). Second, the independent variable should predict the outcome variable (Burnout). Third, the mediator variable should predict the outcome when the initial independent variable is included in the equation (Baron & Kenny, 1986).Before proceeding for regression analysis, we tested the data to check their conformity to regression requirements.

Results

Table 1 presents the means, standard deviation, and zero-order correlations for the study variables. Deep acting has higher mean value = 4.31 and standard deviation 1.74 as compared to surface level acting with mean value = 3.43 and standard deviation = 1.68. Burnout has a mean value = 4.13 with standard deviation = 1.53. TAA scores had the highest mean (102.75) and standard deviation (33.88).

All correlations are significant at p [greater than or equal to] .001 level. Surface acting is negatively related to deep acting (r= -0.360), burnout (r = -0.442) and TAA scores (r = -0.532).Deep acting is positively related to TAA scores (R = 0.667andburnout (r = 0.474). TAA score are positive related to burnout (r = 0.716)

Table 2 shows the regression analysis results to test mediation for surface acting and burnout. To test all conditions of mediation three regressions were evaluated. Model 1 first showed that surface acting had a significant effect on burnout (F = 27.738,p < 0.001, b = 5.516, [R.sup.2] = 0.196). Model 2 showed that surface acting had a significant effect on TAA scores (F = 45.093, p < 0.001, b = -10.714, [R.sup.2] = 0.283). In Model 3 TAA score was added to surface acting. Our results showed that TAA predicted burnout (F = 60.758, p < 0.001, b = 0.030, [R.sup.2] = 0.518) and the effect of surface acting on burnout was not significant. The results indicate that at a significance level of 0.001, there is a complete mediation of TAA scores on the relationship between surface acting and burnout.

Table 3 shows the regression analysis results to test mediation for deep acting and burnout. To test all conditions of mediation three regressions were evaluated. Model 1 first showed that deep acting had a significant effect on burnout (F = 91.57, p < 0.001, b = 12.96, [R.sup.2] = 0.445). Model 2 showed that deep acting had a significant effect on TAA scores (F = 36.099, p < 0.001, b = 0.449, [R.sup.2] = 0.241). In Model 3 TAA score was added to deep acting. Our results showed that TAA predicted burnout (F = 67.279, p < 0.001, b = 0.035, [R.sup.2] = 0.551) and the effect of deep acting on burnout was not significant. The results indicate that at a significance level of 0.001, there is a complete mediation of TAA scores on the relationship between deep acting and burnout. Sobel test was conducted to evaluate the significance of the indirect effect of surface and deep acting on burnout. The test showed that there is a mediation effect of TAA scores in case of the relationship of surface acting with burnout (Sobel test: Z = -5.29 p < 0.001) and deep acting and burnout (Sobel test: Z = 6.196, p < 0.001). Thus, the hypothesis 1 and 2 are supported.

Given the theoretical possibility that TAA scores might moderate the effect of deep acting and surface acting on burnout, we tested for the moderation effect. Following Baron and Kenny (1986), we found that the interaction term was not significant in both cases of surface and deep acting. The results did not support the moderation effect of TAA scores on the effect of both deep acting and surface acting on burnout.

Discussion

The sample in this study has special significance due to the characteristics of ASHA workers who are women, married/ divorced community health care workers who do not possess high educational qualification but still are critical to health care delivery for large population. The results show that the levels of asakti-anasakti make-up of an individual fully mediate the relationship between emotional labor strategies and burnout. The positive relation between surface acting and TAA scores show that surface acting is associated with higher anasakti (non-attachment) whereas the negative relation of deep acting with TAA scores indicates that it is associated with higher asakti (attachment). The negative relation between TAA scores and burnout indicates that as levels of the asakti rise in an individual so does burnout and this relation is the inverse for anasakti.

Theoretical implications

Conservation of resources (COR) theory argues that building rewarding social relations is the most important way that people can (re)gain resources (Hobfoll, 1989). In our case ASHA workers are presented with emotional demands of their work like displaying pleasant behavior to pregnant women, listening and showing sympathy to the sick etc. to which they deal with the expenditure of their resources (i.e., effort in performing surface and deep acting) in anticipation of generating rewarding relationships.

Common relationships that involve exchange have built in emotions to some degree. The social exchange process is thus laden with emotions. Cultural normative approach to this exchange context that outlines the type of emotions to be expressed in a situation in visible or public manner (Lawler & Thye, 1999). In case of ASHA workers, it is the display of emotions as done by nurses for patients form a reference.

According to social identity theory identification with role acts as a moderator for effects of emotional labor; there is a simulation to identify with the role by internal (psychological) and external (organizational) pressures (Ashforth & Humphrey, 1993). In case of ASHA workers deep acting leads to strong psychological identification with their roles thus a high level of the asakti generation which in turn leads them to burnout.

The fit between the person and work environment in service setting is crucial as it affects work behavior and attitudes (Lauver & Kristof-Brown, 2001). Theory of work adjustment links this person-environment fit to important outcomes like satisfaction, tenure, and career success (Bretz Jr & Judge, 1994), job involvement and organizational commitment (Blau, 1987). A fit between the employee's characteristic and those of work environment thus must be in sync for the effective and efficient service delivery. In a service setup the work demands for emotional labor must be supplied by individuals capable in this exercise, therefore the choice of deep and surface level acting must be dictated by work and hence there must be conscious hiring strategies by firms to select those individuals who possess the emotional make-up to display these emotional labor strategies. TAA makeup can be an important factor to decide on the recruitment and selection of these employees.

Managerial Implications

The recognition of the emotional nature of care that is imparted by the ASHA workers constitutes a vital link to added professional development and to tailor-made HRM for the care professions (Prins, 2008). It can be a tool for recruitment and proper training for inculcating desired behavior and limiting undesired outcomes of emotional labor, further training programs can be designed to alter the emotional labor strategies to cater to organizational requirements. Researchers state that hard educational criteria alone should not be the basis for selection of ASHA workers and soft criteria like aptitude, motivation, communication skills, leadership qualities, etc. must also be taken into account (Bajpai & Dholakia, 2011). TAA can be a tool for recruitment and proper training for inculcating desired behavior and limiting undesired outcomes of emotional labor, further training programs can be designed to alter the emotional labor strategies to cater to organizational requirements. A well trained ASHA worker can enhance the effectiveness and efficiency of the "Health care for all" program. Further, the findings can be of utmost importance to developing countries where community health workers could be the way forward to expand the supply of health care services to weaker sections of society.

Conclusion

The study brings forth the effect of a construct borrowed from Indian philosophy to explain a construct predominantly generated by western management thought. Asakti-Anasakti or the attachment-non-attachment framework explained the two emotional labor strategies of surface and deep acting. These findings have implications for both theory and practice. On theoretical arena it highlights the use of Indian constructs in management arena to aid and assist in theory building whereas on a practical front it shows use of tests like TAA to being helpful in explaining the relation between emotional labor strategies and burnout. The present work also points to theoretical anchors upon which further researches can be built upon thus there is ample scope for eastern doors to offer insights from western windows (Sharma, 1996). The limitations of this study can be mitigated by a larger sample across countries comprising different professions. Further male community health care workers can be included for better generalization.

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Jatin Pandey (E-mail:jatinp@iimahd.ernet.in) & Manjari Singh (E mail:manjari@iimahd.emet.in) are from Indian Institute of Management Ahmedabad

Table 1 Mean, Standard Deviation, Cronbach's Alpha
and Zero-Order Correlation among Variables

                 Mean      SD    Deep Acting

Deep Acting      4.30   1.744        (0.789)
Surface Acting   3.43   1.827     -0.360 ***
Burnout          4.13   1.534      0.474 ***
TAA Scores                         0.667 ***

                 Surface Acting    Burnout    TAA Scores

Deep Acting
Surface Acting          (0.878)
Burnout              -0.442 ***     (0.90)
TAA Scores            -0.532 **  0.716 ***        (0.95)

N=116 *** p<.001, ** p< 0.01, SD=standard
deviation, Cronbach's alpha in parenthesis

Table 2 Results of Regression Analysis for Mediation Test for Surface
Acting.

                         Model 1      Model 2         Model 3

                      TAA scores      Burnout         Burnout

[R.sup.2]              0.283 ***    0.196 ***       0.518 ***
Independent Variable
Surface Acting       -10.714 ***   -0.403 ***   -0.077 (n.s.)
Mediator Variable
TAA Scores                                          0.030 ***
F                      45.09 ***    27.73 ***       75.51 ***

Standardized beta weights are shown. n.s.: not significant *** p<.001

Table 3 Results of Regression Analysis for Mediation Test
for Deep Acting.

                          Model 1      Model 2          Model 3

                       TAA scores      Burnout          Burnout

[R.sup.2]               0.445 ***    0.225 ***        0.551 ***
Independent Variable
Deep Acting            12.964 ***    0.417 ***    -0.006 (n.s.)
Mediator Variable
TAA Scores                                            0.033 ***
F                      91.571 ***    33.08 ***        59.51 ***

Standardized beta weights are shown. n.s.: not significant *** p<.001