Criticism of Kant’s position on our moral relationship with animals dates back to the work of Arthur Schopenhauer and Leonard Nelson. Against this, Kantians have continued to defend Kant’s view that animals lack a moral status. Kant’s contemporary defenders have, however, highlighted extensive practical consequences for the protection of animals in favor of Kant’s position. This paper explores the argument from these extensive duties to animals in Kant’s ethics and seeks to show that Kantians underestimate essential differences between Kant and his rivals today  on both a practical and fundamental level. It also argues that those defending Kant tend to neglect theory-immanent problems in Kant’s ethics arising from unfounded value assumptions and unconvincing arguments for the denial of animal moral status. It is suggested that although the human-animal relationship was not a central concern of Kant’s, examination of the animal question within the framework of Kant’s ethics helps us to gain conceptual clarity about his duty concept and the limitations of the reciprocity argument, i.e., the notion that morality is a system of reciprocal relationships.Criticism of Kant’s position on our moral relationship with animals dates back to the work of Arthur Schopenhauer and Leonard Nelson, but historically Kantian scholars have shown limited interest in the human-animal relationship as such. This situation changed in the mid-1990s with the arrival of several publications arguing for the direct moral considerability of animals within the Kantian ethical framework. Against this, another contemporary Kantian approach has continued to defend Kant’s indirect duty view. In this approach it is argued, first, that it is impossible to establish direct duties to animals, and second, that this is also unnecessary because the Kantian notion that we have indirect duties to animals has far-reaching practical consequences and is to that extent adequate. This paper explores the argument of the far-reaching duties regarding animals in Kant’s ethics and seeks to show that Kantians underestimate essential differences between Kant and his rivals today  on a practical and fundamental level. It also argues that Kant’s indirect duty view has not been defended convincingly: the defence tends to neglect theory-immanent problems in Kant’s ethics connected with unfounded value assumptions and unconvincing arguments for the denial of animals’ moral status. However, it is suggested that although the human-animal relationship was not a central concern of Kant’s, examination of the animal question within the framework of Kant’s ethics helps us to develop conceptual clarity about his duty concept and the limitations of the reciprocity argument. To begin with a terminological note, I will introduce the distinction made by Onora O’Neill  between Historically, Kantians have shown little interest in the status of the human-animal relationship in Kant’s ethics and the view that Kant classified animals as things has been implicitly accepted. A few papers dealing with Kant’s views on animals were published in the 1970s and early 1980s e.g., ,4,5,6,7),5,6,74,5This is interesting because the critique of Kant’s views on the moral standing of animals can be dated back to Arthur Schopenhauer 1840) [40 [8], ALooking at the literature, we can see that the discourse changed significantly in the mid-1990s with the work of notable scholars like Paul Guyer (1993) , ChristiThe animal question is important for Kantians, because when we track animals in Kant’s ethics, we arrive at key questions about Kant’s axiology, concept of duty, and view of the foundation of ethics. On the other hand, the study of Kant’s ethics is likely to be fruitful for animal ethicists, given the impact of Kant’s categories and terminology on the field of animal ethics. A Kantian legacy can be detected, for example, in the division of duties into direct and indirect sorts  In recent work on Kantian moral philosophy, three kinds of strategy have been adopted in reaction to Kant’s denial of moral status to animals. (a) The theory-immanent approach retains the main pillars of Kantian ethics. It argues that Kant was mistaken in excluding non-rational beings from the moral community, and that his ethical framework can accommodate an improved position on the moral standing of animals e.g., ,21,22). ,22. 21,2I wish to explore this third approach and examine the arguments for Kant’s indirect duty view, focusing especially on the allegedly far-reaching practical consequences. In Basaglia summarized several reasons why Kant’s ethics is attractive for contemporary Kantians (cf. )  —he covers a wide range of human-animal relationships and mentions several, rather extensive, duties we have regarding (in Ansehung) animals  p. 443)344])   (p. 4n Spiel)  p. 460)0als ein n Spiel) ). Kant an Spiel)  (p. 460)n Spiel) ) ..50]).According to Kant’s moral argument against cruelty, torturing animals is impermissible even if the animal is not protected by its status as the property of its owner, and even if no third party would be negatively affected. As a consequence, Kant’s position is immune from certain criticisms that have been raised against other indirect duty views. For example, the complaint that Kant’s argument is based “on fragile empirical claims about human psychology”  (p. 330)I will now argue that although the proposed human-animal-relationship conforms with what is, prima facie, contemporary common-sense morality, the conclusion that Kant can be compared to today’s animal rights and welfare theorists, or that he even goes beyond utilitarianism, is premature. The defense of Kant’s indirect duty view is not successful, because it (3.1) overestimates the moral reach of Kant’s indirect duty view, (3.2) underestimates the fundamental differences between Kant’s position and direct duty views, and (3.3) fails to provide a satisfactory argument showing why humans are allowed to use animals as mere means in general . It would be beyond the scope of this paper, and against the intention of the author, to defend an alternative view of the way the moral status of animals can be justified. Nevertheless, the reader will find in-depth enquiries in support of moral status for animals in the following works: Kantianism and animal rights: ,33,34,53(3.1) First of all, it must be mentioned that in spite of its historically progressive practical implications, and despite the presentation of it given by its defenders, Kant’s account differs markedly at the practical level from today’s rival accounts. The animal rights view formulated by Regan  leads inEqually, in the utilitarian tradition, the “principle of equal considerations of interests” requires us to consider and weigh the interests of humans and animals impartially. As Singer famously says, “an interest is an interest, whoever’s interest it may be”  (p. 20).indirectly to a human being’s duty with regard to these animals; considered as a direct duty, however, it is always only a duty of the human being to himself”  or Parespect”  (p. 76).respect” )   Finally, I want to mention a further point at which I think the contemporary defense of Kant’s indirect duty view should be challenged. Even if philosophers have good reasons to prefer Kant’s ethics and Kantianism over utilitarianism, contractarianism, virtue ethics, and other approaches, when it comes to the human-animal relationship and its underlying axiology, it remains true that Kant’s position is not only at odds with twenty-first century science, but also insufficiently supported by argument. It will not be possible here to discuss this topic in depth, and to offer an alternative view, but my aim is to show that Kant’s position on the human-animal relationship should not be taken for granted and simply assumed to be sound.The twin premise that animals “have value only relative to human needs and desires, or relative to the ends that human being freely set for themselves”, followed by the conclusion that animals can be treated merely as means to human ends (Altman  followinHomo sapiens) are, like every other species, an arbitrary product of evolution. According to the theory of evolution, no scala nature, with humans on top and all other species below, exists. The teleological view Kant presents in the Conjectures on the Beginnings of Human History )(2) Only one thing has to be noted: Whatever differentia specifica is mentioned by Kant—self-consciousness, rationality, or moral autonomy (and this last is the most precise)—it is an open question whether this has, inevitably, to result in a relationship of domination where animals are no more regarded “as fellow creatures, but as means and instruments to be used at will for the attainment of whatever ends he [man] pleased.”  (p. 114)(3) The essential idea of the reciprocity argument is that morality consists of reciprocal relations of obligation that obtain between persons. Every (human) autonomous being is, at the same time, a legislator , as well as a subordinate , of the moral law  , or that a specific relationship obtains between autonomous beings (where ethics is concerned). About the relationships with other beings here—with passive citizens or with animals—it is impossible to draw further conclusions, or to establish a value theory.This is often overlooked by Kantians, because autonomy—the crux and the cornerstone of Kant’s moral philosophy—has a minimum of three different functions, and these are difficult to distinguish and easily confused. First, it is autonomy that provides the groundwork for morality  , and that the kingdom of ends consists of reciprocal relationships between autonomous beings—Kant needs two additional arguments. He needs to show, first, why every other entity has only instrumental value for autonomous beings, and second, why autonomous beings have a right to treat animals and other non-autonomous beings as mere means.It has to be acknowledged that Kant does not provide a convincing argument showing why animals  lack moral status. His arguments penetrate only so far—they only allow him to describe relations between autonomous beings. This means that the Kantians who maintain that Kant’s indirect duty view is sufficient, at a practical level, have no foundation for their view. What we need are better explanations: Why is the strict distinction between persons and things accurate? Why should we accept that animals have merely relative value, and specifically value to persons? Moreover, why should we assume that animals are on earth simply to serve human ends? However, neither the argument from reciprocity nor the regress argument can be utilized successfully here. Regrettably, Kant’s moral reflections focus on morally autonomous beings, but have little to say about our relation to the non-autonomous world.It must be borne in mind that, although the human-animal relationship was not a central concern of Kant’s, examination of the animal question within the framework of Kant’s ethics leads us to think more carefully about central arguments and concepts in Kant’s moral philosophy, including the regress argument invoked in the development of the formula of humanity, the reciprocity argument, and the relationship between members of the kingdom of ends and the highest duty of all. The interface between Kant’s ethics and contemporary animal ethics encourages us to develop improved conceptual clarity about the nature, and limits, of Kant’s duty concept, and about the focus of, and blind spots in, Kant’s moral philosophy. The “animal question” should not be regarded as a side issue in Kantian moral philosophy  (pp. 48


To the extent that severe and lasting anorexia nervosa (SE-AN) is defined in terms of refractoriness to the best treatments available, it is mandatory to scrutinize the proven effectiveness of the treatments offered to patients. The array of so-called current evidence-based treatments for anorexia nervosa (AN) encompasses the entire spectrum of treatments ranging from specialized brand-type treatments to new treatments adapted to the specific characteristics of people suffering from AN. However, after several randomized control trials, parity in efficacy is the characteristic among these treatments. To further complicate the landscape of effective treatments, this “tie score” extends to the treatment originally conceived as control conditions, or treatment as usual conditions. In retrospection, one can understand that treatments considered to be the best treatments available in the past were unaware of their possible iatrogenic effects. Obviously, the same can be said of the theoretical assumptions underpinning such treatments. In either case, if the definition of chronicity mentioned above is applied, it is clear that the responsibility for the chronicity of the disorder says more about the flagrant inefficacy of the treatments and the defective assumptions underpinning them, than the nature of the disorder itself. A historical analysis traces the emergence of the current concept of “typical” AN and Hilde Bruch's contribution to it. It is concluded that today's diagnostic criteria resulting from a long process of acculturation distort rather than capture the essence of the disorder, as well as marginalizing and invalidating patients' perspectives. It is the theory that describes what we can observe.Albert Einsteinsevere and enduring anorexia nervosa (SE-AN) underscores that a substantial number of AN patients are refractory to currents treatments and become chronic (Chronicity is refractoriness of illness—permanence of the disease state in spite of repeated exposures to state-of-the-art therapy.” (p. 487). However, as Wonderlich , but the implicit message is that intractability is due to the inherent complexity of the essence of AN in these patients. The SE-AN label has been applied to patients with an active disease of 5–10 years in duration  in September of 1984, Gerald Russell remarked on the increase in the number of scientific publications on anorexia nervosa and bulimia in Medlineiduals” In recent years there has been a shift in emphasis on the nature of the central psychopathology of anorexia nervosa, with a greater stress on the patient's morbid preoccupation with her body weight and her dread of fatness. Hilde Bruch was probably first in 1962 to refer to a ‘disturbance of body image’ as part of a more general ‘perceptual and conceptual’ disturbance” (p. 103).This call for professional responsibility highlights the configurative role of clinical and research activity on the psychopathological profile of AN patients. As Gerald Russell mentioned regarding BID: “comments indicating concern about the shape of the body are rare in case reports before the forties, but then become the rule” (p. 3).The appearance of the BID construct was a hiatus, rather than an evolution in the conceptualization of self-starvation. In the 1940s, due to the differentiation of AN from Simmond's disease –15, therThis new endeavor was mainly colonized by the clinical descriptions of psychoanalysts after intense psychoanalytic treatment. This aspect is crucial since the golden rule of psychotherapy states that to work together, both patient and therapist must share a common language. Cases of AN are characterized by the stubbornness of teenagers in recognizing their illness, and adult therapists who impose their preferred specialized language on patients in line with their training. However, the therapist's language emanates from an underlying theory that, as Einstein said, not only tells the therapist what to observeIn all cases I have seen, behind the trivial excuses offered lurks a fanatical desire to be thin and a dread of obesity. Miss M. said: ‘I am terrified of getting fatter or even of not getting thinner.’ The psycho-analytic interpretation of this state of mind would regard fatness as the sign of indulgence in the pleasures of the mouth and that the intense guilt associated with these impulses must be penalized by starvation and purgation. Such mechanisms can be brought to light in analytic investigation of these patients, but their restoration to consciousness does not seem to produce an amelioration of the condition as in other compulsive states” (p. 158). A decade later aspects such as the “fear of gaining weight and a horror to becoming fat” bility” low-up” .ntions” under a new category of body image disorders, together with other mental illnesses in which body image is the dominant feature, such as BN, body dysmorphic disorder (BDD), and muscle dysmorphia (MD)” .DSM-III was released . In the first case of AN described in detail in the literature, Lasègue (tends to increase the aptitude for movement” (p. 266), and also early in the literature Janet acknowledged the negative impact of excessive activity upon eating when he stated that “The exaltation of the strength, the feeling of euphoria, as it is known in the ecstatic saints, for instance, does away with the need of eating” . powers” mptoms” rbance” omfort” strium” atment” f food” omfort” Interestingly, the same gastrointestinal complaints have been consistently mentioned by atypical AN patients , 133. LiIndividuals with anorexia nervosa deny their weight phobia, since general awareness of it would lead to their being considered by others as more responsible for their condition than is usually the case and would render them more vulnerable to outside influence by inviting much closer scrutiny of their motives and habits. Thus only a few anorectics are referred with an explicit history of postpubertal concern about their volume and shape, their dieting and weight phobia. The presence of weight phobia or shape or volume phobia and the overriding terror of fatness, within the context of low body weight and its attendant features described above, is pathognomonic of anorexia nervosa” (p. 687).Nevertheless, digestive discomfort is often seen as an excuse for hiding fear of fatness. This is another example of invalidation of the patient's own experience despite the fact that up to 16% of AN patients have gastric ulcers . PerhapsA history of ‘voluntary dieting’ probably depends on the intelligence of the patient, her ability to rationalize, and her willingness to discuss her symptoms, no less than on the psychiatrists' zeal in searching out ‘motives’”(p. 413).However, to unveil these alleged pathognomonic symptoms referred to by Crisp requires substantial collaboration from patients, which leads to the question as to how this task is accomplished. First, during the clinical examination the clinician could attempt resolutely to discover the BID that fueled the patients' relentless pursuit of thinness. Kay and Leigh  already Furthermore, in addition, patients are usually required to complete a certain number of paper-and-pencil self-reports in face-to-face interviews where patients are again invited to reveal in writing their beliefs and attitudes (is it that they weren't pathognomonic?), these patients are not prone to disclosing their inner thoughts either verbally or non-verbally.Nevertheless, if the previous strategies proved to be unsuccessful there was still the option of psychotherapy. These strategies involved reversing the burden of proof where it was almost impossible for patients to prove their innocence under the ubiquitous suspicion of denial.indoctrination is not used here in a pejorative sense but to highlight the active role of mental health professionals.Undoubtedly, it is during treatment, especially when it involves hospitalization in eating disorder clinics, where the therapeutic culture and contagion from other patients push BID into the open. Though the cultural shaping of the treatment context is inevitable, the absence of a clear boundary between education and indoctrination is relevant in anorexia nervosa, particularly in terms of the patient's age, given that in the case of “early onset” or “onset in infancy” patients lack the possibility of critically examining the therapy rationale. In this sense, the term Even when directly queried about shape and weight concerns during these first two treatment episodes , Ms. A minimized their relevance to her long-standing pattern of restrictive eating. It was not until her third admission that Ms. A began to endorse body image disturbance actively” (p. 17). Moreover, the authors acknowledged that “It cannot be ruled out that simply hearing other patients talk about their own poor body image or hearing clinicians target body image concerns in both group and individual therapy may have contributed to the initial development or increased salience of such concerns as legitimate rationales for food refusal” (p. 18). Nonetheless, Thomas et al. .This is well-documented in Thomas et al.'s  report os et al.  conclude reports –141 sugg reports  report oThe most interesting clinical observation that we could add here relates to the effect of placing such individuals in a group therapy treatment program primarily attended by women with classical North American anorexia nervosa. The inevitable outcome seems to be that over the course of 2 months the women of Chinese or Indian origin acculturate to the dominant culture of the program, gradually abandoning their original rationale for food avoidance and developing a fear of fatness, a drive for thinness, and body image distortion! It is of course not certain that this represents an improvement, although it does allow for a more homogeneous group” (p. 13).More “spontaneous” migrations toward the typical presentation of AN in North America were reported by Woodside and Twose  in the fNorth American AN, but also the widespread North American culture inspiring the BID rationale in the treatment of AN patients.It appears that in the Eating Disorders Program at the Toronto General Hospital what was typical was not just patients displaying the classical I'm still not entirely sure why that is and I could be way off the mark, but I suspect that having significant chunks of my treatment revolve around body image, even when it wasn't currently an issue, may have partly contributed to that faulty line of thought.” This was written by a former AN patient in a blog .Zanker  was evenindoctrination would be more appropriate, appears to have been operative for decades. Thus, Crisp .This acculturation process, or perhaps the term s, Crisp  commenteNow it is a well-known fact that anorexics rarely if ever tell the whole truth, except after prolonged and positive psychotherapeutic contacts” (p. 11). Actually, in the Italian original version of her book there is a final appendix with a table showing demographic and clinical information of the 26 patients she had treated. In 14 of these cases, the duration of psychotherapy varied between 26 and 390 h, and in one case Selvini-Palazoli reported that she had lived with a patient for 4 months.Selvini-Palazzoli  gave a ha significant proportion of patients seeking treatment for ED had no or only mild concerns with body shape. This could be of surprise as body shape concerns are core symptoms of ED” (p. 7). However, the authors rule out this finding because denial “represents the main bias of this type of study and more specifically in patients suffering from AN-R.” In the second study, Pilecki et al. . However, the caution voiced by Russell . Psychotherapy is secondary, and prolonged and deep analysis is discouraged by VenablesAs for the first two treatments proposed by Déjerine and Glauckler  and Venato have been singularly unsuccessful in most patients, despite the hunger-producing effects of the insulin regime” (p. 633), and proposed the combination of insulin and chlorpromazine, also at exceedingly high doses . In a later publication, Dally and Sargant  received E.C.T., leucotomy, or insulin shock. 2 of the 3 patients who had leucotomy benefited, but the follow-up periods do not exceed three years. If, as we believe, most of these patients have personality difficulties, good long-term results following leucotomy are not to be expected. One patient gained a stone during a course of E.C.T. In another case, no improvement occurred after 15 deep insulin comas. A few had no treatment, because they either died, or else recovered, too soon. 30% received some form of psychotherapy, excluding simple reassurance and persuasion” eaders”  attains complete recovery, even without formal treatment, but about one in five suffers from a chronic disorder that carries a high risk of mortality” (p. 117). The term substantial was probably chosen by these authors as they found in their study that “The 5-year clinical recovery rates were similar for the detected and undetected cases: 61.8% versus 68.4%, respectively, for DSM-IV anorexia nervosa, and 60.1% versus 69.5%, for broad anorexia nervosa” [. This finding corroborated a study in Adelaide, Australia, “where many patients make a good recovery without accessing to specialized treatments of any kind.” In fact, receiving treatmentdid not alter long-term outcome either as predicted by variables gathered at recruitment, or by combination of initial and 6-month variables” [. It is easy to agree that at a behavioral level AN patients act “as if” they were deeply invested in a relentless pursuit of thinness. Historically, the egosyntonicity of weight loss in AN patients has been documented, as aptly reflected by the German term magersucht for anorexia nervosa. However, this commitment to thinness has been equated to other allegedly synonymous actions that go beyond simple avoidance to putting on weight such as weight phobia, fat phobia, or intense fear of gaining weight or becoming fat, as stated by Rieger et al.  much greater than that elapsed since the original BID formulation until today (1962–2020). Similarly, current conception of typical AN conveys the suspicion of denial and concealment in cases where the patient experience does not conform to the report expected by doctors and researchers. This atmosphere of pressing acculturation is as unrecognized as the responsibility of clinicians and researchers spreading it widely through scientific literature and mass media and thus approaching susceptible people like Russell pointed out . Seen frLikewise, with hindsight, it is easy to consider that some of the treatments in the past considered the best treatment available see  were unaPrimum non nocere. Only time will probably give us the answer. In the meantime, as Freeman Dyson encouraged (As for the state of the art of current treatments, the qualifier “evidence-based” means weak evidence as we are still far from reaching the criterion of strong evidence. The “Dodo Bird” verdict defining the current landscape of psychosocial treatments in AN depicts our repeated failures in the development of an effective treatment for AN . We shoucouraged , we shouBoth authors made equal contributions to the manuscript and approved it for publication.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.


To date, research has been undertaken to reveal factors contributing to learners’ second/foreign language (L2) speaking and/or learning at particular points in time in separate studies from cognitive, affective, and socio-cultural perspectives as individual variables. Nonetheless, little research has concurrently investigated L2 speaking with the same cohort of learners as participants from these perspectives in a single study, to obtain comprehensive and systematic understandings of how the three dimensions of factors work together in influencing individuals’ L2 speaking. This study, utilizing  To be able to communicate is most often the ultimate goal of learning a second/foreign language (L2). Nevertheless, most people are rarely able to speak an L2 with the same degree of, or even close to, the same level of their first languages . An undeTo fill such a research gap, this study, within Cognitive perceptual processing systems in Apart from the pioneering investigation into cognitive fluency , how othIn addition to the above cognitive dimensions pertaining to speech production, age of acquisition is another critical factor that has been broadly examined for its impact on L2 learning, development, and attainment . To be sMotivation to communicate, as an affective dimension of In line with motivation to communicate, Although a considerable number of studies have examined the impact of various motivations  on L2 learning and use, the influences of other affective factors such as anxiety and self-efficacy on L2 speech production also worth mentioning. In effect, anxiety and self-efficacy have been long recognized as prime factors determining individuals’ L2 learning and use. For instance, Related to the concept of positive psychology is the notion of self-efficacy, which forms part of the learners’ perceptions of how to achieve success . SardegnThe social dimension of One line of such research has qualitatively examined how learners’ interaction in the study-abroad context contributes to their L2 development . For example, Another line of research into the influence of studying abroad on L2 development, on the other hand, was explored through quantitative methods. Apart from the contextual influence, the cultural impact, particularly through the lens of culture interest, on L2 learning and speaking has also been reported. For example, Multilingualism and bilingualism are two generic terms referring to the phenomenon of speaking and understanding two or more languages. Bilingualism, in a narrow sense, includes two languages , and in Multilingualism has drawn increasing attention in recent years not only due to the fact that “multilingualism is as pervasive in the world today as it has always been” , p. 24 bHow do cognitive, affective, and socio-cultural factors contribute to multilinguals’ L2 Chinese speech performance and production ability development?It can be drawn from the above theoretical framework and literature review that L2 speech performance and production ability can be subject to cognitive , affective , and socio-social  factors. Nonetheless, how the three dimensions of factors concurrently influence L2 speaking with a particular focus on L2 Chinese still remains under-researched. Drawing on SD = 4.55). They all had 3–5 years of classroom Chinese learning experience in their home countries and had been learning Chinese in China for more than 2 years prior to this study. All the participants were given pseudonyms for the sake of anonymity and confidentiality. Focus group participants were particularly asked to respect one another’s privacy, given that anonymity could not be guaranteed within group discussions.A total of 17 multilinguals with an advanced level of L2 Chinese proficiency were recruited through convenient and purposive sampling in order to ensure that participants share a similar L2 Chinese learning background  were carried out for the elicitation of multilinguals’ opinions on L2 Chinese speech performance and production ability development from an individual level. In total, 17 multilingual L2 Chinese learners from two universities were documented.The collected qualitative data were then transcribed verbatim by the first author. After transcription, codes were attached to sentences or whole paragraphs in order to dissect them meaningfully . Consequt-test indicated that the two raters’ codes were highly consistent .In this study, confirmability was achieved through repeated coding of the data. A Ph.D. candidate in Chinese applied linguistics was invited to be a peer debriefer. A random sample of 20% of recording transcription was taken for recoding with reference to the developed coding system. All the codes were then numbered and imported into SPSS for the inter-rater reliability test. The results of a paired-samples This study revealed that age of acquisition, cognitive fluency, learning styles, and speaking strategies were main cognitive factors contributing to the multilinguals’ L2 Chinese speech performance and production ability development see .Fourteen out of the 17 multilinguals suggested that the onset of L2 Chinese learning (age of acquisition) could be the reason distinguishing each other’s L2 speech performance and production ability. As Gaoen pointed out, “I do believe that the longer you learn, the better your Chinese will become, such as larger vocabulary, better pronunciation, and more nativelike. I think a person’s speaking ability and performance can be tightly correlated with when he/she starts learning an L2” . Three out of the 17 multilinguals, despite agreeing on the importance of the age of acquisition, pointed out that speech production was a skill that, to a large extent, depended on the frequency of practice. For example, “if I started learning another language at an early age but without much practice, I think I still could not speak well” .Corroborating the critical period hypothesis that a language could not be fully acquired after puberty, our data also showed that age of acquisition has a critical impact on determining learners’ L2 speech production ability . HoweverCognitive fluency, according to Comparing with my (L2) Russian, my Chinese is much slower. I guess because I grew up in a bilingual environment, my Russian is more like a mother tongue to me. If I grew up in a Mongolian and Chinese bilingual environment, I would speak Chinese much faster than my other foreign languages. I think cognitive fluency can determine how fast you speak and it has a lot to do with environment .As suggested, cognitive fluency can be a direct reflection of the multilinguals’ L2 Chinese speech performance and production ability. Such a result adds evidence to All the 17 multilinguals suggested that there was a positive link between learning styles and their L2 Chinese speech production ability development, particularly group, auditory/visual, and individual learning styles. To be more specific, 8 out of 17 multilinguals claimed that the group learning style was of great importance for the improvement of their L2 Chinese speech production ability. As Tao pointed out, “compared with individual learning, group learning provides you with more opportunities to output. Such output is the foundation for the improvement of a person’s speaking ability” . Mads also mentioned that “learning by yourself without socializing with others, you can hardly make any progress in speaking” . The perceived advantage of group learning, according to the participants, lies in the fact that such a style compared with other learning styles provides more meaningful and interactive opportunities for learners to verbalize their ideas and knowledge, which in turn may lead to more gains in L2 speech production ability development.Regarding the auditory/visual learning style, 5 out of the 17 multilinguals claimed that this style could be a factor that directly contributes to their L2 Chinese speech production ability development. As Gaoen mentioned, “watching Chinese television is an effective way to improve my spoken Chinese. By listening and watching to the authentic Chinese, I developed a sense of authenticity which contributes not only to my confidence in speaking but also to the development of my speaking ability” .In terms of the individual learning style, 4 out of the 17 multilinguals claimed that they preferred studying Chinese individually, as individual learning provided them with a much safer, less disturbing, and more self-regulated environment to enhance the development of their L2 speech production ability. For instance, “studying alone is more efficient for me. When studying in groups, I will easily get distracted and end up gossiping with my Korean peers. Studying alone does not mean you cannot practice speaking; you can do self-talking” .The above findings revealed that group, auditory/visual, and individual styles are the three main learning styles that the multilingual L2 Chinese learners utilize to support the development of their L2 speech production ability. However, such a result does not show much support to the literature that learners favor a kinesthetic style and disfavor group and individual styles . We suggPractice-oriented and substitution-oriented strategies were the two major speaking strategies adopted by the 17 L2 Chinese multilinguals. They suggested that speaking strategies, particularly practice-oriented, could positively contribute to their L2 Chinese speech production performance and the development of such an ability .Regarding the practice-oriented speaking strategy, 5 out of the 17 multilinguals pointed out that there was an unconscious accumulation stage before their actual speaking practice. They tried not to consciously memorize new words but, rather, unconsciously picked up some words or expressions that grabbed their attention. As June said, “when I watch TV, I try not to consciously understand every word. Rather, I try to figure out the meaning of the new words from the context. Afterward, I will practice the new words or expressions” . However, another 5 out of the 17 multilinguals’ practice-oriented speaking strategy was to consciously memorize some words and expressions before putting them into actual practice. They found that this was the best way for them to improve their L2 speech production ability. As Hanna added, “I often attentively listen to my Chinese friends’ conversations for useful words and expressions. When I have chance, I will use what I have memorized in my speaking” . Although the 10 learners had different views on memorization, they all agreed that the practice-oriented speaking strategy had a positive impact on their L2 Chinese speech production ability development.Regarding the substitution-oriented strategy, 7 out of the 17 multilinguals indicated that they preferred using such a strategy to help express their ideas. This strategy shares a similarity with the compensation strategy  and paraIn brief, the L2 Chinese multilinguals found it beneficial to use practice- and substitution-oriented strategies for improving their L2 speech production performance and the development of such an ability. Although such a finding enriches our understanding of the multilinguals’ L2 Chinese speaking strategies, teachers and learners should recognize that other strategies such as metacognitive strategies could also be conducive to the development of L2 speech production ability . In addiThis study revealed that motivation, anxiety, speaking self-efficacy, and WTC were influential affective factors influencing the multilinguals’ L2 Chinese speech production performance and the development of such an ability see .The 17 multilinguals all believed that motivation, either intrinsic, extrinsic, or integrative, provided them with the main impetus to improve their L2 Chinese speech production ability. To be more specific, 4 out of the 17 pointed out that they were mainly inspired by their intrinsic motivation. As Mads pointed out, “I am interested in communication. Therefore, I make more effort to improve my speaking ability, such as talking to Chinese friends, learning Chinese online, and visiting China” . This echoes the case of Steve, who claimed, “I have always been interested in Chinese and China even when I was a child. When I was a student in Austria, there was no opportunity for me to learn Chinese. My desire to learn Chinese and speak Chinese well has been accumulating since then” .Apart from the intrinsic motivation, 13 out of the 17 multilinguals were extrinsically motivated. Three main extrinsic motivations emerged, including work-driven, introjection-driven, and people-driven motivations. Work-driven motivation was one of the most frequently mentioned extrinsic motivations. Such outward work-driven motivation often stimulated and sustained learners’ inward responsibility toward their work or their inward desire for getting the work. For example, “I was a Chinese language teacher in Thailand. I came to China for my MA degree, as I believe it is very important for my career development. Thanks to the program, my teaching and my Chinese language speaking abilities have improved much” .Introjection-driven motivation refers to learners’ behavior regulation out of shame, guilt, and ego-enhancement . For exaPeople-driven motivation was another commonly mentioned extrinsic motivation. Jenny mentioned that she tried to speak good Chinese in order to make her parents feel proud of her and also to gain face for them . June also added, “I want to improve my Chinese, particularly my spoken Chinese, while I am doing my MA degree here. With my knowledge gained from my MA program and my improved spoken Chinese, I am sure it will benefit my students more in Burma” .Overall, the above findings showed that both intrinsic and extrinsic  motivations sustained the improvement of the multilinguals’ L2 Chinese speech production ability. Such a result corroborates the literature that motivation is a significant variable in influencing learners’ development of L2 speaking . NeverthThere were two main types of L2 anxiety that emerged from the participants, including fear-related and test anxiety. Specifically, 12 out of the 17 multilinguals pointed out that L2 anxiety could be both facilitating (when anxiety is not intense) and debilitating (when anxiety is intense) to their L2 Chinese speech performance and the development of such an ability. However, 5 out of the 17 did not have any L2 anxiety problem when speaking Chinese in either formal or informal contexts.Fear-related anxiety was a salient cause for the participants’ broken L2 Chinese speech performance. Six multilinguals pointed out that their fear of being negatively evaluated and of impeding the communication flow caused their speech breakdowns. Such examples include: “I am worried when I am speaking, particularly when I speak disfluently. Others will think that you are a postgraduate student, and is this your Chinese level? I am scared of this judgement” ; “Although I like speaking Chinese with my friends, to communicate with them, I am concerned that if I make mistakes or if I cannot speak so well, they will think that okay you are a postgraduate and you cannot speak well” . Four multilinguals mentioned that they were “very scared of causing misunderstandings”  if there was something wrong with their expressions. Therefore, they did not want to “interrupt the normal pace of communication among friends” . Such a fear of impeding the communication flow hindered learners from taking initiative in communication and thus the development of their speech production ability.Test anxiety was another type of L2 anxiety that was commonly reported by the L2 Chinese multilinguals (8/17). In fact, L2 Chinese speaking itself was not a problem for the multilinguals. It was the pressure caused by tests that, to a large extent, affected their L2 Chinese speech performance and production. As Lin pointed out, “you only have one chance for an oral exam, if you cannot get a good score, your GPA will be affected. The pressure is huge. … such anxiety and struggle will result in making more mistakes” .To sum up, it was found that anxiety, such as fear-related and test anxiety, was closely related to the multilinguals’ L2 Chinese speech production and performance. Despite the negative effects of anxiety on L2 speech production , it was The majority of the L2 Chinese multilinguals (15/17) claimed that they were confident about their L2 Chinese speech production and performance in most cases (except in complicated and in-depth discussions), while the rest (2/17) indicated that they were not. Regardless of the perceptions of their own speaking self-efficacy, the multilinguals all agreed that there was a positive link between speaking self-efficacy and L2 Chinese speech performance and the development of such an ability. As June pointed out, “self-confidence can be closely related with speech production. If you are a confident speaker, you will not suffer much from anxiety and nervousness which can exert negative influence on your speech performance” . The participants also pointed out that their L2 speaking self-efficacy was mostly subject to the frequency of practice in addition to self-encouragement and others’ compliments. For example,If you want to speak well, you have to be confident. There are two factors that could support the maintenance of your speaking confidence. One is external, which is the compliments from others. The other is internal. You have to say to yourself over and over again that you can do it. Without speaking self-efficacy, you cannot go far .As a whole, our study showed that there was a positive link between speaking self-efficacy and multilinguals’ L2 Chinese speech production and performance. Specifically, our study not only enriches the literature that speaking self-efficacy could positively contribute to L2 speech performance and the development of such an ability, but also adds to our knowledge of the importance of learning strategies in the enhancement of learners’ speaking self-efficacy e.g., . TherefoWTC was reported to have a positive contribution to the multilinguals’ L2 Chinese speech performance and production ability development. Specifically, 5 out the 17 multilinguals indicated that WTC could influence speech quantity more than speech quality. For example, Dan mentioned, “If I do not want to speak to a person or I do not like the person, I may speak less. However, it does not mean that my overall speaking ability is getting worse” . Interestingly, seven participants pointed out that WTC could be volitional, which means that regardless of willingness, their volition could determine how much they would like to participate in a conversation. For instance: “I used to be more willing to practice my Chinese with people whom I like. I did not talk to people like construction workers. I felt we were from different worlds. I have thrown away such prejudice. Now, I try to talk with anyone rather than people whom I like” .In brief, WTC was revealed to have a positive impact on the multilinguals’ L2 Chinese speech performance and production. Such a finding supports This study revealed that L2 cultural interest, L2 communities, and L2 classes were prominent socio-cultural factors contributing to the multilinguals’ L2 Chinese speech production ability development see .All the 17 L2 Chinese multilinguals pointed out that they were very attracted to Chinese culture, specifically Chinese movies and television. Such an attachment contributed to the progress of their L2 Chinese speech production ability, particularly in terms of aspects such as vocabulary, fluency, and authenticity. As Tom pointed out, he liked Chinese culture very much, such as Chinese television, movies, music, and entertaining shows. “Through watching these TV shows, [Tom gets] to know the current situations of China, people’s opinions at different ages, and popular online expressions. All of these help enlarge [his] vocabulary, enhance [his] authenticity in speaking Chinese, and enriches [his] knowledge of Chinese cultural etiquette” . This echoes Dan’s viewpoint: “I really like Chinese movies and television. Dialogues in movies and television sound more authentic compared with textbooks. I find my speaking has improved so much because of watching movies and television” .The 17 L2 Chinese multilinguals also indicated that their attitudes toward Chinese communities were positively linked with their L2 Chinese speech production ability development. To be more specific, 16 out of the 17 suggested that they liked living and traveling in China and made many friends with local Chinese. As Mads pointed out, “living in China offers me opportunities to communicate and to get to know Chinese across all walks of life, which greatly improved my L2 Chinese speaking ability” . Only one participant suggested that his attitude toward the Chinese community was neutral, pointing out that “[he spends] most of [his] time staying in [his] dorm reading books or surfing the Internet. So, [he is] not sure whether [he likes or dislikes] the Chinese community” . Despite his neutral attitude, he also added: “if you want to speak authentic Chinese, you should appreciate the local culture and make friends with local people” .However, individuals’ attitude toward a community could be subject to its economic status. High economic status would result in a positive attitude toward the community among L2 learners, and vice versa. Learners with a positive attitude toward a community would have more opportunities and be more willing to socialize with the local people. As a result, learners’ L2 speech production ability could be improved through positive social contacts and interactions. As Gaoen pointed out, “I did not like the local environment and dialects in Guangxi. The learning opportunities there were limited and the learning entertainment was so poor. My Chinese did not improve much there” . Gaoen further claimed, “when you love a city, you will love the language there. You will be more active and willing to communicate with the locals, to go traveling, to get to know every aspect of life, and to adapt yourself to the society” .The majority (14/17) of the multilinguals held a positive attitude toward L2 Chinese classes, believing that L2 Chinese classes contributed much to their speech production ability development. Specifically, 11 respondents pointed out that they liked having classes in school, because “Chinese teachers can anticipate problems that learners may have in class. Moreover, students can get instant help if they have any questions” . As a result, “students will become more cooperative in class, which will contribute to the improvement of their L2 speaking ability, such as in terms of grammar, sentence structure, and pronunciation” . Three respondents held Chinese classes in high regard. They enjoyed having classes with native Chinese students, “because it is an effective way to improve overall Chinese quickly” .Nevertheless, the rest (3/17) held a neutral attitude toward Chinese classes, pointing out that “the knowledge from class is limited, because a lot of authentic expressions and slangs cannot be found in textbooks” . Moreover, “taking only Chinese language courses was slightly boring while taking major courses was slightly too difficult. It is hard to find the balance” .As suggested from the above, almost all the multilinguals in this study held positive attitudes toward L2 Chinese culture, community, and classes. These positive attitudes were found to be beneficial to the development of their L2 Chinese speech production ability. Such a finding adds more evidence to the literature from a socio-cultural perspective that L2 learning enjoyment could significantly impact learners’ L2 learning success . SpecifiApart from the cognitive, affective, and socio-cultural dimensions, multilingualism was also found, to some extent, to contribute to the participants’ L2 Chinese speech performance and production ability development. In general, the impact of multilingualism depends on language distance. Specifically, the closer the distance between different L2s is, the easier the language transfer will be. As June pointed out,Chinese tones are very difficult for most L2 Chinese learners. I found it difficult too. However, compared with other learners from the US and the UK, I have certain advantage. In our mother tongue Burmese, we have four tones as well. Of course, Burmese tones and Chinese tones can be different. At least, I have a tonal sense helping me understand different tones in Chinese. I guess that is why my spoken Chinese does not sound so foreign-like .It can be suggested from the above that a multilingual background, to some degree, could be conducive to L2 Chinese speech performance and production ability development, particularly when there is a positive multilingual transfer. However, multilingual transfer cannot always be positive in circumstances when there is a fundamental difference between different languages. As Bai pointed out, “Russian is somehow easier for me, although Chinese and Russian are both drastically different from Mongolian. As a Mongolian, I found we have borrowed more words from Russian than Chinese. Also, Mongolian and Russian both use Cyrillic alphabets” .Although there is no direct evidence from our data showing how multilingualism contributes to L2 Chinese speech performance and production ability development, the potential impact of multilingualism should not be overlooked, as evidenced by the literature that multilinguals can be cognitively, affectively, and socio-culturally more at an advantage in learning L2s e.g., . NeverthThis study was set up to investigate a group of multilinguals’ perceptions toward their L2 Chinese speech performance and production ability development from the cognitive, affective, and socio-cultural perspectives through an in-depth qualitative inquiry that used focus groups and semi-structured interviews as data collection tools. The results of this study showed that the multilinguals’ L2 Chinese speech performance and production ability development could be the result of the synergistic effects of the cognitive , affective , and socio-cultural  dimensions of L2 Chinese learning. In addition, it was also suggested that multilingualism might have a certain influence on multilinguals’ L2 Chinese speech performance and production ability development.This comprehensive and systematic understanding of multilinguals’ L2 Chinese speech performance and the development of such an ability provides empirical support for Like many other studies, our study is not exempt from imitations. First, this study was only a cross-sectional qualitative study that investigated multilinguals’ perceptions of L2 Chinese speaking. Future studies may consider adopting other qualitative methods, such as retrospective diaries and think-aloud protocols, to capture multilinguals’ perceptions from a longitudinal perspective. Also, future research may want to make use of a mixed-methods or quantitative approach to strengthen the trustworthiness of the findings. Second, although this study supports the literature that learners’ multilingual background could influence L2 learning, how multilingualism interplays with cognitive, affective, and socio-cultural factors in influencing multilinguals’ L2 Chinese speech performance and production ability development was not examined. Future research may consider taking the influence of multilingualism into more detailed account. Last, the multilinguals’ L2 Chinese speaking was self-diagnosed, which may not accurately reflect learners’ genuine language proficiency. Alternatively, tests could be developed to measure learners’ actual L2 speech production ability in future research.The datasets for this article are not publicly available. Requests to access the datasets should be directed to the first author.The studies involving human participants were reviewed and approved by the University of Auckland. The patients/participants provided their written informed consent to participate in this study. Written informed consent was obtained from the individual(s) for the publication of any potentially identifiable images or data included in this article.PS and LZ conceived and designed the study, and proofread and revised the manuscript. PS collected the data and drafted the manuscript.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.


Community health workers (CHWs) are the mainstay of the public health system, serving for decades in low-resource countries. Their multi-dimensional work in various health care services, including the prevention of communicable diseases and health promotion of non-communicable diseases, makes CHWs, the frontline workers in their respective communities in India. As India is heading towards the development of One Health (OH), this study attempted to provide an insight into potential OH activists (OHA) at the community level. Thus, this case study in one of India’s western cities, Ahmedabad, targeted identifying OHA by exploring the feasibility and the motivation of CHWs in a local setting.This case study explores two major CHWs, i.e., female  health workers (FHWs) and male (multipurpose) health workers (MHWs), on their experience and motivation for becoming an OHA. The data were collected between September 2018 and August 2019 through a mixed design, i.e., quantitative data  followed by qualitative data (focus group discussion with a semi-structured interview guide).The motivation of the CHWs for liaisoning as OHA was found to be low; however, the FHWs have a higher mean motivation score [40 (36–43)] as compared to MHWs [37 (35–40)] out of a maximum score of 92. Although most CHWs have received zoonoses training or contributed to zoonoses prevention campaigns, their awareness level was found to be different among male and female health workers. Comparing the female and male health workers to act as OHA, higher motivational score, multidisciplinary collaborative work experience, and way for incentive generation documented among the female health workers.ASHAs were willing to accept the additional new liaison role of OHAs if measures like financial incentives and improved recognition are provided. Although this study documented various systemic factors at the individual, community, and health system level, which might, directly and indirectly, impact the acceptance level to act as OHA, they need to be accounted for in the policy regime. The health workforce’s skill and motivation directly influence the health system functionality across the globe , 2. EvidThe umbrella term “community health worker” includes frontline functionaries to deliver patient-centric, comprehensive primary health care, address social determinants of health, and respond to various health challenges and outcomes at the community level . With anIn LMICs, CHWs are fronting challenges in effective healthcare delivery not only for achieving universal health coverage , but alsTo assess the awareness level of selected zoonotic diseases among the CHWs.To document the multi-dimensional work pattern and performance of the CHWs.To understand the level of motivation of the CHWs for becoming an OHA.This case study used a mixed-method design. Quantitative data collection  was followed by qualitative data collection (focused group discussion) from September 2018 to August 2019.The study was conducted in one of the most populous cities of the western state of Gujarat, Ahmedabad. It is the seventh most populous city in India and is the largest city of the western state Gujarat . The citCHWs are working as an interface between the community and the public health system. These CHWs have been engaged in disease awareness, promote good health practices, and help the community in accessing health services for decades. In this study, two types of CHWs were targeted, i.e., Accredited Social Health Activists (ASHAs) as a female health workers (FHWs) and malaria/multipurpose male health workers as a male health workers (MHWs) based on gender. Initially, ASHAs were devoted to reproductive health services and family planning , but wit. [. [. [For the quantitative component, a structured, pilot-tested questionnaire in the vernacular language was used to collect information on the socio-professional details, training in zoonoses, knowledge, and practices about the selected zoonotic diseases, details on the previous collaborative work, perception about the required factors for becoming an OHA and the motivation level. The zoonotic diseases rabies, brucellosis, swine flu, and bird flu had been selected during the previously conducted prioritization workshop for Ahmedabad . A stand.  and orig. [. , was use. [. [.  consistsFGDs were conducted for the qualitative component. The FGDs were conducted face-to-face at a time and place  convenient to the participants, using an interview guide in the vernacular language. The empty hall of the health centers was utilized to conduct these FGDs, there was no other healthcare staff allowed to be present during the discussion, and the disclaimer was made to ensure the information confidentiality, which resulted in the improved degree of comfort and participation in the discussion. The interview guide focused on their current job tasks and the motivation for becoming an OH activist. Each FGD was conducted in the presence of the researcher and participants only and lasted over 1 h. At the end of each FGD, the major points of discussion were summarized for the participants based on the field notes. All FGDs were recorded with due consent from the participants.For the quantitative component, data were entered in Epi-Info (7.2.3.1) and exported to EpiData Analysis (version 2.2.2.183) for analysis . The desFor the qualitative component, the recordings and field notes were uploaded to Atlas.Ti (version 7.5.18) . The recOut of the 349 CHWs sampled from two zones of the Ahmedabad city, 288 were FHWs, and 61 were MHWs, with a mean age of 40.38 ± 7.65, 36.25 ± 6.48, respectively. Although secondary education is the minimum qualification for the FHWs, we have documented that one-third of the sampled FHWs only completed primary education. Most of the MHWs were found to have at least a bachelor's degree. The professional experience in both categories was found to be similar: 8.29 ± 4.56, 8.40 ± 3.78 years, respectively. The mean catering population per FHWs was 3,183 ± 2,108, compared to the 47,718 ± 66,966 for the MHWs. The mean working hours per day were 4.49 ± 0.73 and 8.13 ± 0.81 for FHWs and MHWs, respectively. As the FHWs are on incentive-based working models, their mean income in INR was 4098 ± 1190, whereas MHWs are on salary-based models with mean incomes of 28,662 ± 6914. The detailed differences are presented in Table Table Upon enquiring about their previous work experience with other sectors, it was found that about 55% of FHWs have worked with the Women and Child Department  in their normal daily routine. About 10% have worked with the higher administrative authorities from various departments during health emergencies; whereas, only 6% of MHWs mentioned previous collaborative work with any other sectors. Most health workers (97%) said their involvement in outbreak management in the past, and 80% agreed to additional engagements other than their primary task. Table Overall, the motivation score of FHWs was 40 (36–43), higher as compared to the MHWs 37 (35–40) out of a maximum score of 92. The mean motivational score was significantly different among these groups. The overall mean motivation score was 1.8 ± 0.2 higher among FHWs, compared to 1.6 ± 0.2 among MHWs. Both these groups were found to have low motivation and they sensed burnout in their daily routine work, as shown in Table Six FGDs (four among the FHWs and two among the MHWs) were conducted across two zones of the city. On exploring the current challenges and their motivation for becoming OHAs, the opinions were clustered on the individual, community, and health system levels based on the thematic analysis.“Our name is ‘ASHA’ (in the vernacular language it means Hope!), but we do not have any ‘ASHA’ , they do not appreciate us, ASHA has no any appreciation” (FHWs-FGD-3)“The problem is we are not working for the malaria department only, right now I am working in the malaria department, but I may get transferred to some other department within a few months. Like I was working in the solid waste management department before current assignment” (MHWs-FGD-2)The current job activities and work profile of the FHWs were to implement most of the national health programs like maternal child health, non-communicable diseases, or immunization. Although they are the backbone of the health system at the grass-root level, they felt demotivated due to several reasons. One of the primary reasons might be the absence of appreciation of their dedication by neither the employer nor the community. In contrast, the MHWs are under fixed-term salaries, and they are bound to be transferred to other departments within the city municipal corporation, indicating their lack of consistency in the current role. The low appreciation from the community also remained the same for the MHWs.In addition, both of these workers perceived more motivation when they have been involved in larger team activities like the last outbreaks of swine flu or bird flu. Most of these workers worked extensively during the outbreaks with or without formal training. Apart from routine work, FHWs also evinced working on the implementation of any new public health programs or piloting new interventions. They are also working with school-teachers in school health programs and some of them are also involved in mass sanitation campaigning . This indicates the multidisciplinary working culture of FHWs compared to that of the MHWs.“…..we feel proud that we are doing some good work, we feel good as they listen to us if we don’t go then they call us and tell that why we did not go there, even if we don’t go for a single day than also, they ask for us, they miss us!” (FHWs-FGD-1)“…..in field people still do not understand, they think we are a beggar and came for begging something, so they use to treat us like a beggar and say ‘aage jao’ means go to next door” (FHWs-FGD-2)“People do not cooperate with us! If we go for fogging in the morning, they ask to come in the afternoon, and when we go in their time, then the houses found to be locked and if we request to access to a rooftop or the water tank, they don’t allow us nor follow our any instructions” (MHWs-FGD-1)The community members’ support is a major driving force for these FHWs; they felt motivated to work hard when the community accepted them. There was mixed opinion documented for the community perceptions. Although the appreciation was low for the FHWs in most cases, most of them mentioned a positive reception by community members, from which they gain goodwill and recognition. However, some CHWs reported adverse reactions from the community while disseminating their daily routine. This might be one of the other contributing factors for the low motivation among these CHWs.“We don’t have any fixed work schedule, they (superiors) give us diverse fieldwork if it is from the health department than ‘okay’, but it’s not like that. Today they tell to do this and next day anything else, everyday new work.” (FHWs-FGD-1)“Even though all ASHA workers are working more or less the same, but do not get equal incentives, someone has more population so earning more and someone has not that much population so not getting that much. Even if we work during an outbreak, it was free; we did not get any extra incentives for that.” (FHWs-FGD-3)“At present, we do not have fix pay, we people are doing work on incentive, we will get incentive according to completion of our task, the problem is if we have started any work and couldn’t complete it because of the patient side problem than we will not get the incentive for that. For an example of immunization, we have worked from the first dose of vaccination and in case if a patient would not ready to get measles dose or patient had migrated so, in that case, we would not get incentive even though we worked for rest all.” (FHWs-FGD-2)FHWs are prime actors at the grass-root level with the multidisciplinary working culture for various health programs. Due to the inception of new programs, the activities are increasing tremendously among the FHWs, which sometimes resulted in non-scheduled work. In addition, failure to receive the financial incentives due to the non-completion of tasks or unavailability of data forms a vital system challenge. The primary issue remained the incentive-based payment system. Some of them mentioned that introducing a fixed payment for a package of services would increase their motivation for their work. There were no such system-level challenges documented by the MHWs.“We (ASHA) people were entered in reproductive child health care, that time we didn’t know anything, gradually family planning, vaccination, now non-communicable diseases, yoga many more we are expert, now you can send us anywhere, we can do everything” (FHWs-FGD-3)“Whether we get an incentive or not, but we always do all work for goodness of our area, all people do not think like that if incentive will be more than we will work more dedicatedly” (FHWs-FGD-2)“There should be a specific day for that, and it should be merged with your routine work so you can work in between and instead of two different reports it should go at one place so whoever wants to share about their field they can” (MHWs-FGD-1)“….first of all, we don’t have time. We already have our routine work which we have to finish as per the deadline” (MHWs-FGD-2)Although FHWs have low motivation scores, certain factors documented might increase the motivation of FHWs. One aspect is confidence in what they do, and another is financial, which might motivate them to take on the additional task of OHAs. Some of them voiced concerns about the additive task from the community perspective, i.e., the opposite gender might not respond well. In addition, the acceptance of new tasks produced a concern as most of their current time is spent on data documentation. Most FHWs indicated that if the new assignment generated additional incentives, they would be pleased to do so. Therefore, an incentive package is the most important driver for the FHWs to become OHAs. In contrast, the concerns of the MHWs are mostly operational rather than financial. MHWs were found to be least concerned about the financial matters, as they are on fixed payroll as a salaried employee. MHWs have also produced similar concerns except for financial matters. Further, some of the MHWs refused to consider these additional responsibilities.In addition, both types of workers have expressed their interest in proper training and skill development in the domain of OH, as this is entirely new for them. They have also requested vigorous handholding training and practices across the domains of OH. On the one hand, one group proposed that OH activities should happen on a specific day of each week ; on the other hand, another group proposed OH activities need to be integrated into their daily routine. In summary, promoting MHWs as OHAs requires more stringent top-down directives while FHWs require additional financial incentives to act as OHAs.OH’s operationalization is highly dependent on the development of intersectoral collaboration strategies among all the relevant stakeholders at the global, national, and local levels –43. Howe. [This case study highlighted the current zoonotic disease awareness and certain activities among the CHWs and explored their motivation for becoming an OH activist in the near future. Although the overall motivation of the studied CHWs was found to be poor, they still provided themselves with positive feedbacks to act as OHA, if certain prerequisites are fulfilled. Measures like financial incentives, structured reporting patterns, assignment of clear roles and responsibilities have to be introduced before CHWs to accept the role of OHAs. Evidence indicates the importance of social recognition , 47 and .  document. , the FHW. , which i. , 46. Giv. , 53. WhiAs the current OH operational strategies emphasize the education and training programs including the interdisciplinary research collaborations , the scoWhen this case study recommends considering FHWs as future OHA with specific financial incentive packages, this is based on their advantages in their reach of presence, current multidisciplinary working culture, acceptance of the new health programs, higher awareness about zoonoses and current practices, and last, but not least higher motivation score as compared to the MHWs. In India so far, there have been no plans to establish a liaison between animal and human health care services at the lowest level, i.e., in the communities. Here, the OHA’s potential role could be disease reporting to the human and animal health system simultaneously while also spreading awareness about zoonoses, promoting the health of animals and humans through early detection of hazards and risks. These are no more than speculative roles and responsibilities of OHA. Policy challenges include deciding the amount for incentives, improving their motivation for OH and other health services, and taking organizational structural barriers into account.This study has certain limitations: first, data collection was limited to only two zones of the city, and two types of CHWs were investigated in this study. Second, the other relevant sectors of OH need to be investigated for the presence of such community actors and recommended to test their motivation for becoming OHA. The third concern would be that approximately half of the FHWs did not respond to this study invitation, which might hint to exclusion due to educational level, social standing, or location and have had an implication on the perceptions generated herein. Therefore, there is a probability that the results might have emphasized some aspects that could restrict the generalizability of these study findings to a broader setting. Fourth, there might be other systemic factors that were not studied here and might directly or indirectly impact the CHWs and their motivation to be OHAs. Therefore, future research should consider these limitations and conduct similar studies in India’s diverse geographic settings prior to the finalization of policy recommendations.This case study highlighted the different awareness levels of selected zoonotic diseases and preventive practices among the CHWs. In addition, the overall motivation was found to be low, and most of them expressed a feeling of “burnout” in their current schedule, which needs to be accounted for during the implementation of any health programs. There were several advantages of promoting FHWs to future OHAs at the community level documented in this study, including their reach in presence, higher awareness about the selected zoonotic diseases except for brucellosis, reach in their current practices, current multidisciplinary working culture, and overall higher motivation as compared to the MHWs. However, specific measures like improving their social and institutional recognition, additive financial incentives, and top-down directives with structured guidelines need to be considered for improving their motivation as documented in the study. In addition, FHWs also emphasized gaining more training on social and leadership skills in addition to the subject matter training. FHWs could potentially serve as OHA if all identified challenges  are addressed before the time of commissioning them. Although this study also documented multiple systemic factors influential in shaping the OHA role outside the OH context, we recommend increasing the scope and the geographic context to understand the dynamics of the health system and account for the decisive factors beyond the OH area.