03445nas a2200289   4500000000100000008004100001260002200042653001100064653003200075653001300107653002700120653001700147100001400164700001500178700001200193700001900205700001300224700001300237700001400250700001400264700001100278700001300289245015900302856007600461300000900537520260900546       2026                            d  c02/2026bopenRxiv10aStigma10aPersons affected by leprosy10aPakistan10aLeprosy-related stigma10aStorytelling1 aIbrahim N1 aFastenau A1 aSalam A1 aSchlumberger F1 aWillis M1 aMcKane L1 aMurtaza A1 aSeekles M1 aDean L1 aHotopf I00aOwning the narrative: Exploring the impact of a creative storytelling intervention on Stigma and Empowerment among persons affected by Leprosy in Pakistan  uhttps://www.medrxiv.org/content/10.64898/2026.02.23.26346453v1.full.pdf  a1-493 a<p><strong>Introduction</strong></p>

<p>Despite being curable, leprosy-related stigma in Pakistan persists, undermining dignity, delaying care, and hindering progress toward zero-leprosy targets. Empowerment is critical in counteracting stigma and restoring agency among affected persons. Participatory, contact-based storytelling has potential to reduce stigma and strengthen empowerment, but evidence remains limited. This study evaluates a participatory storytelling intervention involving persons affected by leprosy in Karachi.</p>

<p><strong>Objectives</strong></p>

<p>This study investigates how a participatory storytelling intervention influences stigma and empowerment among persons affected by leprosy in Pakistan. It explores changes in participants’ experiences, examines the mechanisms through which storytelling engages with stigma and identifies practical insights to strengthen future intervention design.</p>

<p><strong>Methods</strong></p>

<p>We conducted a qualitative study following the 2024–25 participatory storytelling pilot at MALC, Karachi. Persons affected by leprosy who participated in the intervention were purposively sampled (age 30-65 years); sixteen participated in photovoice and fourteen completed in-depth interviews (IDIs) (thirteen of which had also participated in photovoice) (total n= 17). Data were analysed thematically using the Social Ecological Model (SEM).</p>

<p><strong>Results</strong></p>

<p>The programme supported a shift from shame and concealment to greater self-acceptance, confidence and openness. Peer groups and creative storytelling built solidarity, a sense of belonging and transferable skills, while organisational endorsement enhanced participants’ visibility and roles. However, stigma remained reinforced by community misconceptions, gender norms and practical barriers. Overall, the intervention’s greatest effect was at the individual level, reducing self and anticipated stigma, with intrapersonal empowerment emerging as the primary gain.</p>

<p><strong>Conclusion</strong></p>

<p>Participatory storytelling enhanced identity and empowerment, but broader social change remained constrained by gender norms, visible disability, and structural barriers. Strengthening impact requires sustained community contact, supported peer educators, inclusive outreach to women and persons with visible impairments, and links to socioeconomic opportunities. Embedding peer-led storytelling within skin NTD services and national and WHO strategies can support community ownership and sustainability.&nbsp;</p>