Assessing a community social action intervention for effective leprosy control: process, adaptation, and outcomes

Objectives

Community social action processes have a role in strengthening community engagement and supporting leprosy control within the National Leprosy Elimination Program. We aimed to: (i) assess the contribution of community social action to community-linked identification and referral of suspected leprosy cases; (ii) examine changes in knowledge, discussion, and willingness to participate as dimensions of community engagement; and (iii) explore the influence of local socio-cultural context on community engagement processes and intervention outcomes.

Methods

A mixed-methods study using a quasi-experimental intervention-control design was conducted in selected high-endemic districts of Chhattisgarh and Odisha, India. The Community Social Action intervention, focusing on knowledge of early signs and symptoms of leprosy, discussion, and participation in leprosy control activities, was implemented through self-help groups, ASHAs, and other community platforms. Quantitative data were analyzed using difference-in-differences and multivariable logistic regression methods. Qualitative data from community interactions, focus group discussions, field observations, and feedback processes were analyzed thematically to understand contextual influences, implementation processes, and community responses to the intervention.

Results

The Community Social Action intervention resulted in improvements in knowledge levels related to leprosy symptoms, in occurrence of discussion, and in willingness to participate in intervention areas compared to control areas. Knowledge, discussion, and willingness to participate did not change in the same way across settings. This was further reflected in the MVLR analysis, where the strength of associations varied between study areas, suggesting the influence of local social, cultural, and contextual factors. Qualitative findings highlighted the role of self-help groups and family-level interactions in facilitating discussion, increasing openness to conversations about leprosy, and supporting the identification and referral of suspected cases.

Conclusion

The findings suggest that Community Social Action intervention can enhance community engagement for leprosy control through local social groups for effective discussion and action. Knowledge, discussion, and willingness to participate in leprosy control activities are interrelated dimensions of engagement rather than sequential steps. Community social action intervention being adaptive and embedded within existing community structures can promote early case detection and strengthen program implementation.