The impact of contact interventions on leprosy related community stigma in Cirebon District.

Objective Leprosy is a major public health issue in countries in South East Asia, among others due to the leprosy related stigma. The Stigma Assessment and Reduction of Impact (SARI) project applied three different interventions in order to try to reduce the leprosy related stigma in Cirebon District, Indonesia. The focus of the present study is on the contact intervention, which is used to try to increase the interaction between persons affected with leprosy and the public in order to decrease the stigmatising behaviour of the public towards persons affected with leprosy. The purpose of this study was to assess the impact of the contact intervention on community stigma in Cirebon District. Methods The research was situated in Cirebon District as this is an area with a high number of new leprosy cases every year and an area with a high stigma around leprosy. Different data collection methods were used in this study; Questionnaires pre and post to the contact events (N=769) and three months after the contact events (N=114); Short interviews (N=80) directly after the contact event; Reports of the contact events (N=91). All of the before mentioned data was obtained from the community members who participated in a contact event and was already collected at the start of the present study. First this data was analysed, both qualitatively with WeftQDA and quantitatively with SPSS. From the data analysis it appeared that not much was known about the effects of the contact event in the months after persons participated in the contact event. Therefore, three additional focus group discussions (FGD) with three different community member groups were organised. Results Interviewees indicated to be less afraid directly after the contact event, either less afraid for leprosy of for persons affected with leprosy. Furthermore they indicated that they gained knowledge about the cause, transmission and treatment of leprosy and were willing to interact with persons affected with leprosy instead of excluding them from social life. Further analyses showed less relapse after three months for the participants who listened to a testimony during a contact event compared to participants who did not listen to a testimony. Furthermore, analyses show a higher increase in sum score for the 6-question questionnaire (6-QQ) for females compared to males; a high sum score represents a lower stigmatising behaviour of the person. Discussion Compared to similar research in the field of leprosy and stigma, this study shows corresponding results. Although it seems as if the contact intervention helps to reduce community stigma, it should also kept in mind that due to the special focus on leprosy with these interventions community members could get the notion that leprosy is different from other diseases and therefore will treat persons affected with leprosy as different. One of the strengths of this study is the inclusion of a lot of persons with a different role within the community, this ensures that the entire community is involved instead of only one particular group. A limitation of this study is the three different community member groups which participated in the FGDs, these three groups are probably not representative for the entire community as they could have different education levels and are maybe more involved in the stigma reduction process and could therefore be more positive towards the contact events. Conclusion The contact events seem to be effective to reduce community stigma. Attitudes towards persons affected with leprosy changed according to the community members from being afraid and minimal social interaction towards supportive community members who will try to motivate the persons affected with leprosy to get medication. Knowledge about leprosy increased according to the participants and in the FGDs they could still remember the information presented to them in the contact events. Further research and observations are needed to confirm the perceived attitude changes of the community towards persons affected with leprosy and contact intervention need to continue in order to reduce and eventually eradicate leprosy related stigma in Cirebon District.