Evaluation of a self-help intervention to promote the health and wellbeing of marginalised people including those living with leprosy in Nepal: a prospective, observational, cluster-based, cohort study with controls

Abstract

Background People affected by leprosy are at increased risk of ulcers from peripheral nerve damage. This in turn can lead to visible impairments, stigmatisation and economic marginalisation. Health care providers suggest that patients should be empowered to self-manage their condition to improve outcomes and reduce reliance on services. Self-care involves carrying out personal care tasks with the aim of preventing disabilities or preventing further deterioration. Self-help, on the other hand, addresses the wider psychological, social and economic implications of leprosy and incorporates, for example, skills training and microfinance schemes. The aim of this study, known as SHERPA (Self-Help Evaluation for lepRosy and other conditions in NePAl) is to evaluate a service intervention called Integrated Mobilization of People for Active Community Transformation (IMPACT) designed to encourage both self-care and self-help in marginalised people including those affected by leprosy. Methods A mixed-method evaluation study in Province 5, Nepal comprising two parts. First, a prospective, cluster-based, non-randomised controlled study to evaluate the effectiveness of self-help groups on ulcer metrics (people affected by leprosy only) and on four generic outcome measures (all participants) - generic health status, wellbeing, social integration and household economic performance. Second, a qualitative study to examine the implementation and fidelity of the intervention. Impact This research will provide information on the effectiveness of combined self-help and self-care groups, on quality of life, social integration and economic wellbeing for people living with leprosy, disability or who are socially and economically marginalised in low- and middle- income countries.

Experiences of living with leprosy: A systematic review and qualitative evidence synthesis

“…[29,33] Most self-help centres run skills training workshops and microfinance schemes to help these people become independent. [4,34,35] Coping with leprosy are the varying ways people manage stressful or traumatic situations to maintain their emotional wellbeing. Algorani and Gupta [36] identified four categories of coping: problem-focused, which is characterised by addressing the problems, such as talking to professionals to seek information, planning their activities, and getting expert help; emotionfocused to reduce negative thoughts and emotions by reframing and accepting the problems, using humour and religion; meaning-focused by using intellectual reasoning to manage the stressful situation; and social coping by requesting for support from their family, friends, and community.…”

“…[ 29 , 33 ] Most self-help centres run skills training workshops and microfinance schemes to help these people become independent. [ 4 , 34 , 35 ]…”

The Relationship between Self-Care Agency and the Level of Disability to Patient with Leprosy at Daha Husada Hospital, Kediri

“…Other studies also state that self-care measures are one of the efforts to prevent disability in leprosy patients so that there is a need for family support (information support) through optimizing family-based self-care group programs (Laili, 2016). This is in line with the research of Shrestha et al, (2021) that self-help and self-care groups combined are effective in preventing disability, improving quality of life, social interaction and welfare of leprosy patients.…”

Microfinance Intervention and Health Outcomes of Marginalized People: A Systematic Literature Review

“…With the help of the Nova MF intervention, women can lower their risk of contracting HIV and have access to alternative economic opportunities should they decide to cut back or cease sex work [44]. For those with leprosy, disabilities, or who are socially and economically marginalized in low-and middle-income countries, the success of integrated selfhelp and self-care groups affects the quality of life, social integration, and economic well-being [45]. Among HIVpositive people in Kenya, the intervention included a microfinance loan, financial and agricultural training, and a human-powered water pump.…”