Intervention framework towards a community-driven approach to improve health-seeking in cutaneous leishmaniasis in...

Cutaneous leishmaniasis (CL) is a re-emerging neglected tropical disease (NTD) in Sri Lanka. The prevention and control of CL mainly rely on early detection and treatment. The WHO roadmap for NTDs highlights the importance of community-based approaches to reduce disease burden. Accordingly, our study aimed to design and evaluate the feasibility of a community-based intervention framework to improve early and appropriate health-seeking in CL in rural Sri Lanka.

We designed the intervention by integrating key principles of community engagement and involvement (CEI) with the first four steps of the Intervention Mapping approach, in a high-incidence area for CL, Anuradhapura, Sri Lanka. We followed the steps of developing a logic model of the problem (needs assessment), a logic model of change, and selecting theory-informed, pragmatic behavioural change strategies, resulting in the design of a culturally appropriate framework for the intervention. This framework was evaluated for feasibility across six domains: acceptability, implementation, practicality, adaptation, integration, and scalability. We involved community members and professional stakeholders at each step of this process.

The needs assessment resulted in a logic model of problem, identifying multilevel behavioural, social, and structural determinants contributing to delayed health-seeking for CL. The logic model of change resulted in a matrix of change objectives, connecting the modifiable determinants, objectives and outcomes of the intervention. Theory-based change methods and corresponding practical strategies, including tailored health communication, participatory and entertainment-education activities, peer-led approaches, and capacity building of community members and professionals, were selected in collaboration with stakeholders. These outputs informed the development of the community-based intervention framework comprising four interdependent phases: community entry and contextual analysis, community sensitisation, community-led actions, and maintenance and sustainability. Feasibility assessment demonstrated high acceptability of the intervention across community and professional stakeholders. Implementation, practicality, adaptation, integration, and scalability were perceived to be context-dependent and influenced by local leadership, adaptive capacity, and multisectoral collaboration.

CEI-based, theory-informed, and evidence-driven approach offers a feasible and contextually appropriate intervention framework to improve health-seeking in CL in rural Sri Lanka. Our intervention framework can be recommended for pilot testing to inform refinement before broader implementation.