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

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  • Dilip Shrestha
  • Indra B. Napit
  • Subi Ansari
  • Bishnu Dhungana
  • Frances Griffiths
  • Deanna Hagge
  • Shovakhar Kandel
  • Suraj Puri
  • Jo Sartori

Colleges, School and Institutes


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.

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.

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.

Bibliographic note

Funding Information: This research was funded by the National Institute for Health Research (NIHR: 200132) using UK aid from the UK Government to support global health research. RL and PG are also funded by NIHR ARC West Midlands. The views expressed in this publication are those of the author(s) and not necessarily those of the NIHR or the UK Department of Health and Social Care. Funding Information: We acknowledge Professor Mark Sculpher, Rita Faria and Jessica Ochalek from the Centre for Health Economics, University of York for their assistance in the selection of outcome measurements. We acknowledge the contribution of other members of the NIHR RIGHT grant SHERPA study team including Melita Harris and Thomas Lingard (University of Birmingham). We acknowledge TLM Australia for granting us permission to carry out the evaluation of IMPACT activity and finally, we would also like to acknowledge the staff of the TLM Nepal IMPACT project. We also acknowledge Peter Chilton (University of Birmingham) for his help with preparing the manuscript for submission and production of some Figures.


Original languageEnglish
Article number873
JournalBMC Public Health
Issue number1
Publication statusPublished - 6 May 2021


  • Disability, Economic improvement, Leprosy, Low and middle-income countries, Self-care, Self-help groups, Self-management, Ulcers, Self Efficacy, Prospective Studies, Humans, Leprosy/therapy, Quality of Life, Nepal, Cluster Analysis, Cohort Studies