Addressing Behavioural Determinants of Cutaneous Leishmaniasis Through Community Dialogue in Kalu District, Ethiopia: A Mixed‐Methods Study

Abstract

BACKGROUND: Cutaneous leishmaniasis (CL) is a major public health challenge in Ethiopia, with 20-30,000 new cases annually. Limited awareness and misconceptions contribute to delayed care seeking, stigma, prolonged healing, and reduced uptake of preventive measures in CL-endemic communities. To address these challenges, a participatory community dialogue (CD) intervention was implemented to evaluate a structured CD intervention in improving knowledge, attitudes, and preventive practices related to CL in Kalu District, Ethiopia. METHODS: A convergent parallel mixed-methods study was conducted in three CL-endemic clusters. Structured CD sessions were held between May and September 2024. Post-intervention qualitative data were collected through in-depth interviews with facilitators and mobilisers (n = 6) and 10 focus group discussions with participants (n = 81), analysed thematically. Quantitative data were obtained from questionnaires before (n = 128) and after the intervention (n = 109), compared using paired t-tests and odds ratios. RESULTS: Participants in group discussions explained that CD sessions helped them to abandon misconceptions, such as beliefs that CL is transmitted through bat urine and that CL-affected people need to self-isolate during treatment to avoid contacts with those who had sexual intercourse and might cast a 'shadow' that could harm their healing. The intervention reframed contagion fears and encouraged biomedical explanations. Questionnaire data indicated attribution of CL to 'germs/parasites' increased from 21% (27/128) before the CD to 88% (96/109) after the CD and belief in self-isolation declined from 61% (78/128) to 8% (9/109). Perceptions of CL as preventable and treatable at health facilities increased, with modest improvements in preventive practices. CONCLUSIONS: The CD intervention addressed behavioural determinants of CL by improving knowledge, reducing misconceptions, and encouraging timely care seeking. It reduced shadow-related isolation beliefs and increased correct causal attribution, underscoring its potential to strengthen CL control in endemic settings. Integrating participatory approaches into public health strategies offers a pathway to sustain behavioural change.