Combining peer-led self-care interventions for people affected by leprosy or diabetes in leprosy-endemic countries. What do health care professionals think?

摘要

Leprosy is slowly decreasing in incidence whereas diabetes is a growing health concern. Despite differences in aetiology, both diseases may lead to peripheral neuropathy and subsequent injuries and permanent impairments. There are also indications of similarities in psychosocial consequences. Prevention of Disability (POD) and self-management are often recommended for both diseases. This led to the idea of exploring the feasibility of combined peer-led self-care interventions for people with these disorders. To explore the opinions of health care professionals about combining peer-led self-care interventions for people affected by leprosy or diabetes in leprosy-endemic countries. An exploratory study was conducted to collect quantitative data by means of an e-questionnaire and qualitative data through in-depth semi-structured interviews with key informants. In total, 227 respondents answered the e-questionnaire and 22 in-depth interviews were conducted. Resemblances in physical complications between leprosy and diabetes were confirmed by the respondents. Psychosocial similarities included limitations in daily activity and in social participation, but stigma in leprosy was thought to be an important difference. Considerable overlap in current practices was found, mainly in patient education in POD, skin assessment and skin care, and the recommendation to use protective footwear. Knowledge exchange between leprosy and diabetes specialists is limited, although combined interventions were reported. The majority of respondents think that combined interventions are 'possible' (33.3%) or 'possible and promising' (30.8%). Professionals working with both diseases are more positive than those working with leprosy or diabetes only. The greatest barriers for combined interventions are perceived to be leprosy-related stigma, differences in underlying socio-economic status, attitudes of health care professionals and the current organization of health care systems. Responses indicate perspectives for combined interventions for the prevention of disabilities. For this, it is essential to intensify knowledge exchange between leprosy and diabetes professionals, to overcome barriers and to secure government policy support. Opportunities should be assessed in a situation-specific way.