Impact of socio-economic development, contact and peer counselling on stigma against persons affected by leprosy in Cirebon, Indonesia - a randomised controlled trial

Objectives: People affected by leprosy are often stigmatised, but stigma is rarely
quantified and the effectiveness of interventions is often not evaluated. The SARI
Project aimed to test and evaluate three interventions: counselling (involving peer
counsellors), socio-economic development (SED) and contact between community
members and affected people.
Results: This study used a controlled trial design in which pairs of the stigmareduction
interventions were randomly allocated to sub-districts in Cirebon District,
Indonesia. The study sample consisted of one cohort of people affected by leprosy (on
treatment or treated) and two independent samples of community members. The latter
were selected through purposive sampling. Three scales (e.g. SARI Stigma Scale,
Participation scale) were applied among leprosy-affected people and two scales
(e.g. Social Distance Scale) were used among community members pre- and post-intervention. Among affected people (n ¼ 237), significant differences in
reduction of stigma and participation restrictions were found in all intervention areas
and an improvement in quality of life in some intervention areas. Social distance and
social stigma significantly reduced among community members (n ¼ 213 and 375)
in the two intervention areas where the contact intervention was implemented. Two
of the five instruments indicated changes in the control area, but the changes in the
intervention areas were much larger.
Conclusion: The SARI Project has demonstrated that a measurable reduction in
leprosy-related stigma can be achieved, both at community level and among people
affected by leprosy, using reproducible interventions that can be adapted to different
settings and target groups.