Project coordination
RedAid Nigeria

Partners
German Leprosy and Relief Association Germany (GLRA)Leprosy and TB Relief Initiative Nigeria (LTR)

Aim: The study aimed to assess the impact of an audio-delivered intervention on the perception of community members with regard to leprosy in Nigeria, by comparing an audio-delivered intervention with written health education messages

Full title:
Participatory development of audio-delivered interventions and written material and assessment of their impact on the perception and knowledge of and attitudes towards leprosy: a cluster randomised trial in Nigeria

Final project summary:
Leprosy continues to be one of the most stigmatized diseases in Nigeria, with many people affected by the disease facing discrimination, social exclusion, and psychological distress. Misconceptions about leprosy, particularly fears about contagion and deeply rooted cultural beliefs, often fuel negative attitudes within communities. At the same time, many persons affected by leprosy internalize this stigma, leading to low self-esteem, reduced social participation, and poorer quality of life.

While health education has been shown to improve knowledge and perceptions about leprosy, traditional approaches often rely on written materials. In settings where literacy levels may be low, written information can fail to reach those most in need. This project explored whether audio-delivered health education messages could provide a more effective way of reducing stigma and improving community perceptions of leprosy.

The study was conducted in two states in Nigeria and involved both community members and persons affected by leprosy. Researchers first assessed existing knowledge, attitudes, and beliefs about leprosy among 811 community members, revealing widespread misconceptions and high levels of stigma. Nearly half of respondents had poor knowledge of the disease, with fears of contagion and cultural misconceptions strongly influencing negative attitudes towards people affected by leprosy.

The project also examined internalized stigma and self-esteem among persons affected by leprosy before undertaking a participatory process to develop intervention materials. Importantly, 18 persons affected by leprosy were actively involved in designing both audio and written educational messages, ensuring that the content reflected local realities, language, and experiences.

The interventions were then evaluated through a three-arm cluster-randomized trial involving at least 770 community members, comparing audio-based messages, written health education materials, and a control group. In addition, the study validated four stigma and perception measurement tools in Nigerian Pidgin English and Hausa, creating valuable resources for future research and programme implementation.

The findings demonstrated that culturally sensitive educational messages can successfully reduce stigma and discriminatory attitudes. However, the study revealed that how messages are delivered can be just as important as the content itself.

The audio-delivered intervention produced the strongest results, significantly improving community perceptions of leprosy and reducing stigma levels. Participants exposed to the audio messages showed reductions of more than 40% on community stigma measures and over 80% on measures of desired social distance, indicating a substantial decline in discriminatory attitudes. While some improvements were observed across all intervention groups, the audio format proved considerably more effective than written materials.

The impact extended beyond community attitudes. Among the persons affected by leprosy who participated in the project, self-esteem improved significantly and levels of internalized stigma declined over time. Many participants became active advocates for leprosy awareness within their own communities, demonstrating the empowering effects of meaningful participation in programme design and implementation.

The study highlights the value of participatory approaches, where people affected by leprosy are not simply beneficiaries but active contributors and leaders. Their involvement helped ensure that messages were authentic, relevant, and impactful, while also reducing self-stigma and building confidence.

As the first study of its kind in Nigeria, the project provides important evidence for the design of future anti-stigma programmes. The findings suggest that audio-based interventions can be a highly effective and accessible tool for improving knowledge, changing attitudes, and reducing discrimination in communities where literacy barriers may limit the effectiveness of written materials.

Importantly, the project's outputs are already being used in leprosy-related anti-stigma campaigns. The evidence generated offers practical guidance for policymakers, health programmes, and community organizations seeking to create more inclusive environments for people affected by leprosy.

By combining culturally relevant messaging, accessible communication channels, and meaningful involvement of affected persons, this project demonstrates a powerful approach to tackling stigma, strengthening community understanding, and helping people affected by leprosy live with greater dignity, confidence, and social acceptance.

Impact

Murphy-Okpala, N., Dahiru, T., van’t Noordende, A. T., Gunesch, C., Chukwu, J., Nwafor, C., ... & Ekeke, N. (2024). Participatory development and assessment of audio-delivered interventions and written material and their impact on the perception, knowledge, and attitudes toward leprosy in Nigeria: protocol for a cluster randomized controlled trial. JMIR Research Protocols, 13(1), e53130.

Murphy-Okpala, N., Dahiru, T., Eze, C., Nwafor, C., Ekeke, N., Abdullahi, S., ... & Chukwu, J. (2024). Investigation of community knowledge, attitudes and stigma towards leprosy in Nigeria: a mixed-methods study. Transactions of the Royal Society of Tropical Medicine and Hygiene, 118(10), 697-709.

Nwafor, C., Murphy-Okpala, N., Eze, C., Ukwaja, K. N., Chukwu, J., van Brakel, W., ... & Ekeke, N. (2025). Cross-cultural validation of the Pidgin-English version of the EMIC-CSS and SDS among adults in Southern Nigeria. Leprosy Review, 96(3), 0-0.