Risk factors for participation restriction in leprosy and development of a screening tool to identify individuals at risk

The World Health Organisation International Classification of Functioning, Disability and Health defines participation as involvement in a life situation. Participation restrictions are problems experienced in any life situation, for example, in relationships or in employment. Our research explored risk factors for participation restrictions experienced by people affected by leprosy. Our objective was to develop a screening tool to identify individuals at risk. An initial round of qualitative fieldwork in eight centres in Nepal, India and Brazil identified 35 potential risk factors for participation restriction. These were then further assessed through quantitative fieldwork in six centres in India and Brazil. In all, 264 individuals receiving leprosy treatment or rehabilitation services made a retrospective assessment of their status at time of diagnosis. Their level of participation restriction was assessed using the Participation Scale. Regression analysis identified risk factors for participation restriction including fear of abandonment by family members (odds ratio 2•63, 95% CI 1•35–5•13) and hospitalization at diagnosis (3•98, 1•0–7•32). We recommend four consolidated items as the basis for a simple screening tool to identify individuals at risk. These are the physical impact of leprosy, an emotional response to the diagnosis, female gender and having little or no education. Such a tool may form the basis for a screening and referral procedure to identify newly diagnosed individuals at risk of participation restrictions and in need of actions that may prevent such restrictions

Do self-reported changes in life situations have a role in screening for individuals at risk of participation restrictions?

This research focussed on the importance of leprosy affected persons' self-reported changes in life situations as indicators of underlying change in participation status as defined by World Health Organisation's International Classification of Functioning, Disability and Health. The authors designed a one-question questionnaire to be used at the primary level to explore recent changes in participation status reported by people receiving treatment for leprosy and assessed its potential as a means to identify individuals experiencing participation restrictions. Primary level workers explored and reported change in the domains of physical status, psychological status, plus changes in relationships with family members, with friends or with community and changes in the ability to work.Five centres in India participated in the study, collecting data on 197 individuals affected by leprosy. Using the Participation Scale, the authors made baseline and follow-up assessments and recorded self-reported changes at the time of follow-up. Regression analysis demonstrated that self-reported changes in physical and psychological state were predictive of changes in scores on the Participation Scale. So too, were reported changes in the ability to work. Discussion focuses on the potential for a simple screening procedure that would draw attention to individuals experiencing participation restrictions, who may be in need of counselling or rehabilitation interventions