Health beliefs surrounding leprosy induced footulceration ; an exploratory qualitative study fromSouth Nepal

Leprosy is a complex and multi-faceted disease responsible for significant disabilityin several endemic countries. Physical impairments caused by leprosy are oftenamplified by local sociocultural phenomena in many parts of the world. In Nepal,sociocultural phenomena such as stigmatisation and health beliefs affecting treatmentcompliance and health seeking behaviours are known to play an important role in theacquisition of disability. Foot-ulceration is reported to be a common sequelae ofleprosy, however, presently little research has been published investigating thepotential influence of patient beliefs on management of foot ulceration in leprosyaffected persons.Objective: In light of this we conducted an exploratory qualitative study toinvestigate the health beliefs held by patients with foot ulceration at a Leprosyhospital in Nepal.Methods: A mixture of open-ended interviews (n ¼ 21), three focus groups and aseries of field observations were used to explore the explanatory models of footulceration thought to be used by leprosy affected people to understand and explainthis specific comorbidity.Results: Our findings indicated that a wide range of health beliefs were present inour sample, many of which lie outside of the biomedical understanding of illness.This included a range of non-biomedical beliefs regarding wounds and widespreadapplication of the traditional ‘hot-cold’ model of illness used to explain footulceration.Discussion: The findings of this study appear to suggest many beliefs held byleprosy affected persons concerning foot ulceration are highly complex, with someexpressed beliefs potentially having a negative impact on self-management ofulceration