# Effectiveness of community-based and community-led interventions to improve the psychosocial well-being of those affected by skin-NTDs: A systematic review

## TL;DR

This review shows that community-based and community-led programs can help reduce stigma and improve mental health for people with skin-related neglected tropical diseases.

## Contribution

The study highlights the importance of community leadership in creating sustainable mental health interventions for skin-NTD patients.

## Key findings

- Community-based interventions effectively reduce internalized stigma and improve well-being for those with skin-NTDs.
- Community-led interventions are crucial for sustainability in resource-limited settings.
- There is limited evidence on the cost-effectiveness of these interventions.

## Abstract

Skin-related neglected tropical diseases (skin-NTDs) are a subgroup of neglected tropical diseases (NTDs) that present with manifestations of the skin, often leading to stigmatization and discrimination of those affected. Community models may be a promising feature in improving the mental health of those affected by skin-NTDs by providing mental health care or resources in areas without formal mental health services. This review aimed to identify existing community-based interventions for improving the psychosocial well-being of individuals affected by skin-NTDs, as well as to evaluate their effectiveness. Sub-questions focused on identifying which interventions are also community-led and evaluating cost-effectiveness.

This study is a systematic review, and the protocol was registered with PROSPERO (CRD420251015152). The interventions were evaluated according to an integrated framework and if provided, the cost-effectiveness of the interventions was also assessed. 16 papers were included in this review, and interventions were grouped as either: (I) Group-based, (II) Counselling, (III) Basic Psychological Support, (IV) Management Programs, or (V) Mixed interventions. Results indicated that community-based interventions were effective in reducing internalized stigma and improving the well-being of persons affected by skin-NTDs. Results emphasized how community leadership of interventions is a foundation for its sustainability. There was sparse information on the cost of interventions.

The findings emphasize that community leadership and participatory methods are a promising method for research in this field and future research should aim to follow this. While only a few interventions addressed multiple skin-NTDs, there is potential for integration of these interventions, both in addressing multiple diseases and for integration within local health structures. The findings highlight that effective interventions exist to support communities without formal mental health resources to improve the psychosocial well-being of those affected by skin-NTDs.

Skin-NTDs are a subgroup of neglected tropical diseases (NTDs) that manifest on the skin, often resulting in disfigurements and chronic disability. Due to this, persons affected by skin-NTDs are often subject to hostility, discrimination, and social exclusion. This systematic review explores how communities attempt to intervene in the negative psychosocial effects that persons with skin-NTDs often face. Our review included 16 papers. The papers included interventions in 5 categories: Group-based, counselling, basic psychological support, management programs, and mixed interventions. Additionally, four of the papers included interventions where the community itself had roles in leading the intervention. Although evidence on cost-effectiveness was limited, the interventions showed encouraging results to improve the psychosocial outcomes for people affected by skin-NTDs. Our findings highlight a gap in the field of NTD research: The need for attention to one’s mental health and well-being, as well as the need for community involvement in such interventions. Community involvement and leadership can help in creating sustainable and effective interventions in resource-constrained settings where such patients are more likely to be neglected.