# Understanding healing: A comparative analysis in chronic diseases with leprosy—A scoping review

## TL;DR

This review explores how healing is understood in leprosy and other chronic diseases, highlighting the need for a holistic approach beyond medical cure.

## Contribution

The paper introduces a 5D Healing Framework to guide person-centred post-cure leprosy care by integrating multidimensional recovery.

## Key findings

- Healing in chronic diseases is often defined as adaptation and reintegration, not just cure.
- Leprosy care remains largely biomedical, neglecting psychosocial and spiritual aspects.
- A 5D framework is proposed to include physical, psychological, socio-relational, socioeconomic, and spiritual dimensions of healing.

## Abstract

Healing in leprosy has long been synonymous with bacteriological cure, often overlooking persistent disability, stigma, and psychosocial consequences. Insights from other chronic diseases may inform a broader understanding of healing. recovery.

To map how healing is defined and experienced in leprosy, tuberculosis, HIV/AIDS, diabetes mellitus, and schizophrenia, and to identify conceptual and practical lessons relevant for post-cure leprosy care.

A scoping review was conducted following the Arksey and O’Malley framework and reported in accordance with PRISMA-ScR guidelines. PubMed and PsycINFO were searched for qualitative studies (January 2012–December 2022) in English language from low- and middle-income countries. Eligible studies explored definitions, determinants, or models of healing in the five conditions. Data were charted and thematically synthesized across physical, psychological, socioeconomic, socio-relational, and spiritual domains following the Joanna Briggs approach.

Eighty-five studies met inclusion criteria (leprosy = 20, TB = 9, diabetes = 8, HIV = 36, schizophrenia = 12). Healing was most often defined as adaptation, resilience, or reintegration rather than cure. Across diseases, five interrelated dimensions—physical, psychological, socioeconomic, socio-relational, and spiritual—shaped recovery. Compared to other chronic conditions, leprosy literature remained largely biomedical, with limited exploration of psychosocial and spiritual healing.

Achieving zero leprosy requires person-centred care that embraces multidimensional healing. The proposed 5D Healing Framework offers a roadmap for integrating psychosocial, economic, and spiritual dimensions into post-cure leprosy services.

Healing from leprosy has been defined by bacteriological cure, yet many people continue to live with the effects of disability, stigma, and social exclusion long after treatment ends. This scoping review explored how healing is conceptualized across five chronic conditions—leprosy, tuberculosis, HIV/AIDS, diabetes mellitus, and schizophrenia—to draw lessons that can guide holistic leprosy care. By analysing 85 studies from low- and middle-income countries, we found that recovery is not limited to physical health but includes psychological, social, economic, and spiritual well-being. Other chronic diseases have progressively integrated counselling, peer support, and livelihood interventions into their care models, while leprosy programs remain largely biomedical. We propose a 5D Healing Framework—covering physical, psychological, socio-relational, socioeconomic, and spiritual dimensions—to help design comprehensive, person-centred post-cure leprosy services. This approach emphasizes that achieving “zero leprosy” must include restoring dignity, belonging, and purpose for persons affected, not merely eliminating infection.