Co-designing the ‘LEAD’ strategy: A theory-informed stakeholder-led behavioural intervention to improve mass drug administration compliance for lymphatic filariasis elimination in an urban block of Odisha, India

@article{rehman2026codesigning,
  title = {{Co-designing the ‘LEAD’ strategy: A theory-informed stakeholder-led behavioural intervention to improve mass drug administration compliance for lymphatic filariasis elimination in an urban block of Odisha, India}},
  author = {Tanveer Rehman and Ananya Anurakta Pattanaik and Madhusmita Bal and Prakash Kumar Sahoo and Krushna Chandra Sahoo and Shubhashisha Mohanty and Sandipana Pati and Sanghamitra Pati},
  journal = {PLOS Neglected Tropical Diseases},
  year = {2026},
  month = sep,
  doi = {10.1371/journal.pntd.0014632},
  url = {https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0014632},
  note = {CC BY 4.0},
}

TY  - JOUR
TI  - Co-designing the ‘LEAD’ strategy: A theory-informed stakeholder-led behavioural intervention to improve mass drug administration compliance for lymphatic filariasis elimination in an urban block of Odisha, India
AU  - Tanveer Rehman
AU  - Ananya Anurakta Pattanaik
AU  - Madhusmita Bal
AU  - Prakash Kumar Sahoo
AU  - Krushna Chandra Sahoo
AU  - Shubhashisha Mohanty
AU  - Sandipana Pati
AU  - Sanghamitra Pati
PY  - 2026
DA  - 2026/09/16
JO  - PLOS Neglected Tropical Diseases
DO  - 10.1371/journal.pntd.0014632
UR  - https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0014632
AB  - Introduction: Sustained compliance with Mass Drug Administration (MDA) is essential for interrupting transmission of Lymphatic filariasis (LF). However, behavioural and system-level barriers persist to hinder its uptake. We aimed to explore determinants of MDA participation using behavioural frameworks and to co-design a theory-informed, stakeholder-led intervention to enhance MDA compliance. Methods: A mixed-methods formative study was conducted between January and June 2025 in an LF-endemic block of Odisha, India. The quantitative component comprised a community-based KAP survey(n = 400) assessing knowledge, MDA coverage, and compliance. The qualitative component involved two focus group discussions and three key informant interviews with frontline health workers, community members, and programme supervisors to explore perceptions, barriers, and delivery challenges. Findings were mapped to the Theoretical Domains Framework (TDF) and the Capability–Opportunity–Motivation–Behaviour (COM-B) model to identify behavioural determinants and inform intervention design. Two stakeholder workshops were subsequently held to co-develop a contextually relevant implementation package. Results: Among 400 survey respondents (mean age 46 years; 52% female), MDA coverage was 81% (n = 322), while MDA compliance was 57% (n = 229). The main reasons for non-compliance included fear of side effects (40%), misconceptions about the disease, and mistrust of government medicines. Qualitative findings revealed barriers in Capability (limited awareness, inadequate communication skills), Opportunity (weak supervision, irregular supply, competing workloads), and Motivation (low risk perception, fear, misinformation). Stakeholders jointly developed the ‘LEAD’ strategy (Leveraging existing community platforms, Education in schools, Awareness via digital media, and Delivery through Frontline Health Workers). LEAD integrates interpersonal communication by health workers, school-based education using children as health messengers, community mobilisation through self-help groups, and message reinforcement via digital media. Conclusion/Significance: The study identified multi-level behavioural and operational determinants influencing MDA uptake in an endemic Indian setting. The LEAD package will be evaluated in the next phase of our study for feasibility, acceptability, and effectiveness in strengthening India’s LF elimination efforts. Author summary: The main strategy to prevent transmission of Lymphatic filariasis (LF) is annual Mass Drug Administration (MDA), where all eligible individuals in endemic areas are offered antifilarial tablets free of cost. However, in many communities, people hesitate to take the medicine because of fear of side effects, low risk perception, and misinformation. Addressing these behavioural barriers is essential to meet its LF elimination targets. We conducted this study in a highly endemic district of Odisha, India, to systematically understand why people do not take the MDA drugs and how those barriers can be addressed through context-specific solutions. We used behavioural science frameworks to analyse data from community surveys, interviews, and discussions with health workers and programme managers. Through a series of participatory workshops with stakeholders, we then applied these insights to co-develop a locally relevant intervention package designed to improve MDA compliance. The process resulted in the creation of a multicomponent strategy that strengthens health workers’ communication skills, engages schools and self-help groups for community mobilisation, and uses digital media to reinforce key messages. This paper illustrates how a systematic, theory-informed, and stakeholder-driven approach can be used to design practical interventions for complex public health challenges, offering a transferable model for other neglected tropical disease programmes.
SN  - 1935-2735
ER  -