Tuberculosis.

In tuberculosis, nine studies were identified, primarily from Asia, including three from India, with additional contributions from Ghana. While no one explicitly defined healing or recovery, the literature described a broad range of experiences shaping wellbeing during and after treatment. Physical aspects included early reporting of symptoms, difficulties with treatment side effects such as hearing loss, appetite changes and reduced mobility, and challenges with adherence and dietary restrictions. Socially, stigma emerged as a major theme, contributing to depression, loss of self-worth, and social withdrawal, while family support, workplace acceptance, and positive interactions with healthcare providers were described as protective. Psychological distress was commonly reported, often continuing beyond cure, though encouragement and reassurance from others were highlighted as important for adherence and recovery. Several studies also pointed to limited knowledge and misperceptions—such as reluctance to use the word “TB,” doubts about curability, and reliance on herbal or spiritual remedies—while counselling and improved patient–provider communication were seen as critical for overcoming these barriers. Economic consequences were substantial, with income loss, debt, and asset pledging commonly reported, and socioeconomic status shown to correlate with quality of life. Finally, spiritual resources were invoked in coping, with reliance on God’s power described as supporting individuals through the uncertainties of illness and treatment. Support for these needs was primarily accessed through public TB programs, supplemented by NGO-led counselling initiatives and, in some settings, government nutritional and cash support schemes.

Diabetes mellitus.

From 316 identified records, eight qualitative studies were included, most of which focused on type 2 diabetes, with one involving participants with type 1 diabetes. These studies explored lived experiences through interviews and focus groups, examining coping strategies, cultural influences, and social support in self-management. Healing was not explicitly defined, but was described implicitly through practices that enabled coping, adaptation, and resilience.

Self-management emerged as a central theme, though it was often shaped by cultural and contextual factors. In some settings, patients initially did not view self-management as their own responsibility, while others emphasized the importance of culturally tailored education and local-language training to strengthen disease control. Religious faith was another prominent coping mechanism. Prayer, fasting, and acceptance of diabetes as part of “God’s plan” were seen not only as sources of strength and resilience, but also as pathways to healing and even glycaemic control [25].

Social support played a critical role in navigating the disease. Peer groups reduced isolation and fostered shared learning, while families provided emotional, financial, and practical assistance. Yet stigma and reluctance to disclose diabetes limited open discussion, contributing to hidden burdens. Cultural practices, financial constraints, and food insecurity further complicated management, with some patients turning to traditional remedies when biomedical options were inaccessible.

Across studies, the psychological impact of diabetes was clear, with participants reporting stress, frustration, and depression linked to economic and social pressures. Healing in this context was understood not as a cure, but as the ongoing ability to adapt, endure, and find meaning within the realities of chronic illness.

Schizophrenia.

Twelve studies were included, employing qualitative, mixed-method, and scoping designs with sample sizes ranging from 9 to 282 participants. Healing was framed less as cure and more as recovery, described as a multidimensional and personal process. Key elements included adherence to or choice around medication, developing resilience, maintaining hope, and achieving psychological stability, Support systems particularly from family, community-based rehabilitation programs, and peer groups—was central to fostering belonging and reducing stigma. Employment and livelihood opportunities enhanced self-esteem and integration, while poverty and social exclusion were barriers. Spirituality and prayer were described as sources of finding meaning in life, coping, and comfort. Overall, healing in schizophrenia was defined as a continuum of recovery, combining clinical stability, psychological integration, spiritual strength, and social inclusion.

HIV.

Thirty-five qualitative studies were included, most from Africa and Asia. Healing in HIV was not defined as cure but as a process of acceptance, adaptation, and sustaining quality of life. Clinically, barriers and facilitators to anti-retroviral therapy (ART) adherence, including provider relationships, mobility, and knowledge were significant. Socioeconomic factors, particularly family and peer support, economic stability, and participation in community networks, strongly influenced healing, while poverty and stigma hindered it. Mental health challenges such as shame, isolation, and fear of disclosure were recurrent, with acceptance of HIV status, hope, and purpose identified as key turning points. Quality of life was defined as living a “normal life,” being socially accepted, and engaging in family and community roles. Spirituality was ambivalent: traditional beliefs could obstruct treatment, but faith and prayer provided coping, meaning, and motivation when combined with strong social support. Overall, healing in HIV was understood as acceptance, resilience, and integration into social and spiritual life while adhering to long-term treatment and support was commonly accessed through public ART programs, community-based peer networks of people living with HIV, NGO-led counselling services, and faith-based organizations

Leprosy.

Thirty-eight studies, largely qualitative, examined healing among people affected by leprosy in low- and middle-income countries. Healing encompassed physical, psychological, and social recovery. Self-care education and peer support improved quality of life and reduced disability risks, but misconceptions, high turnover of medical professionals, and limited counselling skills often left patients insecure. Stigma and discrimination resulted in shame, anxiety, and depression, while peer bonding and counselling enabled resilience. Socioeconomic challenges—especially unemployment, financial insecurity, and marital rejection of women—undermined self-esteem, though microcredit, family support, and community acceptance promoted reintegration.

Interventions highlighted in the literature included early detection, health education, counselling, self-care groups, and community sensitization. Healing was thus framed as restoring dignity and reducing stigma but remained narrowly tied to physical cure and functional recovery.

In contrast, the understanding of healing in tuberculosis, diabetes, HIV, and schizophrenia has progressively expanded to integrate psychological, social, and existential dimensions. Compared to these, leprosy literature remains largely anchored to biomedical outcomes, with limited attention to long-term psychological, socio-relational, and spiritual recovery. This support was largely delivered through vertical leprosy programs and NGO-led services, with limited integration into mainstream health systems, social protection schemes, or mental health services.

Table 2 illustrates these contrasts and exposes the gaps of leprosy recovery and how the proposed five-pillar framework addresses them.

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Table 2. Gaps in the current framing of leprosy recovery.

https://doi.org/10.1371/journal.pntd.0013748.t002

Physical domain.

In all chronic conditions reviewed, the physical domain remains foundational to recovery, yet the emphasis and strategies differ considerably. In tuberculosis, healing is strongly anchored in achieving microbiological cure through strict treatment adherence and consistently highlight that physician–patient communication plays a critical role in adherence and long-term health outcomes [26]. In HIV/AIDS, biomedical management is central, but layered with self-care routines such as ART adherence, symptom monitoring, and nutritional support. In diabetes, the physical aspect of healing extends beyond glycemic control to include the management of long-term complications—foot care, retinopathy screening, and lifestyle adjustments—requiring patient education and continuous self-management. In schizophrenia, while the biomedical model emphasizes medication adherence, physical healing is increasingly linked to the management of medication side effects and promotion of healthy routines such as diet, sleep, and exercise, which support overall recovery.

By contrast, in leprosy, the biomedical focus has historically been narrower, centered on multidrug therapy (MDT) completion and prevention of disability. However,physical limitations persist well beyond treatment completion, with residual nerve damage and impairments impacting daily life [27,28]. Studies in Ethiopia further highlight that integrated approaches to limb care—such as those developed for lymphatic filariasis and podoconiosis —could be beneficial for leprosy as well, offering shared strategies for wound care, footwear provision, and physiotherapy [12]. In practice, physical care for leprosy-related complications in low- and middle-income countries is accessed primarily through public health facilities for MDT and reactions, and through NGO-supported referral centres for disability care, ulcer management, and physiotherapy. Community-based rehabilitation programs and integrated limb-care initiatives, often supported by non-governmental organizations, play a crucial role in bridging gaps in long-term physical support, particularly after release from treatment [29,30].

A key transferable lesson from TB, HIV, and diabetes is the emphasis on patient engagement in long-term physical self-care. For leprosy, this implies moving beyond clinic-based disability prevention to models that empower patients in self-care of neuropathic feet, wound management, and prevention of secondary complications. From schizophrenia and other chronic conditions, another relevant lesson is the integration of healthy lifestyle support—dietary advice, physical activity, and sleep hygiene—which are rarely addressed in leprosy but could reduce vulnerability to complications, particularly in patients on long-term corticosteroids.

Taken together, while the physical domain remains central across chronic illnesses, the framing differs. Leprosy can benefit from adopting a more holistic physical care model—one that combines MDT completion with structured, patient-led self-care, integrated chronic complication management of reactions and impairment, lifestyle support and communication strategies that build trust and adherence.

Psychological dimension.

The psychological challenges of chronic diseases often extend far beyond the clinical course, shaping identity, relationships, and opportunities for social participation. Lessons from other long-term conditions illustrate how structured psychological support can improve adherence, recovery, and overall wellbeing.

In case of HIV, integrated counselling has become a cornerstone of care. Trained counsellors provide health education at diagnosis, during treatment initiation, and at points of crisis, ensuring patients are supported through the uncertainties and stigma of a life-altering diagnosis. Peer-support networks—often described as “treatment buddies”—play an equally important role by normalizing the illness experience, sharing coping strategies, and offering sustained encouragement for adherence.

In tuberculosis, psychosocial interventions have been crucial in addressing depression and the social isolation caused by prolonged treatment. Counselling and psychosocial support programs not only improve adherence but also reduce loss-to-follow-up. These lessons demonstrate that emotional support and treatment completion are deeply intertwined. Schizophrenia care emphasizes recovery-oriented approaches where psychosocial interventions, including peer support groups [31], vocational rehabilitation [32], and psychoeducation for families [33], counterbalance the disabling impact of persistent symptoms. Community-based mental health teams reinforce the idea that illness management must extend beyond pharmacological control to restoring social functioning and dignity.

Diabetes programs highlight another transferable lesson: By focusing on collaborative goal-setting and empowering individuals, such approaches help patients regain agency in managing a demanding, long-term condition.

For leprosy, where stigma and social exclusion remain persistent barriers, these experiences offer clear directions for adaptation. Structured counselling at key stages—diagnosis, treatment initiation, and during episodes of reaction—could normalize the disease experience and pre-empt psychological distress. Such support, where available, is most often delivered through NGO-led counselling services, peer-support groups, and community outreach workers, rather than being embedded within routine public leprosy services [34–36]. Access remains uneven, with mental health care frequently dependent on project-based initiatives rather than integrated health system provision [37,38].

Peer-support groups modelled on HIV networks may provide safe spaces for shared learning [37–39] and reduce isolation, while involving family members through psychoeducation could help rebuild trust and support systems strained by stigma. Integrating mental health screening into routine leprosy services, alongside basic counselling skills for frontline workers, could ensure that emotional wellbeing is treated as integral to clinical care rather than an afterthought. Ultimately, a psychosocial care package for leprosy must aim not only to reduce distress but to enable participation, restore dignity, and foster resilience within both individuals and communities.

Socioeconomic dimension.

Experiences from other chronic conditions show that socioeconomic stability is central to sustained health outcomes. In HIV programs, the introduction of cash transfer schemes in Sub-Saharan Africa (e.g., Kenya’s Cash Transfer for Orphans and Vulnerable Children) and livelihood support programs improved adherence and reduced catastrophic costs. Tuberculosis care in India and other high-burden countries has integrated nutrition support packages [40]—such as the Nikshay Poshan Yojana, which provides monthly cash assistance to patients during treatment—and pilot schemes for wage compensation have demonstrated positive effects on treatment completion [41,42]. In diabetes, many countries have expanded insurance coverage for essential medications and launched workplace wellness initiatives, acknowledging the dual burden of treatment costs and productivity loss. In schizophrenia, structured vocational rehabilitation programs and supported employment models—like the Individual Placement and Support (IPS) approach—have enabled social reintegration, reduced dependency, and enhanced quality of life.

For leprosy, these lessons argue for a shift from the historically charity-based rehabilitation model to a rights-based socio-economic empowerment approach. In most endemic settings, access to such support remains mediated by non-governmental organizations, with limited systematic inclusion of persons affected by leprosy in government social protection and livelihood schemes. While microfinance initiatives, cooperative enterprises, and self-help groups are already well established in leprosy work, they have often remained NGO-driven and small-scale. The challenge now is to move beyond these stand-alone models toward systemic inclusion in mainstream livelihood and social protection frameworks. Advocacy should focus on ensuring that persons affected by leprosy are fully included in government-led schemes such as disability pensions, job reservations, and national livelihood missions. At the same time, lessons from HIV and mental health programs—particularly in workplace reintegration, social protection linkages, and scale-up of community enterprises—can inform a more sustainable and rights-based economic empowerment pathway for people affected by leprosy, especially in addressing the dual burden of stigma and disability.

Socio-relational dimension.

The role of relationships—within families, peer groups, and communities—is a consistent determinant of long-term outcomes across chronic conditions. In HIV care, support groups and family-centred models of care have been instrumental in reducing isolation, improving adherence, and strengthening resilience. Couples counselling programs have further demonstrated benefits in disclosure, prevention, and shared responsibility for treatment. In schizophrenia, interventions such as family psychoeducation and community reintegration programs have reduced relapse, improved functioning, and alleviated caregiver burden by building shared understanding and support networks. Tuberculosis and diabetes programs have successfully utilized patient clubs and community adherence groups, which not only improved treatment completion but also created safe spaces for peer-to-peer learning and solidarity.

For leprosy, these experiences point to the need to invest in structured self-help and family support groups. Community-based rehabilitation (CBR) should be emphasized not only for restoring functional ability but also for strengthening social belonging and reducing stigma. Finally, peer networks—modelled after successful People Living with HIV (PLHIV) networks—also called Champions in leprosy (Leprosy mission’s Initiative) can be powerful stigma-reduction tools, providing platforms where persons affected by leprosy visibly lead advocacy, education, and mutual support, thereby normalizing participation and challenging discrimination. These peer-led initiatives are predominantly facilitated by civil society organizations and faith-based agencies, with emerging but still limited formal recognition within national leprosy programs.

Spiritual dimension.

Spirituality has been recognized as a profound resource in coping with chronic conditions, offering both meaning and community-based support. In HIV and tuberculosis, partnerships with faith-based organizations have proven effective for stigma reduction, treatment adherence, and community mobilization. Faith leaders, when engaged positively, can shift public discourse from condemnation to compassion, influencing large networks of believers. In schizophrenia, approaches that integrate meaning-making and recovery narratives—sometimes including the individual’s spiritual beliefs—have helped patients interpret their illness within a broader existential framework, building hope and resilience.

For leprosy, these insights highlight the value of collaborating with faith leaders to actively reshape community narratives, moving away from centuries-old associations of sin or curse. Recent global health discourse, including WHO-aligned calls to integrate spiritual well-being within people-centred care, provides an opportunity to formally acknowledge and responsibly integrate these dimensions within leprosy services [43,44].Care providers should also acknowledge and integrate patients’ own spirituality as coping strategies, which may include prayer, meditation, or other practices that give strength during long periods of treatment and disability, enabling individuals to alter their experience of leprosy not as social exclusion but as part of a meaningful life journey.

S2 Table summarizes findings from 85 studies analyzed in the scoping review categorized by five key dimensions of healing.