03747nas a2200373   4500000000100000008004100001260001200042653004500054653003500099653001300134653001200147653001800159653002100177653001400198653002400212653002900236653002500265653001600290653001000306100001300316700001600329700001000345700001200355700001200367700001400379700001100393700001100404245021700415856009900632300001100731490000700742520261000749022001403359       2026                            d  c09/202610aBehavioural and social aspects of health10aHealth education and awareness10aTeachers10aSchools10aCommunication10aadverse reaction10aWorkshops10aDrug administration10aMass drug administration10aLymphatic filariasis10aElimination10aIndia1 aRehman T1 aPattanaik A1 aBal M1 aSahoo P1 aSahoo K1 aMohanty S1 aPati S1 aPati S00aCo-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.  uhttps://journals.plos.org/plosntds/article/file?id=10.1371/journal.pntd.0014632&type=printable  a1 - 180 v203 a<p><strong>INTRODUCTION: </strong></p>

<p>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.</p>

<p><strong>METHODS: </strong></p>

<p>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.</p>

<p><strong>RESULTS: </strong></p>

<p>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.</p>

<p><strong>CONCLUSION/SIGNIFICANCE: </strong></p>

<p>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.</p>
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