Introduction
Leprosy remains a profoundly stigmatised condition in many rural communities worldwide,
fostering social exclusion, body image dissatisfaction, and diminished mental health
outcomes. Traditional biomedical approaches, while essential for physical recovery, often
neglect the psychological and social ramifications of the disease. Trauma-Informed
Motivational Interviewing (TIMI) emerges as a promising paradigm to address these
psychosocial challenges, enhancing resilience, improving self-perception, and fostering
social re-engagement.
Understanding the Psychological Impact of Leprosy
Leprosy-related stigma is multifaceted, rooted in cultural beliefs, misinformation, and
visible physical impairments. Affected individuals frequently endure social rejection,
which fosters feelings of shame, body image dissatisfaction, and emotional distress.
These experiences, akin to trauma, may disrupt self-efficacy and hinder engagement with
both healthcare systems and social networks.
Trauma-Informed Motivational Interviewing: Core Principles
TIMI integrates two evidence-based approaches: Trauma-Informed Care (TIC) and
Motivational Interviewing (MI). TIC emphasises understanding and acknowledging the impact
of trauma on individuals' behaviours and emotional well-being. MI, a client-centred
approach, fosters intrinsic motivation for change by exploring ambivalence and
strengthening personal autonomy.
The synergy of TIMI rests on five core principles:
Safety: Ensuring physical and emotional safety in all interactions.
Trustworthiness and Transparency: Building a collaborative, open relationship.
Peer Support and Empowerment: Encouraging individuals to harness personal and community
strengths.
Collaboration and Mutuality: Shifting the power dynamic to promote shared
decision-making.
Cultural, Historical, and Gender Awareness: Respecting cultural narratives and addressing
systemic inequalities.
Addressing Key Psychosocial Challenges
Combatting Discrimination and Stigma: TIMI helps reframe self-perceptions, encouraging
individuals to challenge internalised stigma and societal bias. By fostering empathy and
understanding, community members may also engage in reducing discriminatory attitudes.
Improving Body Image and Self-Esteem: Acknowledging the emotional weight of physical
changes, TIMI supports individuals in developing healthier self-concepts. Through guided
dialogue, participants explore their strengths and redefine their value beyond
appearance.
Building Resilience: TIMI fosters a growth mindset, promoting coping strategies that
empower individuals to navigate adversity. This is crucial in rural settings where access
to mental health services may be limited.
Enhancing Social Engagement: By empowering participants to explore their personal goals
and values, TIMI helps identify pathways to meaningful social connections, promoting
reintegration into community life.
Implementation in Rural Contexts
Adapting TIMI to rural environments necessitates a culturally sensitive approach.
Training local healthcare providers, community leaders, and peer mentors in TIMI
principles ensures sustainability. Additionally, integrating TIMI within existing
community health frameworks, such as primary healthcare clinics or local support groups,
facilitates accessibility.