Codeveloping a community-based, peer-led psychosocial support intervention to reduce tuberculosis-related stigma in Indonesia: a mixed-methods participatory action study

Introduction: Peer support and community-based psychological interventions can reduce infectious diseases-related stigma and mental illness. The evidence for such interventions among people with tuberculosis is limited. This study aimed to engage with multisectoral stakeholders in Indonesia to co-develop a peer-led, community-based psychosocial intervention that is replicable, acceptable, and sustainable. Methods This study used a participatory action design and engaged key national, multisectoral stakeholders to ensure that the intervention co-design was relevant and appropriate within both the TB health system and sociocultural context of Indonesia. The co-design of the intervention evolved through four phases: (1) a scoping review to identify a long list of potential TB stigma reduction interventions; (2) a Delphi survey to define a shortlist of the potential interventions; (3) a national multisectoral participatory workshop to identify and pre-finalize the most viable elements of psychosocial support to distil into a single complex intervention; and (4) finalization of the intervention activities. Results The scoping review identified 12 potential intervention activities. These were then reduced to a shortlist of six potential intervention activities through a Delphi Survey completed by 22 stakeholders. At the national participatory workshop, the suitability, acceptability, feasibility, and scalability of the six potential intervention activities, both alone and in combination, were discussed by the key stakeholders. Based on these discussions, the research team selected the final four complementary activities to be integrated into the psychosocial support intervention, which consisted of: individual psychological assessment and counseling; monthly peer-led psychological group counseling; peer-led individual support; and community-based TB Talks. Conclusion Meaningful participation of multisectoral stakeholders facilitated co-design of a community-based, peer-led intervention to reduce stigma and depression amongst people with TB and their households, which was considered locally-appropriate and viable. The intervention is now ready for implementation and evaluation.