Leprosy is endemic in Nepal and disproportionately affects the most marginalized. Leprosy related stigma can be characterized as a social curse, because those affected are excluded from group life and social participation which has severe implications for psychological health. The Nepal Leprosy Trust run a community-based self-help group intervention that aims to develop a new empowered identity to re-establish access to multiple group memberships' through social participation. In this applied cross-sectional study, informed by the Social Identity Model of Identity Change, we assess this intervention. Participants (N = 98) were members of self-help groups in 10 rural villages in Nepal, and completed measures of self-help group identification, access to multiple groups, internalized stigma and wellbeing. Mediation models indicated that self-help group identification was indirectly linked to reduced stigma and increased well-being through access to multiple groups. Supporting the Social Identity Model of Identity Change, we present novel evidence that group-based interventions can offer new valued identities that link to social cure resources, even in the most adverse circumstances. Please refer to the

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There is increasing appreciation that group memberships can have both beneficial and damaging impacts on health. In collaboration with Nepal Leprosy Trust (NLT), this longitudinal study explores a group-based approach to stigma reduction among people affected by leprosy in rural Nepal (N = 71)-a hard to reach and underrepresented non-WEIRD population. Informed by the 'social cure' literature, and the progressive model of self-stigma, we use a longitudinal design. We found that a sense of belonging to a self-help group can facilitate education in terms of health literacy, and over time these two factors also have impacts on participants stigma. Specifically, self-help group belonging predicted improvements in health literacy, leading to reduced endorsement of negative stereotypes and thus less stigma-related harm among people affected by leprosy. The study offers promising evidence that group-based interventions, which support health education, can reduce the harmful impact of stigma in very challenging contexts.

Objectives: Communities affected by leprosy encounter multiple traumas and adversities and are some of the poorest in the world. A diagnosis of leprosy can have catastrophic implications for peoples social, health, and economic circumstances. In this article, we describe a reciprocal collaboration with a nongovernmental organization (NGO) that supports people affected by leprosy, trauma, and adversity in rural Nepal. We offer a social identity-based empowerment approach for two reasons. We argue this approach is particularly suited to support those impacted by trauma and its psychological aftermath as those affected are disproportionately from disempowered and marginalized groups. Second, we know that people gain strength from others with whom they share experiences. Method: We offer longitudinal data (N = 71) to support this model of a mutually respectful, participatory, and collaborative approach with the Nepal Leprosy Trust (NLT), a social development NGO. Results: Findings of mediation analysis highlight that where a traumatic experience is highly stigmatized and isolating there is value in a group-based, self-help approach that emphasizes empowerment. Conclusion: A group-based approach that focuses on increasing knowledge and collective social resources is empowering for those affected by leprosy and adversity, because these resources build resilience. Clinical Impact StatementBuilt on the understanding that trauma and resilience are group-based phenomena, we present a groupbased social identity empowerment approach that orients to social position, resources, and power. We describe a reciprocal collaboration with the Nepal Leprosy Trust (NLT), a social development nongovernmental organization working with impoverished, stigmatized, and traumatized leprosy affected communities in rural Nepal. NLT provide community outreach, using self-help groups with participatory, peer-to-peer learning. Our longitudinal research includes efforts to share empowering research capital with NLT. Results show that this group-based approach encourages shared social identity, which is the basis for learning, social participation, and psychological resilience.