Determinants of Health-Seeking Behaviour for Leprosy Among High-Risk Populations in Gunungkidul District, Indonesia: A Community-Based Cross-Sectional Study

Objective: Indonesia ranks third globally in leprosy burden, with 9.2 of new 2023 cases presenting with Grade 2 disabilities (G2D), indicating delayed detection. Gunungkidul District continues to exhibit high G2D rates despite ongoing screening programs. This study examined the determinants of health-seeking behaviour among leprosy contacts, a high-risk population with a 5- to 13-fold higher risk of developing G2D. Methods: A community-based cross-sectional study was conducted across all 13 sub-districts of Gunungkidul District (February March 2025). Stratified random sampling enrolled 264 leprosy contacts. Structured interviews assessed knowledge, attitudes, perceived effectiveness of leprosy treatment, family support, healthcare worker support, accessibility to healthcare services and stigma. Data were analyzed using univariate, bivariate and multivariate logistic regression. Results are presented as adjusted odds ratios (aORs) with 95 confidence intervals (CIs). Results: Among the 264 participants (mean age 46.5 years; 63.3 female), most were of productive age (18-59 years, 79.2) and had completed at least junior high school. Homemakers formed the largest occupational group (42.1). Only 30.7 of contacts reported appropriate health-seeking behaviour. Multivariate analysis identified three key predictors of health-seeking behaviour: perceptions of leprosy treatment, accessibility to healthcare services and stigma. Favourable perceptions (aOR = 3.60; 95 CI: 1.90-6.80; p < 0.001), good accessibility (aOR = 2.46; 95 CI: 1.29-4.37; p = 0.006) and low stigma (aOR = 5.74; 95 CI: 3.03-10.87; p < 0.001) were strongly associated with health-seeking behaviour. Conclusion: Addressing social stigma, improving healthcare accessibility and promoting positive perceptions of leprosy treatment are crucial to encouraging health-seeking behaviour. These findings highlight the need for targeted public health interventions to enhance early detection and treatment, particularly among high-risk groups such as leprosy contacts. © 2025 John Wiley & Sons Ltd.