A conceptual model for healthcare-seeking research and interventions in cutaneous leishmaniasis

Healthcare-seeking is not merely a biomedical response to illness but a socially and culturally embedded practice reflecting the dynamic interplay of multiple factors. Traditional health behavioural models often overlook the nuanced socio-cultural, environmental, and systemic dimensions associated with neglected tropical diseases. We developed a conceptual model for healthcare-seeking grounded in the lived experiences of rural Sri Lankan communities with cutaneous leishmaniasis (CL). We employed a systematic, participatory, and iterative approach to develop the conceptual model, beginning with stakeholder identification. The problem context was explored using empirical data collected through multimethod studies and expert consultations, which informed the model’s objectives and scope. Data were analysed and synthesised to conceptualise key components and influencing factors of healthcare-seeking in CL. The model was iteratively refined through expert review, with sustained stakeholder engagement ensuring contextual relevance and applicability. Our conceptual model outlines the healthcare-seeking process for CL, integrating two complementary dimensions. On the horizontal axis of the model, we describe the pathway dimension, consisting of four key landmarks: (1) symptom recognition, (2) perceived health threats, (3) decisions on taking actions, and (4) help seeking from the biomedical sector. The vertical axis shows the determinant dimension, which emphasises both proximal and distal factors that shape healthcare-seeking and is grouped into four aspects: (1) individual factors, (2) disease characteristics, (3) social context, and (4) structural determinants. Some Individual factors (i.e. disease awareness, perceived severity) affected the entire pathway, whereas others (i.e. perceived treatability, psychosocial impact, and costs) influenced decisions on when, where and how to seek healthcare. Disease-related characteristics, including clinical manifestations, prevalence, transmission, and progression, played a critical role, while factors within the social context, such as family and neighbourhood cohesion, health beliefs, and myths about CL, further shaped healthcare decisions. Broader structural determinants, including health and non-health policies, health literacy, media influence, medical pluralism, and healthcare system factors, indirectly but significantly affected the entire process. This conceptual model presents the dynamic interplay of cognitive, social, cultural, and structural factors shaping healthcare-seeking in CL. By mapping how individuals navigate illness pathways within broader societal and systemic contexts, this model provides a holistic understanding, informing the design of interventions to improve healthcare-seeking in CL at different levels.