Structured digital health intervention for leprosy awareness: a case study of analyzing public engagement and sentiment in a Sri Lankan leprosy awareness campaign on Facebook.

BACKGROUND: Leprosy is a curable yet stigmatized disease that persists in Sri Lanka, despite the country having met the World Health Organization (WHO) elimination threshold in 1995. Disruptions in outreach during the COVID-19 pandemic heightened concerns regarding unreported cases, emphasizing the necessity for innovative awareness strategies. Although social media is progressively utilized for health promotion in low- and middle-income nations, there is no understanding of how expert-moderated digital discussions can influence public attitudes and stimulate clinical visits in these countries. METHODS: We employed a single embedded case study of a government-led Facebook awareness post on leprosy, analyzing 806 public comments and replies. Data were examined using reflexive thematic analysis and the framework method to characterize user archetypes, stigma expressions, sentiment shifts, and referral actions. Intervention episodes, where identified medical experts engaged, were compared with non-intervention episodes to assess changes in misinformation, reassurance, and intent to seek care. Language equity was considered by analyzing contributions in Sinhala, Tamil, and English. To enhance trustworthiness, intercoder reliability, analyst triangulation, and ethical safeguards for Internet-mediated research were applied. RESULTS: In this case, the thread showed features we describe as a ‘digital frontline,’ a public, expert-moderated space that provided triage-like guidance, corrected misinformation, and signposted users to care. The WhatsApp line was followed by more than 150 inbound WhatsApp contacts within 24 h, as reported to the study team by the Anti-Leprosy Campaign, Ministry of Health; however, the downstream clinical outcomes were not independently verified. Expert communication was followed by observable shifts in sentiment from anxiety and confusion to reassurance and gratitude, whereas community amplification appeared to reinforce credibility and limit misinformation. Stigma emerged in two forms: fear-based concerns about contagion and deformity, and normalized humor that trivialized illness and may risked deterring help seeking. A key limitation was the reliance on Sinhala, with limited Tamil engagement despite the high prevalence in Tamil-speaking regions. CONCLUSION: This case suggests that expert-moderated social media threads may, in some contexts, take on ‘digital frontline’ features as defined here and may support referral-oriented engagement. Future studies should test whether similar arrangements produce reliable referrals and equitable access across languages when linked to national leprosy services and WHO strategy priorities.