Reasons for underutilization of healthy lifestyle centers: Perceptions of health care providers

Abstract

INTRODUCTION & OBJECTIVES: Healthy lifestyle centers (HLC) for screening for non-communicable diseases (NCDs) and providing referrals for management and lifestyle modification advice are a response to the growing burden of NCDs in Sri Lanka. Currently HLCs are underutilized by its target population (adults >35 years). The aim of this study was to explore the health care providers' perceptions reasons for underutilization of HLCs in Gampaha district of Sri Lanka. METHODS: Ten key informant interviews were held with health care providers of HLCs in Gampaha district selected by judgmental sampling. The data collected via semi-structured interviews were analyzed using thematic analysis. RESULTS: Perceived reasons emerged in-eight categories: Sense of healthiness - absence of symptoms stimulating deviations from a healthy lifestyle; Negative past experiences - related to individual health seeking behaviours and outcomes; Clients' attitudes - dissatisfaction and mistrust towards the services provided; Client's employment related - loss of income for daily wagers and difficulties in obtaining leave; Lack of awareness - as promotions have been confined in health care setup and no community level mechanisms; Service provider related - opening times of the center and lack of basic facilities for screening; Gender and social norms such as falling ill being an insult to masculinity and elderly women exercising being considered strange; Private sector - clients being able to afford and feasibly access private sector services. CONCLUSION: Service providers believe underutilization of HLCs is due to a diverse range of individual, service related, and societal level factors, some of which can be easily addressed.