Design, implementation and evaluation of a community intervention to improve utilisation of healthy lifestyle centres in two districts of Sri Lanka

Abstract

INTRODUCTION: Healthy Lifestyle Centres (HLCs) are underutilised in Sri Lanka. Effectiveness of empowering communities to improve utilisation of HLCs by its target f population (adults aged 35 to 65 years) is not explored. OBJECTIVE: To design, implement and evaluate a community intervention to improve utilisation of HLCs in two districts (Gampaha and Kalutara) of Sri Lanka. METHODS: Phase I, a mixed-methods descriptive study comprising: a qualitative study using grounded theory to explore reasons for the utilisation of HLCs using interviews and a cross-sectional study to assess the profile of users and nonusers and determine associated factors. A multistage cluster sampling method was used to recruit 1727 individuals. Data collected using an interviewer-administered questionnaire were analysed using bivariate and multivariable analysis. Phase II: a quasi-experimental study in six grama niladari divisions each from the catchment areas of two selected HLCs as Intervention (IG) and Comparison Groups (CG). Health Promotion Approach was used to empower Community Support Groups (CSGs) to address underutilisation. Phase III: a pre-post design to evaluate the outcomes. A random sample of 498 from each group was assessed and the primary outcome was the improvement in utilisation (Utilisation of the HLC by a study participant as a first time or as a follow-up client at the time of data collection). RESULTS: The rate of utilisation of the HLCs was 11.3% (n=195, 95% CI:9.80-12.8). HLC utilisation was found to be significantly associated with 14 factors. The factors with highest Odds Ratios (OR) were perceiving screening as useful (OR=10.2, 95% CI: 4.04-23.4) and perceived susceptibility to NCDs (OR= 6.78, 95% CI: 2.79- 16.42). The qualitative study revealed that negative past experiences and attitudes related to staff and services in state health care institutions and HLCs, and employment-related barriers negatively influenced HLC utilisation. The HLC utilisation, which was similar among the IG and CG in the pre assessment (p=0.056), showed a significant improvement in the post assessment (p<0.001). The HLC utilisation in IG increased by 29.5% (pre: 5.85% ; 95% Cl: [3.74-7.95], post: 35.3%; 95% CI: [30.9-39.8]). The CG did not show a significant difference in use. CONCLUSION AND RECOMMENDATIONS: HLC utilisation can be improved through empowering CSGs. The developed intervention model is recommended for use after accounting for contextual differences.