Under-utilisation of noncommunicable disease screening and healthy lifestyle promotion centres: A cross-sectional study from Sri Lanka

Abstract

BACKGROUND Healthy Lifestyle Centres (HLCs) are state-owned, free-of-charge facilities that screen for major noncommunicable disease risks and promote healthy lifestyles among adults older than 35 years in Sri Lanka. The key challenge to their effectiveness is their underutilisation. This study aimed to describe the underutilisation and determine the factors associated, as a precedent of a bigger project that designed and implemented an intervention for its improvement. METHODS Data derived from a community-based cross-sectional study conducted among 1727 adults (aged 35 to 65 years) recruited using a multi-stage cluster sampling method from two districts (Gampaha and Kalutara) in Sri Lanka. A prior qualitative study was used to identify potential factors to develop the questionnaire which is published separately. Data were obtained using an interviewer-administered questionnaire and analysed using inferential statistics. RESULTS Forty-two percent (n = 726, 95% CI: 39.7–44.4) had a satisfactory level of awareness on HLCs even though utilisation was only 11.3% (n = 195, 95% CI: 9.80–12.8). Utilisation was significantly associated with 14 factors. The five factors with the highest Odds Ratios (OR) were perceiving screening as useful (OR = 10.2, 95% CI: 4.04–23.4), perceiving as susceptible to NCDs (OR = 6.78, 95% CI: 2.79–16.42) and the presence of peer support for screening and a healthy lifestyle (OR = 3.12, 95% CI: 1.54–6.34), belonging to the second (OR = 3.69, 95% CI: 1.53–8.89) and third lowest (OR = 2.84, 95% CI: 1.02–7.94) household income categories and a higher level of knowledge on HLCs (OR = 1.31, 95% CI: 1.24– 1.38). When considering non-utilisation, being a male (OR = 0.18, 95% CI: 0.05–0.52), belonging to an extended family (OR = 0.43, 95% CI: 0.21–0.88), residing within 1–2 km (OR = 0.29, 95% CI: 0.14–0.63) or more than 3 km of the HLC (OR = 0.14, 95% CI: 0.04– 0.53), having a higher self-assessed health score (OR = 0.97, 95% CI: 0.95–0.99) and low perceived accessibility to HLCs (OR = 0.12, 95% CI: 0.04–0.36) were significantly associated. CONCLUSION In conclusion, underutilisation of HLCs is a result of multiple factors operating at different levels. Therefore, interventions aiming to improve HLC utilisation should be complex and multifaceted designs based on these factors rather than merely improving knowledge.