Empowering communities to use healthy lifestyle centres: an implementation research from Sri Lanka

Abstract

Objective Healthy lifestyle centres (HLCs), a state service that screens for major non-communicable disease (NCD) risk factors and promotes lifestyle modifications in Sri Lanka, report underutilisation. The study aimed to assess the effectiveness of a participatory intervention to empower communities in improving HLC utilisation. Design A quasi-experimental study based on the principles of community-based participatory research Setting Six rural communities each as the intervention (IG) (Gampaha district) and comparison (CG) groups (Kalutara district) from the capital province of Sri Lanka. Participants Study population was healthy individuals aged 35–65 years, the target group of HLCs in Sri Lanka. A random sample of 498 individuals was selected from each group for evaluation. Interventions Community support groups (CSGs) were established and empowered using health promotion approach from August 2019 to February 2020. Group discussions and participatory mapping were conducted to identify determinants of underutilisation of HLCs, design activities to address prioritised determinants and develop indicators to monitor the progress of CSGs. Primary and secondary outcome measures The primary outcome was improvement of HLC utilisation and the secondary outcome was initiation of lifestyle modifications. Results Significant improvements were seen in the IG, compared with the CG in the seven determinants that contribute to HLC utilisation. The largest differences were seen in reducing negative perceptions of susceptibility for NCDs (pre=64.7%; post=33.3%; p<0.001) and usefulness of screening (pre=66.6%; post=17.3%; p<0.001). The HLC utilisation in IG increased by 29.5% (pre=5.85%; 95% CI 3.74 to 7.95, post=35.3%; 95% CI 30.9 to 39.8, p<0.001), while the utilisation of the CG showed no difference. Furthermore, there was an improvement in the proportion of users who initiated lifestyle modification (pre=64.3%; post=89.9%; p=0.039) in IG, which was not observed in CG. Conclusion HLC utilisation and initiation of lifestyle modification can be improved by a community-based health promotion intervention through empowering CSGs.