Improving Health Seeking Behaviour for Non-Communicable Diseases in Sri Lanka through Health Promotion Interventions

Abstract

Objective: We piloted evidence-based health promotion interventions to increase health seeking behaviour (HSB), as measured primarily by utilization of Healthy Lifestyle Centers (HLC). HLCs were introduced in Sri Lanka to increase screening of Non-Communicable Diseases (NCDs), but utilization has not met the pre-defined targets.

Design: This case-control study involved: development and validation of a contextually adapted tool to assess HSB; examination of HSB for selected NCDs; co-design and delivery of interventions to promote HSB; and evaluation of how these interventions impacted proxy measures of HSB, such as HLC utilization. The HSB tool was developed based on the Health Belief Model (HBM) and validated by local experts. HSB was assessed using a survey involving 850 participants selected using multi-stage cluster sampling. Community-based and health-system interventions were developed through four focus group discussions (FGD). The impact evaluation was completed in study and control areas, with 85 individuals from each area selected through cluster-sampling.

Setting: The intervention setting was the Kekanadura Medical Officer of Health (MOH) area and the control was Akuressa MOH area in Matara District, Sri Lanka

Main outcome measures: Pre-post survey results regarding HBM constructs, and awareness and utilization of HLCs, were conceptualised as proxy indicators of changes to HSB.

Results: Initially, only 46.5% of survey participants were aware of HLCs, 30.1% had ever visited a HLC and, of those, only 40.2% (n=102) were satisfied with HLC services. FGDs revealed lack of awareness, personal and service-related factors as common reasons for limited HLC utilization. Significant post-interventional improvements were identified regarding HLC utilization, but and self-reported improvements to HBM constructs were not statistically significant.

Conclusions: The structured, rigorous approach used in this study can be replicated in other resource-constrained settings to improve HSB, strengthen the identification and management of NCDs and, in this way, reduce demand for curative services.