Faculty of Health-Care Sciences, Department of Primary Health Care, Eastern University, Batticaloa, Sri Lanka.
Faculty of Medicine, Department of Public Health, University of Kelaniya, Ragama, Sri Lanka.
PLoS One. 2024 Apr 4;19(4):e0301510. doi: 10.1371/journal.pone.0301510. eCollection 2024.
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.
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.
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.
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.
健康生活中心（HLC）是国有免费设施，用于筛查 35 岁以上成年人的主要非传染性疾病风险，并促进健康的生活方式。其有效性的主要挑战是利用率低。本研究旨在描述利用率低的情况，并确定相关因素，为一项旨在改善其利用率的干预措施的设计和实施提供参考。
数据来自斯里兰卡两个地区（Gampaha 和 Kalutara）采用多阶段聚类抽样方法从 1727 名 35 至 65 岁成年人中进行的基于社区的横断面研究。先前的定性研究用于确定可能的因素来开发问卷，该问卷已单独发表。使用访谈者管理的问卷获得数据，并使用推断统计进行分析。
尽管利用率仅为 11.3%（n=195，95%CI：9.80-12.8），但仍有 42%（n=726，95%CI：39.7-44.4）对 HLC 有满意的认知水平。利用率与 14 个因素显著相关。五个具有最高优势比（OR）的因素是认为筛查有用（OR=10.2，95%CI：4.04-23.4），认为自己易患非传染性疾病（OR=6.78，95%CI：2.79-16.42）以及存在同伴支持筛查和健康生活方式（OR=3.12，95%CI：1.54-6.34），属于第二（OR=3.69，95%CI：1.53-8.89）和第三低（OR=2.84，95%CI：1.02-7.94）家庭收入类别以及对 HLC 的知识水平较高（OR=1.31，95%CI：1.24-1.38）。在考虑未利用时，男性（OR=0.18，95%CI：0.05-0.52）、大家庭（OR=0.43，95%CI：0.21-0.88）、居住在 HLC 1-2 公里（OR=0.29，95%CI：0.14-0.63）或 3 公里以上（OR=0.14，95%CI：0.04-0.53）、自我评估健康得分较高（OR=0.97，95%CI：0.95-0.99）和感知到 HLC 可及性低（OR=0.12，95%CI：0.04-0.36）与未利用显著相关。
总之，HLC 利用率低是多个因素在不同层面作用的结果。因此，旨在提高 HLC 利用率的干预措施应该是基于这些因素的复杂和多方面的设计，而不仅仅是提高知识。
