赋权社区使用健康生活方式中心：来自斯里兰卡的实施研究。

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

机构信息

Department of Primary Health Care, Faculty of Health-Care Sciences, Eastern University, Sri Lanka, Batticaloa, Sri Lanka

Department of Public Health, Faculty of Medicine, University of Kelaniya, Sri Lanka, Ragama, Sri Lanka.

出版信息

BMJ Open. 2024 Sep 10;14(9):e075634. doi: 10.1136/bmjopen-2023-075634.

DOI:10.1136/bmjopen-2023-075634

PMID:39260853

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11409384/

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.

TRIAL REGISTRATION NUMBER

SLCTR/2019/028.

摘要

目的

健康生活中心（HLC）是斯里兰卡提供的一项国家服务，用于筛查主要非传染性疾病（NCD）风险因素并促进生活方式改变，但利用率较低。本研究旨在评估一项参与式干预措施的效果，该措施旨在增强社区能力，提高 HLC 的利用率。

设计

基于社区参与式研究原则的准实验研究。

地点

斯里兰卡首都省的六个农村社区，每个社区均为干预组（IG）（Gampaha 区）和对照组（CG）（Kalutara 区）。

参与者

研究人群为年龄在 35-65 岁之间的健康个体，这是斯里兰卡 HLC 的目标人群。从每个组中随机抽取 498 名个体进行评估。

干预措施

2019 年 8 月至 2020 年 2 月，使用健康促进方法建立和增强社区支持小组（CSG）。进行小组讨论和参与式绘图，以确定 HLC 利用率低的决定因素，设计解决优先决定因素的活动，并制定监测 CSG 进展的指标。

主要和次要结果测量

主要结果是 HLC 利用率的提高，次要结果是生活方式改变的开始。

结果

与 CG 相比，IG 在有助于 HLC 利用率的七个决定因素方面取得了显著改善。最大的差异在于降低对 NCD 易感性的负面看法（前=64.7%；后=33.3%；p<0.001）和筛查的有用性（前=66.6%；后=17.3%；p<0.001）。IG 中的 HLC 利用率增加了 29.5%（前=5.85%；95%CI 3.74 至 7.95，后=35.3%；95%CI 30.9 至 39.8，p<0.001），而 CG 中的利用率则没有差异。此外，IG 中开始生活方式改变的用户比例有所提高（前=64.3%；后=89.9%；p=0.039），而 CG 中则没有观察到这种情况。