Browsing by Author "Herath, H.M.T.P."

Now showing 1 - 5 of 5

Design, implementation and evaluation of a community intervention to improve utilisation of healthy lifestyle centres in two districts of Sri Lanka
(University of Kelaniya, Sri Lanka, 2022) Herath, H.M.T.P.
INTRODUCTION: Healthy Lifestyle Centres (HLCs) are underutilised in Sri Lanka. Effectiveness of empowering communities to improve utilisation of HLCs by its target f population (adults aged 35 to 65 years) is not explored. OBJECTIVE: To design, implement and evaluate a community intervention to improve utilisation of HLCs in two districts (Gampaha and Kalutara) of Sri Lanka. METHODS: Phase I, a mixed-methods descriptive study comprising: a qualitative study using grounded theory to explore reasons for the utilisation of HLCs using interviews and a cross-sectional study to assess the profile of users and nonusers and determine associated factors. A multistage cluster sampling method was used to recruit 1727 individuals. Data collected using an interviewer-administered questionnaire were analysed using bivariate and multivariable analysis. Phase II: a quasi-experimental study in six grama niladari divisions each from the catchment areas of two selected HLCs as Intervention (IG) and Comparison Groups (CG). Health Promotion Approach was used to empower Community Support Groups (CSGs) to address underutilisation. Phase III: a pre-post design to evaluate the outcomes. A random sample of 498 from each group was assessed and the primary outcome was the improvement in utilisation (Utilisation of the HLC by a study participant as a first time or as a follow-up client at the time of data collection). RESULTS: The rate of utilisation of the HLCs was 11.3% (n=195, 95% CI:9.80-12.8). HLC utilisation was found to be significantly associated with 14 factors. The factors with highest Odds Ratios (OR) were perceiving screening as useful (OR=10.2, 95% CI: 4.04-23.4) and perceived susceptibility to NCDs (OR= 6.78, 95% CI: 2.79- 16.42). The qualitative study revealed that negative past experiences and attitudes related to staff and services in state health care institutions and HLCs, and employment-related barriers negatively influenced HLC utilisation. The HLC utilisation, which was similar among the IG and CG in the pre assessment (p=0.056), showed a significant improvement in the post assessment (p<0.001). The HLC utilisation in IG increased by 29.5% (pre: 5.85% ; 95% Cl: [3.74-7.95], post: 35.3%; 95% CI: [30.9-39.8]). The CG did not show a significant difference in use. CONCLUSION AND RECOMMENDATIONS: HLC utilisation can be improved through empowering CSGs. The developed intervention model is recommended for use after accounting for contextual differences.
The effect of a community-based health promotion intervention to improve utilization of healthy lifestyle centers in Sri Lanka
(College of Community Physicians of Sri Lanka, 2021) Herath, H.M.T.P.; Perera, K.M.N.; Kasturiratne, A.
Background: Healthy lifestyle centers (HLCs) report underutilization by the target population. There is a dearth of evidence on improving HLC utilization through the Health Promotion (HP) approach. This study aims to evaluate of the effectiveness of a HP intervention in improving the utilization of HLCs.Methods: A quasi-experimental study was conducted in six grama niladari divisions from the catchment area of two selected HLCs, one each in Gampaha (intervention) and Kalutara (comparison) districts. Community support groups (CSGs) were developed and empowered as the intervention. Contributory factors for the underutilization were addressed with the CSG.The pre and post intervention assessments were done in a random sample of 498 (aged 35-65 years) from each group. Primary outcome was improvement in the attendance of the HLC and secondary outcomes were changes in contributory factors. Data collected using an interviewer-administered questionnaire and secondary data from the HLCs were used. Results: Utilization of the HLC improved significantly among the sample from the intervention group (Post 35.3% [95% CI: 30.9 - 39.8]; Pre 5.85% [95% CI: 3.74 - 7.95], P < 0.001). The comparison group showed no significant change (Post 3.49% [95% CI: 1.80 -5.17] - Pre 3.25% [95% CI: 1.62 - 4.87], p = 1.00). There was a significant improvement in mean HLC attendance in the intervention group (Mean difference= 91.83, P < 0.05) compared to the comparison group (Mean difference = 2.66, P > 0.05). Conclusions: The utilization of the HLCs can be improved by a HP intervention through developing and empowering CSGs.
How do Men who Choose Not to Participate in Healthy Lifestyle Centres Reason About Their Decision?
(Sri Lanka Medical Association, 2020) Herath, H.M.T.P.; Perera, K.M.N.; Kasturiratne, K.T.A.A.
INTRODUCTION AND BJECTIVES: In Sri Lanka, both women and men are expected to visit a cost-free population-based cardio-vascular screening programme held at a specific centre called the Healthy Lifestyle Centre (HLC) at their nearest primary health care institution. However, screened male to female ratio in 2016 first quarter was approximately 3:7 portraying that many men choose not to visit HLC compared to their female counterparts. This study explored how men who declined participation in the healthy lifestyle centre reasoned out their choice. METHODS: This qualitative study was conducted using constructivist grounded theory in Gampaha and Kalutara districts in Sri Lanka. Three focus group discussions (n= 7) and six interviews from men who actively declined participation in the healthy lifestyle centre were analysed using thematic analysis. RESULTS: Factors related to men’s decision not to participate in HLC included masculine perceptions such as male having a lower risk for diseases compared to a female, poor perceived susceptibility due to absence of symptoms, previous negative experiences related to health care services, lack of confidence in the tests conducted at the HLC and barriers due to their employment as HLC is being conducted in a fixed day and a time. CONCLUSION: Men’s decision not to participate in screening at HLC is linked with individual attitudes and influence by masculinity. The existing male-unfriendly nature of the health-care services also had a significant impact on the decision. Thus, targeted interventions are urgently needed to improve utilization of HLCs by men addressing these identified reasons.
Leadership styles on the organization citizenship behavior within divisional secretariats in Colombo district, Sri Lanka
(2013) Herath, H.M.T.P.
Reasons for underutilization of healthy lifestyle centers: Perceptions of health care providers
(Sri Lanka Medical Association, 2019) Herath, H.M.T.P.; Perera, K.M.N.; Kasturiratne, K.T.A.A.
INTRODUCTION & OBJECTIVES: Healthy lifestyle centers (HLC) for screening for non-communicable diseases (NCDs) and providing referrals for management and lifestyle modification advice are a response to the growing burden of NCDs in Sri Lanka. Currently HLCs are underutilized by its target population (adults >35 years). The aim of this study was to explore the health care providers' perceptions reasons for underutilization of HLCs in Gampaha district of Sri Lanka. METHODS: Ten key informant interviews were held with health care providers of HLCs in Gampaha district selected by judgmental sampling. The data collected via semi-structured interviews were analyzed using thematic analysis. RESULTS: Perceived reasons emerged in-eight categories: Sense of healthiness - absence of symptoms stimulating deviations from a healthy lifestyle; Negative past experiences - related to individual health seeking behaviours and outcomes; Clients' attitudes - dissatisfaction and mistrust towards the services provided; Client's employment related - loss of income for daily wagers and difficulties in obtaining leave; Lack of awareness - as promotions have been confined in health care setup and no community level mechanisms; Service provider related - opening times of the center and lack of basic facilities for screening; Gender and social norms such as falling ill being an insult to masculinity and elderly women exercising being considered strange; Private sector - clients being able to afford and feasibly access private sector services. CONCLUSION: Service providers believe underutilization of HLCs is due to a diverse range of individual, service related, and societal level factors, some of which can be easily addressed.