Browsing by Author "Perera, M."

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Behavioral Intention towards using M-Learning among Higher Educational Students in Sri Lanka
(University of Kelaniya, 2014) Perera, M.
The proliferation and popularity of mobile phone usage in Sri Lanka has created an untapped potential for educators and organizations. The very recent introduction of mobile learning to the higher education sector of the country is set to exploit much of this opportunity, but there remains some doubt on readiness of students towards this revolutionary distance learning method. This research was focused on increasing the knowledge for the education sector towards understanding of students' intention in accepting and adopting into M-learning as many of the benefits of M-learning has not yet been fully realized in Sri Lanka. Also, the study was also conducted with a view of identifying the factors affecting behavioral intention of higher educational students in Sri Lanka towards M-learning. Based on prior studies, related theories and frameworks four variables were identified in order to assess the behavioral intention of students towards and M-learning system and those were: attitudes, subjective norms, perceived behavioral control and perceived risk. The research approach of the study was deductive discipline and primary data were gathered from a self-administered questionnaire. The relationship between each independent and dependent variables were examined along with the hypotheses developed. The sample size was 200 students who represented four public universities and four other higher educational institutes in Sri Lanka. The results revealed that there were positive relationships between attitudes, subjective norms and perceived behavioral control and behavioral intention while perceived risk demonstrated a negative relationship with the behavioral intention. The study has discussed the findings followed by both descriptive and inferential statistics and based on the findings it is possible to provide recommendations in favor of implementing M-learning systems within the higher educational sector in Sri Lanka.
The Effect of Foreign Exchange Market Returns on Stock Market Performance in Sri Lanka
(Faculty of Commerce and Management Studies, University of Kelaniya, 2015) Perera, M.
Exchange rate is one of the most influencing macroeconomic variables on stock returns in most of the countries. Thus, main objective of this study is to identify the effect of foreign exchange market returns on stock market performance in Sri Lanka. In order to evidence the study, researcher used publicly available secondary data from Colombo Stock Exchange and Central Bank of Sri Lanka. According to Guneratne (2011), exchange rate has a strong explanatory power in determining the stock market returns of the country. All share price index percentage changes are observed as dependent variable and the respective percentage changes of USD/LKR, EUR/LKR and GBP/LKR exchange rates as independent variables of this research. Exchange rate data for the period of 2002 to 2014 are considered for the research. A linear multiple regression model is developed to find the relationship between selected variables and following Noel & John (2009), correlation between variables are tested. Results of the research discloses that USD/LKR and GBP/LKR exchange rate returns have a strong explanatory power to All share price index (ASPI) returns. At the same time USD/LKR returns exhibits a negative correlation while other two exchange rates have a positive but weak correlation to ASPI returns. Findings of this research provide valuable information to investors in equity markets, to forecast potential stock returns with reference to exchange market fluctuations.
The Effect of Western Colonization on ‘School Cultures’ and its Impact on Learning and Teaching English
(University of Kelaniya, 2005) Perera, M.
It has been argued that any classroom methodology to be appropriate it needs to be ‘culture sensitive’ (Holliday, 1994). Further, it is also claimed that ‘culture sensitivity’ needs to be realized through ethnographic action research. This paper examines the influence of western colonization on Education in Sri Lanka and as a result how different ‘school cultures’ developed. Next, based on the findings of observational case studies of two schools the paper examines how the different school cultures provided opportunities for learning English. Finally, the implications of the different ‘school cultures’ on learning English is discussed and the challenges for the future learning teaching process are identified.
Empowering communities to use healthy lifestyle centres: an implementation research from Sri Lanka
(BMJ Publishing Group Ltd, 2024) Herath, T.; Perera, M.; Guruge, D.; Kasturiratne, A.
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.
Factors influencing the decision to use state-funded healthy lifestyle centres in a low-income setting: a qualitative study from Sri Lanka
(BMJ Publishing Group, 2023) Herath, T.; Perera, M.; Kasturiratne, A.
OBJECTIVE: Healthy lifestyle centres (HLCs) in Sri Lanka provide screening and lifestyle modification services targeting major non-communicable diseases (NCDs). Even though the service is highly accessible and affordable, HLCs are underused by its target population (adults >35 years). We aimed to explore the factors that influence the decision-making process of utilisation of HLCs in Sri Lanka. SETTING: Two districts (Gampaha and Kalutara) from the highest populous province (Western) located adjacent to the capital district of Sri Lanka. PARTICIPANTS: Nine service providers, 37 HLC clients and 52 community participants were selected using judgemental, convenient and purposive sampling methods. Theoretical sampling method was used to decide the sample size for each category. METHOD: A qualitative study design based on constructivist grounded theory was used. Data collected using in-depth interviews and focus group discussions during January to July 2019 and were analysed using the constant comparison method. RESULTS: The decision-making process of utilisation of HLCs was found to be a chain of outcomes with three main steps, such as: intention, readiness and utilisation. Awareness of HLCs, positive attitudes on health, intrinsic or extrinsic motivators, positive attitudes on NCDs and screening were internal factors with a positive influence on intention. Readiness was positively influenced by positive characteristics of the HLCs. It was negatively influenced by negative attitudes on staff and services of HLCs and negative past experiences related to services in state healthcare institutions and HLCs, service provider-related barriers and employment-related barriers. Family-related factors, social support and norms influenced both intention and readiness, either positively or negatively. CONCLUSION: The decision-making process of utilisation of HLCs links with factors originating from internal, family, service provider and societal levels. Thus, a multifactorial approach that addresses all these levels is needed to improve the utilisation of HLCs in Sri Lanka.
Impact of the Procurement System of Supermarkets on the Rural Vegetable Farmers in Sri Lanka
(University of Kelaniya, 2005) Jayatunga, P.; Perera, M.; Kodithuwakku, S.S.; Weerahewa, J.
Changes in the Scio-economic environment over the past years have contributed to the emergence of supermarkets in Sri Lanka. Previous research studies have observed that the procurement system of the supermarket chain with the largest number of outlets has created an alternative channel which is different from the existing traditional vegetable supply chains. The particular channel purchase vegetables directly from the producer and sells directly to the consumer with the supermarket being the only intermediary in between. It was found to be comparatively more efficient and effective as opposed to the traditional vegetable supply chains in moving vegetables from the producer to the consumer. The proposed study aimed to investigate this aspect further by investigating the possible impacts the supermarket channel under consideration may have on the farmers in vegetable producing areas. The research was conducted in the form of a case study in Hanguranketha. The sample of farmers was selected using the simple random sampling technique. Data was collected using semi-structured interviews and observations from a sample of 30 farmers who supply to the supermarket channel and 30 farmers who supply to traditional market channels. The research revealed that the supermarket channel pay a higher price to the farmers, which has contributed to increase their income. It has reduced the degree of dominance among intermediaries attached to traditional channel. Employees attached to the supermarket provide farmers with information and advice relating to production. However, it was found that only farmers in the near vicinity of the regional collecting centre of the supermarket have the ability to access the particular channel. Even among farmers who do have access, only about 29% of their total harvest was purchased by the supermarket. There were no buy-back agreements between the supermarket and the farmers. Hence, due to the uncertainty with respect to price and quantity, farmers were not willing to change the production practices. Thus, it can be concluded that the emergence of the particular supermarket channel deem to be beneficial to farmers. However, there is a scope for possible improvements.
The importance of context sensitivity of Basic Interpersonal Communication Skills (BICS) in Content and Language Integrated Learning (CLIL) in Bilingual Education
(Faculty of Graduate Studies, University of Kelaniya, 2015) Perera, M.; Kularathne, S.A.
National Education Commission proposed Bilingual Education to the national curriculum in 2003. One of the main objectives of this introduction is to improve the second Language proficiency of learners. The Ministry of Education in collaboration with the National Institute of Education is designing a model based on CLIL; a widely used learning teaching approach in bilingual education, to suit the Sri Lankan context. Cummins (1981) claims two language proficiencies that are necessary in improving the bilingual learner‘s second language proficiency; BICS (Basic Interpersonal Communication Skills) and Cognitive Academic Language Proficiency (CALP). BICS is an informal day today language that learners acquire when exposed to an acquisition rich environment while CALP refers to the use of academic language in formal learning teaching contexts. Cummins claim that BICS lays the foundation for CALP. The objective of this paper is to examine Cummins‘ BICS in relation to Bilingual Education in Sri Lankan context. This analysis is based on interviews held with a purposive sample of bilingual teachers and teachers of English and observation of classrooms and content analysis of pupils textbooks. Literature relating to CLIL too was studied. Cummins‘ interpretation of BICS has to be modified if it is to be applied to Sri Lanka. Opportunities for the pupils to acquire BICS are not adequately available in Sri Lanka as the teachers are not well equipped with learning teaching strategies facilitating BICS .Therefore BICS should be facilitated in the formal classroom context. Text books prescribed to teach bilingually are the direct translation of monolingual textbooks designed for monolingual learners .It is recommended that teachers be trained in CLIL pedagogy and textbooks be revised. Teachers should be equipped with knowledge and skills to adapt available textbooks to facilitate BICS.
Knowledge on health promotion approach among Public Health Midwives in a district in Sri Lanka
(Postgraduate Institute of Medicine, University of Colombo, 2015) Perera, M.; Guruge, N. D.; Gunawardena, N.
BACKGROUND: The Ottawa Charter defines Health Promotion as the "process of enabling people to increase control over, and to improve, their health". The National Health Promotion Policy recognizes health promotion as an efficient and cost effective approach to promote health in Sri Lanka. The Public Health Midwife (PHM) is the grass root level health worker responsible for promoting the health of communities in Sri Lanka. Their knowledge regarding health promotion has not been assessed. The main aim of this study was to describe their knowledge on health promotion and associated factors. METHODS: A cross sectional descriptive study was conducted among all PHMM (N=364) in the Kandy District who were eligible, using a self-administered questionnaire. Level of knowledge was based on scores obtained for responses to close ended questions and case scenarios. RESULTS: Knowledge on health promotion was „poor‟ among 238 (65.4%). Incorrect labeling of other activities as activities using a health promotion approach was common 257(70.6%). Training programmes 285(73.9%) were the commonest source of knowledge while 95(26%) were never trained on health promotion approach during their career. The factors that were significantly associated with a level of „good‟ knowledge on health promotion in multivariate analysis were; experience in the public health field less than 20 years (p=0.012), participating in training programmes on health promotion (p=0.03) and experience in implementing health promotion programmes (p=0.04). CONCLUSIONS: The study concludes that PHMM in the Kandy District have a "poor" level of knowledge on health promotion and recommends increasing training opportunities and improving opportunities for application to improve the situation.
Near-death experiences in a multi-religious hospital population in Sri Lanka
(Springer, 2018) Chandradasa, M.; Wijesinghe, C.; Kuruppuarachchi, K.A.L.A.; Perera, M.
Near-death experiences (NDEs) are a wide range of experiences that occur in association with impending death. There are no published studies on NDEs in general hospital populations, and studies have been mainly conducted on critically ill patients. We assessed the prevalence of NDEs and its associations in a multi-religious population in a general hospital in Sri Lanka. A randomised sample of patients admitted to the Colombo North Teaching Hospital was assessed using the Greyson NDE scale and clinical assessment. Out of total 826 participants, NDEs were described by 3%. Compared to the NDE-negative participants, the NDE-positive group had a significantly higher mean for age and a ratio of men. Women reported deeper NDEs. Patients of theistic religions (Christianity, Islam and Hinduism) reported significantly more NDEs compared to patients from the non-theistic religious group (Buddhism). NDE-positive patient group had significantly higher reporting of a feeling 'that they are about to die', the presence of loss of consciousness and a higher percentage of internal medical patients. This is the first time that NDEs are assessed in a general hospital population and NDEs being reported from Sri Lanka. We also note for the first time that persons with theistic religious beliefs reported more NDEs than those with non-theistic religious beliefs. Medical professionals need to be aware of these phenomena to be able to give an empathic hearing to patients who have NDE.
Near-death experiences in suicide attempters in Sri Lanka
(International Association for Near-Death Studies, 2008) Kuruppuarachchi, K.A.L.A.; Gambheera, H.; Padmasekara, G.; Perera, M.
No Abstract
Neoadjuvant therapy for rectal cancer down-stages the tumor but reduces lymph node harvest significantly
(Springer International, 2005) Wijesuriya, S.R.E.; Deen, K.I.; Hewavisenthi, J.; Balawardana, J.; Perera, M.
PURPOSE: The impact of neoadjuvant therapy (NAT) for rectal cancer on lymph node yield is not well known. This study evaluates the impact of NAT on tumor regression and lymph node harvest. METHODS: The subjects were 40 patients with rectal cancer; 20 receiving high-dose, long-course neoadjuvant therapy, and 20 age- and sex-matched controls who did not receive neoadjuvant therapy. Tumor regression (TRG) was graded from 1 to 5 as: TRG1, no residual tumor cells; TRG2, occasional residual tumor cells with marked fibrosis; TRG3, marked fibrosis with scattered tumor cells or groups; TRG4, abundant cancer cells with little fibrosis; TRG5, no tumor regression. We also evaluated the number of lymph nodes retrieved from excised specimens, the size of the largest node, and the extent of lymph node involvement by the tumor. RESULT: Tumor regression was seen in all patients; as TRG1 in 6 (30%), TRG2 in 2 (10%), TRG3 in 3 (15%), and TRG4 in 9 (45%). The median nodal harvest was 4 (range (0-12) in the NAT group vs 9 (range 1-19) in the control (P = 0.001). The median size of the largest lymph node was 5 mm (range 2-12 mm) in the NAT group vs 9 mm (range 4-15 mm) in the control group (P = 0.004). Tumor-positive nodes were identified in 4 of 17 of the NAT group patients and in 9 of the 20 controls (P = 0.308). CONCLUSION: Although NAT down-stages rectal cancer, it results in a significantly low yield of lymph nodes, which are also significantly smaller than those in nonirradiated controls. Therefore, surgeons and histopathologists must ensure adequate sampling and accurate staging is done for patients with irradiated rectal cancer.
Patient perspectives on hypertension management in health system of Sri Lanka: a qualitative study.
(BMJ Publishing Group Ltd, 2019) Perera, M.; de Silva, C.K.; Tavajoh, S.; Kasturiratne, A.; Luke, N. V.; Ediriweera, D.S.; Ranasinha, C.D.; Legido-Quigley, H.; de Silva, H.A.; Jafar, T.H.
INTRODUCTION:Uncontrolled hypertension is the leading risk factor for mortality globally, including low-income and middle-income countries (LMICs). However, pathways for seeking hypertension care and patients' experience with the utilisation of health services for hypertension in LMICs are not well understood.OBJECTIVES:This study aimed to explore patients' perspectives on different dimensions of accessibility and availability of healthcare for the management of uncontrolled hypertension in Sri Lanka.SETTING:Primary care in rural areas in Sri Lanka.PARTICIPANTS:20 patients with hypertension were purposively sampled from an ongoing study of Control of Blood Pressure and Risk Attenuation in rural Bangladesh, Pakistan, Sri Lanka.METHOD:We conducted in-depth interviews with patients. Interviews were audio-recorded and transcribed into local language (Sinhala) and translated to English. Thematic analysis was used and patient pathways on their experiences accessing care from government and private clinics are mapped out.RESULTS:Overall, most patients alluded to the fact that their hypertension was diagnosed accidentally in an unrelated visit to a healthcare provider and revealed lack of adherence and consuming alternatives as barriers to control hypertension. Referring to the theme 'Accessibility and availability of hypertension care', patients complained of distance to the hospitals, long waiting time and shortage of medicine supplies at government clinics as the main barriers to accessing health services. They often resorted to private physicians and paid out of pocket when they experienced acute symptoms attributable to hypertension. Considering the theme 'Approachability and ability to perceive', the majority of patients mentioned increasing public awareness, training healthcare professionals for effective communication as areas of improvement. Under the theme 'Appropriateness and ability to engage', few patients were aware of the names or purpose of their medications and reportedly missed doses frequently. Reminders from family members were considered a major facilitator to adherence to antihypertensive medications. Patients welcomed the idea of outreach services for hypertension and health education closer to home in the theme 'Things the patients reported to improve the system'.CONCLUSION:Patients identified several barriers to accessing hypertension care in Sri Lanka. Measures recommended improving hypertension management in Sri Lanka including public education on hypertension, better communication between healthcare professionals and patients, and efforts to improve access and understanding of antihypertensive medications.TRIAL REGISTRATION NUMBER:NCT02657746.
Patterns and perceptions of wildlife crop raiding in and around the Kaludiyapokuna Forest Reserve in the dry zone of Sri Lanka
(Department of Zoology and Environmental Management, University of Kelaniya, Sri Lanka, 2017) Perera, M.; Vandercone, R.
Expanding human population and rapid conversion of natural habitat to agricultural land has led to greater proximity between humans and wildlife. Crop-raiding is an outcome of both natural resources becoming less accessible and the nutritional benefits of cultivated foods becoming increasingly known to wildlife. The resulting financial losses suffered by farmers from crop raiding can be relatively high and is compounded by the lack of compensation for losses. Such a situation can make farming communities intolerant and unsympathetic towards wildlife and even coerce farmers to adopt drastic measures such as killing of problem species and hence impede conservation strategies. However, in order to mitigate this form of human–wildlife conflict, it is first necessary to understand the temporal nature of crop raiding by different animal species as it is fundamental towards developing cost effective guarding strategies. Data on perceived and actual crop raiding event was collected from July 2013-August 2014, from 36 farms around the Kaludiyapokuna Forest Reserve, Sri Lanka. Study respondents have identified Pavo cristatus (38%), Elephas maximus (27%), Semnopithecus priam (21%) and Macaca sinica (14%) as the most destructive crop pests. From 8012 crop raids by eight species of animals, most raids were indeed made by the Pavo cristatus (59%) and Semnopithecus priam (28%). The average monthly relative frequency of crop raiding was 0.07 (range 0.02-0.27). The highest monthly relative frequency was recorded in August. Only the monthly relative frequency of crop raiding by M. sinica was positively and statistically significantly correlated (p= 0.09) with monthly rainfall. When cropping systems were considered, 64% of the crop raiding incidents were recorded from monoculture farms, while only 36% were recorded from polyculture farms. Our study demonstrates that animals differ in their crop raiding behavior and also that certain species show temporal variation in crop raiding patterns. In addition, cropping systems also appear to be linked to crop raiding preferences of wildlife. Our study also provides a useful starting point for future studies investigating temporal and spatial factors predicting crop raiding by wildlife.
Proximal and distal rectal cancers differ in curative resectability and local recurrence
(Baishideng Publishing Group, 2011) Wijenayake, W.; Perera, M.; Balawardena, J.; Deen, R.; Wijesuriya, S.R.; Kumarage, S.K.; Deen, K.I.
AIM: To evaluate patients with proximal rectal cancer (PRC) (> 6 cm up to 12 cm) and distal rectal cancer (DRC) (0 to 6 cm from the anal verge). METHODS: Two hundred and eighteen patients (120 male, 98 female, median age 58 years, range 19- 88 years) comprised 100 with PRC and 118 with DRC. The proportion of T1, T2 vs T3, T4 stage cancers was similar in both groups (PRC: T1+T2 = 29%; T3+T4 = 71% and DRC: T1+T2 = -31%; T3+T4 = 69%). All patients had cancer confined to the rectum - those with synchronous distant metastasis were excluded. Surgical resection was with curative intent with or without preoperative chemoradiation (c-RT). Follow-up was for a median of 35 mo (range: 12 to 126 mo). End points were: 30 d mortality, complications of operation, microscopic tumour- free margins, resection with a tumourfree circumferential margin (CRM) of 1 to 2 mm and > 2 mm, local recurrence, survival and the permanent stoma rate. RESULTS: Overall 30-d mortality was 6% (12): PRC 7 % and DRC 4%. Postoperative complications occurred in 14% with PRC compared with 21.5% with DRC, urinary retention was the complication most frequently reported (PRC 2% vs DRC 9%, P = 0.04). Twelve percent with PRC compared with 37% with DRC were subjected to preoperative c-RT (P = 0.03). A tumour-free CRM of 1 to 2 mm and > 2 mm was reported in 93% and 82% with PRC and 88% and 75% with DRC respectively (PRC vs DRC, P > 0.05). However, local recurrence was 5% for PRC vs 11% for DRC (P < 0.001). Three and five years survival was 65.6% and 60.2% for PRC vs 67% and 64.3% for DRC respectively. No patient with PRC and 23 (20%) with DRC received an abdomino-perineal resection. CONCLUSION: PRC and DRC differ in the rate of abdomino-perineal resection, post-operative urinary retention and local recurrence. Survival in both groups was similar.
Pseudo-Meigs syndrome secondaray to pedunculated leiomyoma associated with intra uterine pregnancy
(Sri Lanka College of Obstetricians and Gynaecologists, 2006) Dias, T.D.; Herath, H.M.R.P.; Ganeshananthan, S.; Perera, M.; Karunananda, A.
No Abstract Available
Student voices- an underutilized quality input in school education in Sri Lanka
(University of Kelaniya, 2008) Perera, M.
Supportive facilities and challenges for education during covid-19 pandemic among orphaned children in child development centres in Gampaha district
(Faculty of Medicine, University of Kelaniya, Sri Lanka, 2021) Jayarathne, M.; Jayasooriya, Y.; Jayasooriya, N.; Jayasundara, P.; Jayalath, B.; Perera, M.
Introduction: Children living in Child Development Centers (CDCs) are critically underprivileged in receiving and accessing positive learning experiences in general. This may have worsened during a global pandemic with movement restrictions. Objectives: To describe the supportive facilities and challenges for education before and during Covid-19 pandemic in CDCs in Gampaha District. Methods: A descriptive cross-sectional study targeted all wardens of CDCs in Gampaha District compatible with the inclusion criteria (N=46) using a telephone interview in February, 2021. Results: The response rate was 56.5% (26/46) as others declined participation due to legal and administrative issues. Sixteen CDCs (61.5%) accommodated fewer than 20 children. Majority could not state a cost for education. However, 80.7%(n=21) stated they “managed”. Essentials for schooling and stationeries were adequately available. Only 10(38.5%) had a separate chair and a table for each child and only 23(88.5%) had libraries. Twenty-four (92.3%) reported that they sent their children to extra tuition classes. Only 16 CDCs had computers and 15 had internet connections before the pandemic. During COVID-19, roughly equal proportions used printed material sent from school (n=24;34%), online learning platforms (n=23;32%) and television (n=21 ;30%) to continue education. Only 18(69.2%) was able to provide equal e-leaming facilities for all children and only 17(65.3%) could continue education without any interruption. The majority (n=21;80.7%) claimed that cost increased during pandemic which was covered mainly through private organizations (n=14;53.8%) and individual donations (n= 10;38.4%). Conclusions: COVID-19 pandemic had a negative impact on children’s education in the studied institutions due to inadequate facilities.
Under-utilisation of noncommunicable disease screening and healthy lifestyle promotion centres: A cross-sectional study from Sri Lanka
(Public Library of Science, 2024) Herath, T.; Perera, M.; Kasturiratne, A.
BACKGROUND 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. METHODS 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. RESULTS 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. CONCLUSION 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.