Community Health Promotion for COVID-19 Prevention and NCD Risk Reduction in Rural Sri Lanka

Seven initial sessions (one in each of six villages and one with a children's group; 246 participants) were followed by 17 follow-up contacts by health promotion facilitators through home visits, telephone and social media. The programme followed four steps: identifying prevention of COVID-19 spread as a collective goal; understanding the determinants of COVID-19 spread and NCD risk; identifying and prioritising actions; and implementing and monitoring actions using indicators agreed with the community.

Data were recorded in aggregated, village-level form: session-mean self-ratings of household NCD risk (0 to 10, 10 = highest risk) at the start and end of the initial session; baseline waist circumference classified against South Asian cut-off points; household kitchen risk classified by the Kussi Calendar (oil, sugar, salt and rice); and counts of families and community members reporting practices at programme end, obtained by telephone and a group discussion. Audio-recorded group discussions in Sinhala were translated into English and analysed thematically.

The study was single-arm with no comparison group, and all analyses were descriptive.

Community members of six villages and a children's group who took part in the initial sessions and community groups.

Behavioral: Community-based health promotion programme

Initial session on COVID-19 transmission and prevention, the link between NCDs and severe COVID-19, NCD risk factors, family happiness and home gardening; formation of community groups; follow-up contacts by health promotion facilitators; and community co-designed monitoring tools (Corona, Kussi and Happiness Calendars), following a four-step community-based health promotion process.

Plazo: Day 1 (immediately before and immediately after the initial session)

Session-mean rating by participants of the risk of non-communicable diseases in their own home on a scale of 0 (lowest risk) to 10 (highest risk), recorded at the start and end of the initial session.

Plazo: Up to 5 months (end of programme)

Number of active families reporting a household handwashing place, removing slippers or changing clothes before entering the house, as a proportion of active families in each village.

Plazo: Up to 5 months (end of programme)

Number of active families reporting reduced consumption of oil, sugar, salt, flour or junk food, or checking E-numbers on packaged food, as a proportion of active families in each village.

Plazo: Baseline (Day 1) to 5 months (end of programme)

Number of community members who monitored their weight and reported a reduction.

Plazo: Baseline

Proportion of participants with waist circumference above the cut-off (women more than 80 cm; men more than 90 cm).

Plazo: Baseline

Proportion of households classified red, orange or green by the Kussi Calendar according to consumption of oil, sugar, salt and rice against household-agreed levels.

Community Empowerment for COVID-19 Prevention and Non-Communicable Disease Risk Reduction Using a Health Promotion Approach: A Mixed-Methods Community Intervention Study From Rural Sri Lanka