Impact of the economic crisis on general health-seeking behavior and chronic disease management: a comparative study of public perceptions in the Western and Uva Provinces of Sri Lanka.

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Τίτλος:	Impact of the economic crisis on general health-seeking behavior and chronic disease management: a comparative study of public perceptions in the Western and Uva Provinces of Sri Lanka.
Συγγραφείς:	Nilaweera AI; Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka. akhilaimantha@gmail.com., Fernando DR; Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka., Adikaranayake PR; Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka., Perera AN; Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka., Dakshina T; Diabetes Research Unit, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka., Weerakoon S; Diabetes Research Unit, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka., Wijayathilaka N; Diabetes Research Unit, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka., Nethmini T; Diabetes Research Unit, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka., Jayalath D; Diabetes Research Unit, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka., Hettiarachchi D; Diabetes Research Unit, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka., Indrawansa S; Diabetes Research Unit, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka., Dissanayake H; Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka., Wijayaratne DR; Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka., Katulanda P; Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka.
Πηγή:	BMC health services research [BMC Health Serv Res] 2026 Apr 28; Vol. 26 (1). Date of Electronic Publication: 2026 Apr 28.
Τύπος έκδοσης:	Journal Article; Comparative Study
Γλώσσα:	English
Στοιχεία περιοδικού:	Publisher: BioMed Central Country of Publication: England NLM ID: 101088677 Publication Model: Electronic Cited Medium: Internet ISSN: 1472-6963 (Electronic) Linking ISSN: 14726963 NLM ISO Abbreviation: BMC Health Serv Res Subsets: MEDLINE
Imprint Name(s):	Original Publication: London : BioMed Central, [2001-
Ιατρικοί όροι (MeSH):	Patient Acceptance of Health Care/statistics & numerical data , Economic Recession , Disease Management*, Chronic Disease/therapy ; Humans ; Sri Lanka ; Female ; Cross-Sectional Studies ; Male ; Adult ; Middle Aged ; Retrospective Studies
Περίληψη:	BACKGROUND: Sri Lanka experienced its most severe economic crisis (EC) in 2022. Its impact on general health-seeking behavior and chronic disease management remains poorly documented. We aimed to compare the effects of EC on general health seeking behavior and patient-perceived quality of care in the management of chronic diseases among adults in the Western (WP) and Uva (UP) provinces of Sri Lanka. METHODS: A comparative cross-sectional study with retrospective recall was conducted in WP and UP among adults (≥18 years) during Nov–Dec 2022, recruiting 1,568 participants per province using two-stage stratified random cluster sampling. Structured telephone interviews captured sociodemographic, chronic disease history, perceived effects of the EC on clinic visits and disease control, and perceived changes in health-seeking behavior, comparing experiences before the EC (Jan–May 2018) and during the EC (Jan–May 2022). Summary statistics are presented as % with 95% CI. Between-province comparisons on perceptions on chronic disease management were made using Chi-square test. Changes in the general healthcare-seeking behavior were analyzed with Generalized Estimating Equations (GEE), reported as odds ratios (OR) with 95% CI. RESULTS: Among 1568 invited participants per province, 1043 (66.5%) from the WP [mean age 49.5(±13.9), females = 52.0%] and 1016 (64.7%) from the UP [mean age = 47.2(±13.8), females = 49.7%] participated. Chronic conditions were reported by 35.7% in WP (95%CI:32.8–38.6) and 28.6% in UP (95%CI:25.8–31.4) (p < 0.001). During the EC, clinic visits declined 29.6% of WP and 36.4% of UP (p = 0.33) participants. Service decline was higher in UP (40.5% vs 26.3%,p < 0.001). Chronic condition deterioration (31.3% vs. 21.2%,p = 0.004) and medication omission (32.9% vs. 22.0%,p = 0.002) were more common in UP. Changes in health-seeking behavior was reported by 17.8% in WP (95%CI:15.5–20.1) and 25.9% in UP (95%CI:23.3–28.6). Use of private healthcare was declined during the EC (OR = 0.23,95%CI:0.19–0.28), while access to Ayurveda (OR = 1.32,95%CI:1.22–1.43) and self-medication (OR = 1.29,95%CI:1.19–1.39) increased and government facilities remained unchanged (OR = 1.04,95%CI:0.96–1.14). CONCLUSION: Despite reliance on alternative healthcare, the public sector remained the primary source. Nearly one-third of patients reported worsened chronic disease control, reduced clinic attendance, and lower service quality, with greater impact in UP than in WP mainly due to limited accessibility to medications and increased travel costs. TRIAL REGISTRATION: Not applicable. CLINICAL TRIAL: Not applicable.
Competing Interests:	Declarations. Ethical approval: The study was conducted in accordance with the ethical standards of Ethics Review Committee of the Faculty of Medicine, University of Colombo, Sri Lanka and the 1964 Declaration of Helsinki and its later amendments. Ethical approval was obtained from Ethics review committee, Faculty of Medicine, University of Colombo (Ref No: EC-22–094). All participants were informed about the purpose, procedures, risks and benefits of the study, and informed consent was obtained from each participant prior to their inclusion. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.
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Contributed Indexing:	Keywords: Chronic diseases; Economic crisis; Government health care; Health seeking; Private health care
Entry Date(s):	Date Created: 20260429 Date Completed: 20260627 Latest Revision: 20260813
Update Code:	20260813
PubMed Central ID:	PMC13270623
DOI:	10.1186/s12913-026-14599-8
PMID:	42050623
Βάση Δεδομένων:	MEDLINE

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ISSN:	1472-6963
DOI:	10.1186/s12913-026-14599-8