ArticleBMC health services research2026
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.
Article in BMC health services research, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundSri 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.
methodsA 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.
resultsAmong 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).
conclusionDespite 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 registrationNot applicable. CLINICAL TRIAL: Not applicable.
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