The purpose of this study was to determine primary health care workers' knowledge, attitudes, and skills in establishing health promotion settings in the Kalutara district of Sri Lanka.In this descriptive, cross-sectional study, data were collected from study participants using a structured, pretested, and self-administered questionnaire.The data was analysed using statistical tests and Chi-square values. The majority (215 people, or 70.0%) had "poor" knowledge. Knowledge was found to be significantly related to educational level, general certificate of education, advance level or higher (p = 0.012), and ability to read English (p = 0.021). Public health experience of less than five years for public health midwives (PHMs) was significantly associated with knowledge (p = 0.002). The attitude level was favourable (204, 69.4 %). The level of knowledge was found to be significantly related to the level of attitudes (p = 0.004). Only 25.1% (77) of those polled had adequate skills. The presence of health promotion settings in their fields was found to be significantly related to skill level (p = 0.000). The availability of healthy settings in the fields of PHMs with the extent of field areas less than the mean (p = 0.017) was significantly associated.The current study concluded that primary health care workers had "poor" knowledge and skills in establishing health promotion settings, but "good" attitudes. The most common barriers identified were a lack of time and insufficient training in the field of health promotion.