Effects of health literacy improvement program on self-care behaviors and health outcomes in older adults with type 2 diabetes and hypertension comorbidities 10.55131/jphd/2022/200203

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Pimnada Kakahthum
Sunee Lagampan
Kwanjai Amnartsatsue


Health literacy is a necessary factor affecting self-care behaviors. This randomized control trial research aimed to study the effects of a health literacy improvement program on self-care behaviors and health outcomes in older adult patients with diabetes and hypertension comorbidities. Older adults at a private primary care unit, Bangkok, Thailand; aged 60-69 years, who had been diagnosed with diabetes and hypertension, were selected by simple random sampling into experimental and control groups, of 30 people each. The experimental group received eight weeks of a health literacy improvement program.  Group activities were held in three sessions at 4-week intervals. The control group received standard care only. Data were collected by using interview questionnaires at baseline, post-intervention, and follow-up. Research instrumentation included collected data on general characteristics and illness history.  Health literacy, self-care behavior, healthy eating, physical activity, stress management, and medication adherence scales were also included. In addition, blood pressure and HbA1C were examined at baseline and follow-up. Descriptive statistics, independent t-test, chi-square, Repeated Measures ANOVA, and Bonferroni post hoc test were used for data analysis.  After the intervention and follow-up, the experimental group had the following mean scores:  health literacy (ME.118.33±7.79, 123±4.90; MC 94.53±7.51; 94.17±5.86, p< .001), self-care behaviors in healthy eating (ME 49.10±3.14, 52.13±3.19; MC 43.70±2.83, 43.66±3.25, p< .001), physical activities (ME36.90±2.26, 38.53±2.56; MC 26.90±2.67,26.83±2.67, p<.001), stress management (ME26.83±1.89, 28.30±1.89; MC 21.33±2.00,21.60±2.09, p<.001), and medication adherence (ME34.60±2.47, 36.07±1.87; MC 27.40±2.64, 28.30±3.18, p< .001), all of which were significantly higher than the control group.  Furthermore, HbA1C (Diff_ME -0.46±0.50; Diff_MC.0.06±0.45, p< .05) and systolic blood pressure (Diff_ME -9.70±9.29; Diff_MC. -1.26± 12.89, p< .05) were significantly lower than the control group.

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Kakahthum P, Lagampan S, Amnartsatsue K. Effects of health literacy improvement program on self-care behaviors and health outcomes in older adults with type 2 diabetes and hypertension comorbidities: 10.55131/jphd/2022/200203. J Public Hlth Dev [Internet]. 2022 May 1 [cited 2024 Apr. 24];20(2):32-4. Available from: https://he01.tci-thaijo.org/index.php/AIHD-MU/article/view/256033
Original Articles
Author Biographies

Pimnada Kakahthum, Faculty of Public health, Mahidol University, Thailand

Faculty of Public health, Mahidol University, Thailand

Sunee Lagampan, Faculty of Public health, Mahidol University, Thailand

Faculty of Public health, Mahidol University, Thailand

Kwanjai Amnartsatsue, Faculty of Public health, Mahidol University, Thailand

Faculty of Public health, Mahidol University, Thailand


Foundation of Thai Gerontology Research and Development Institute. Situation of the elderly in Thailand. [Cited 2020 Aug 16]. Available from: https://thaitgri.org/

Jiamjarasrangsri W. Type 2 diabetes epidemiology, prevention and support self-management. 1st ed. Bangkok: Text and Journal Publication; 2017.

Petrie JR, Guzik TJ, Touyz RM. Diabetes, Hypertension, and Cardiovascular Disease: Clinical Insights and Vascular Mechanisms. Can J Cardiol. 2018;34(5):575-84.doi: 10.1016/j.cjca.2017.12.005.

Wang Z, Yang T, Fu H. Prevalence of diabetes and hypertension and their interaction effects on cardio-cerebrovascular diseases: a cross-sectional study. BMC Public Health. 2021;21(1):1224. doi: https://doi.org/10.1186/s12889-021-11122-y

Thai Hypertension Society. 2019 Thai Guidelines on the Treatment of Hypertension [Internet]. 2019. Chaingmai: Trickthink; 2019 [Cited 2020 Aug 16]. Available from: http://www.thaihypertension.org/guideline.html

Abdullah A, Liew SM, Salim H, Ng CJ, Chinna K. Prevalence of limited health literacy among patients with type 2 diabetes mellitus: A systematic review. PLOS ONE. 2019;14(5):e0216402. doi: 10.1371/journal.pone.0216402

Bailey SC, Brega AG, Crutchfield TM, Elasy T, Herr H, Kaphingst K, et al. Update on health literacy and diabetes. Diabetes Educ. 2014;40(5):581-604. doi: 10.1177/0145721714540220

Dewalt DA, Berkman ND, Sheridan S, Lohr KN, Pignone MP. Literacy and health outcomes: a systematic review of the literature. J Gen Intern Med. 2004;19(12):1228-39. doi: 10.1111/j.1525-1497.2004.40153.x.

Fransen MP, von Wagner C, Essink-Bot ML. Diabetes self-management in patients with low health literacy: ordering findings from literature in a health literacy framework. Patient Educ Couns. 2012;88(1):44-53. doi: 10.1016/j.pec.2011.11.015

Diabetes Association of Thailand under the Patronage of Her Royal Highness Princess Maha Chakri Sirindhorn. Practice Guideline for Diabetes 2017 [Internet]. 2017 [Cited 2020 Aug 16]. Available from: https://www.dmthai.org/index.php/knowledge/healthcare-providers/cpg/443-guideline-diabetes-care-2017

Nutbeam D. The evolving concept of health literacy. Soc Sci Med. 2008;67(12):2072-8. doi: 10.1016/j.socscimed.2008.09.050

Aaby A, Friis K, Christensen B, Rowlands G, Maindal HT. Health literacy is associated with health behaviour and self-reported health: A large population-based study in individuals with cardiovascular disease. Eur J Prev Cardiol. 2017;24(17):1880-8. doi: 10.1177/2047487317729538

Reisi M, Fazeli H, Mahmoodi M, Javadzade H. Application of the social cognitive theory to predict self-care behavior among type 2 diabetes patients with limited health literacy. Journal of Health Literacy. 2021;6(2):21-32.

Norasing M, Thanomphan S. Health literacy and health behavior in patients with uncontrolled blood sugar level or blood pressure: a case study of Nakornping Hospital, Chiang Mai. J Nakornping Hosp. 2019;10(1):36-50

Mitty E, Flores S. Assisted living nursing practice: health literacy and chronic illness management. Geriatr Nurs. 2008;29(4):230-5. doi: 10.1016/j.gerinurse.2008.06.007.

Cavanaugh KL. Health literacy in diabetes care: explanation, evidence and equipment. Diabetes Manag (Lond). 2011;1(2):191-9. doi: 10.2217/dmt.11.5.

McDonald M, Shenkman LJ. Health Literacy and Health Outcomes of Adults in the United States: Implications for Providers. IJAHSP. 2018;16(4). doi: 10.46743/1540-580X/2018.1689

Souza JG, Apolinario D, Magaldi RM, Busse AL, Campora F, Jacob-Filho W. Functional health literacy and glycaemic control in older adults with type 2 diabetes: a cross-sectional study. BMJ Open. 2014;4(2):e004180. doi: 10.1136/bmjopen-2013-004180.

Caruso R, Magon A, Baroni I, Dellafiore F, Arrigoni C, Pittella F, et al. Health literacy in type 2 diabetes patients: a systematic review of systematic reviews. Acta Diabetol. 2018;55(1):1-12. doi: 10.1007/s00592-017-1071-1

Cohen J. Statistical power analysis for the behavioral sciences. 2nd ed. Hillsdale, NJ: L. Erlbaum Associates; 1988. p. 567

Chiangkhong A, Intarakamhang U, Duangchan P, Macaskill A. Effectiveness of Health Literacy through Transformative Learning on Glycemic control Behavior in Adult Diabetes Patients: A Mixed Methods Approach. TJBS. 2019;14(3):49-61.

Intarakamhang U, Macaskill A. Effectiveness of a health literacy intervention based on transformative learning and incorporating positive psychology on health behavior and well-being of Thai families with NCDs risk. J Public Health Res. 2021;11(2). doi: 10.4081/jphr.2021.1935

Saentecha P, Lamluk P. The Effectiveness of a Program for Health Literacy Development in the Patients with Type 2 Diabetes. TH J of Health Edu. 2020;43(2):150-64.

Pannak P, Moolsart S, Kaewprom C. The Effectiveness of a Program for Health Literacy Development of the Patients with Uncontrolled Type 2 Diabetes at. Nursing Journal of The Ministry of Public Health. 2018;27(3):91-106.

Rattanapongsai P, Lagampan S, Pitchayapinyo P. Impact of a Medication Literacy Programme on Uncontrolled Type 2 Diabetic Patients’ Health Literacy on Medication and Medication Adherence. Thai Journal of Nursing Council. 2016;31(4) 50-62.

Thepin K, Moolsat S, Jantacumma N. Effectiveness of a Health Literacy Developmental Program in Patients with Uncontrolled Hypertension. Boromarajonani College of Nursing, Uttaradit Journal. 2018;11(1):197-212.

Sørensen K, Van den Broucke S, Fullam J, Doyle G, Pelikan J, Slonska Z, et al. Health literacy and public health: a systematic review and integration of definitions and models. BMC Public Health. 2012;12:80. doi: 10.1186/1471-2458-12-80