Effect of Health Literacy Promotion Program among Diabetic Patients with Stage 3 Chronic Kidney Disease in Chronic Disease Clinic, Nakhon Thai Sub-district, Nakhon Thai District, Phitsanulok Province

Abstract

Chronic kidney disease (CKD) in patients with type 2 diabetes is a major public health concern, leading to substantial healthcare costs and diminished quality of life. A key challenge in managing this population is fostering effective self-management behaviors, which are often hindered by inadequate health literacy. This quasi-experimental study, using a pretest-posttest control group design, aimed to evaluate the effectiveness of a health literacy promotion program on self-care behaviors and clinical outcomes (HbA1c and eGFR). A total of 70 patients with type 2 diabetes and stage 3 CKD were purposively selected from a chronic disease clinic and assigned to either an experimental (n=35) or a control group (n=35). The experimental group participated in a 10-week health literacy promotion program emphasizing practical skills and family involvement, while the control group received standard care. Post-intervention, the experimental group demonstrated significantly higher self-care behavior scores, lower HbA1c levels, and higher eGFR levels compared to their pre-intervention measurements          (P-value < 0.05). After the intervention, ANCOVA results, controlling for pretest scores, revealed that the experimental group had significantly higher adjusted mean scores for self-care behaviors than the control group (4.55 vs. 3.60, P-value < 0.001). Regarding clinical outcomes, the experimental group showed a significantly lower mean HbA1c (7.75% vs. 8.45%, P-value < 0.001) and a significantly higher mean eGFR (47.30 vs. 44.10 ml/min/1.73m², P-value = 0.025) compared to the control group. This study provides strong evidence that a health literacy promotion program is an effective strategy for improving self-care behaviors and achieving tangible clinical improvements. Therefore, this program should be considered for integration into standard clinical practice in chronic disease clinics to empower patients, slow the progression of kidney disease, and sustainably enhance their quality of life.