Effectiveness of Health Literacy Enhancement Integrated with Telehealth in People Newly Diagnosed with Hypertension in Suburban Thailand: A Quasi-Experimental Study
Effectiveness of a health literacy promotion program
DOI:
https://doi.org/10.60099/prijnr.2026.278838Keywords:
Health literacy, Hypertension, Hypertension control, Newly diagnosed, Self-care behaviors, Telehealth, ThailandAbstract
People newly diagnosed with hypertension often have insufficient health literacy and suboptimal self-care behaviors, particularly in diet, physical activity, and medication adherence. Thus, health literacy enhancement is essential. This quasi-experimental study examined the effectiveness of a telehealth-integrated health literacy enhancement among people newly diagnosed with hypertension. Fifty participants diagnosed with hypertension within the past year were consecutively recruited from subdistrict health-promoting hospitals in two districts. They were assigned at the cluster level to the experiment or control group (25 per group). The experimental group received usual care plus a six-week telehealth-integrated health literacy enhancement program. The control group received only usual care. Data were collected at baseline and post-intervention using a Personal Health Questionnaire, the Health Literacy Questionnaire, and the Self-Care of Hypertension Inventory. Data were analyzed using descriptive statistics, paired t-tests, and independent t-tests.
After the intervention, the experimental group demonstrated significant improvements in health literacy and self-care behaviors, as well as a substantial reduction in systolic blood pressure compared with baseline and the control group. In contrast, no significant differences in diastolic blood pressure were observed. The findings demonstrate the effectiveness of the Health Literacy Enhancement Integrated with Telehealth program in improving health literacy, self-care behavior, and blood pressure control among people newly diagnosed with hypertension. Nurses can incorporate this program into routine care to improve outcomes, reduce long-term complications, and support continuity of care. However, future studies should include long-term follow-up, a randomized controlled trial, and multisite research before it can be widely used.
References
World Health Organization. Hypertension. 2025 [cited 2025 Dec 10]. Available from: https://www.who.int/news-room/fact-sheets/detail/hypertension.
World Health Organization. Global report on hypertension 2025: high stakes – turning evidence into action. Geneva: World Health Organization; 2025.
Patanavanich R, Aekplakorn W, editors. The 7th National Health Examination Survey (NHES VII), 2024–2025. Bangkok: Faculty of Medicine Ramathibodi Hospital, Mahidol University; 2025.
Thai Hypertension Society. 2024 Thai guideline on the treatment of hypertension by the Thai Hypertension Society. Chiang Mai: Trickthink; 2024.
Sari EA, Mirwanti R, Herliani YK, Pratiwi SH. Self-care behavior based on knowledge of patients with hypertension: a cross-sectional study. Vasc Health Risk Manag. 2025;21:17–24. doi:10.2147/VHRM.S489688.
Nutbeam D. Health literacy as a public health goal: a challenge for contemporary health education and communication strategies into the 21st century. Health Promot Int. 2000;15(3):259–267. doi:10.1093/heapro/15.3.259.
Kareesun K, Malathum P, Sutti N. Relationship among health literacy, knowledge about hypertension control, and health behavior in older persons with hypertension. Nurs Res Inno J. 2020;25(3):280–295.
Department of Disease Control, Ministry of Public Health. National plan for the prevention and control of non-communicable disease (2023–2027), Thailand [Internet]. Nonthaburi: Ministry of Public Health; 2023 [cited 2025 Dec 10]. Available from: https://ddc.moph.go.th/uploads/publish/1625920241004031950.pdf.
Suerungruang S, Chamnankong K, Wanwaja M, Kloyiam S. The 2nd national health literacy survey of Thai population aged 15 Years and above (2023): promotion of health literacy in Thailand: assessment of current situation, determinants, and policy recommendations [Internet]. Nonthaburi: Health Systems Research Institute; 2024 Nov [cited 2025 Dec 10]. Available from: https://kb.hsri.or.th/dspace/handle/11228/6197?locale-attribute=th
Bawornthip P, McDonall J, Tamdee D, Driscoll A, Hutchinson A. Health literacy and uptake of healthy diet and exercise amongst individuals with prehypertension in Thailand. Health Promot Int. 2025;40(3):1–13. doi:10.1093/heapro/daaf089.
Kongneam S, Moolsart S, Sakunhongsophon S. Effectiveness of a health literacy development program for patients with hypertension at risk of cardiovascular disease in Mueang Trang District, Trang Province. J Thai Nurse Midwife Counc. 2024;39(1):148–65. doi:10.60099/jtnmc.v39i01.266842.
Ongkulna K, Pothiban L, Panuthai S, Chintanawat R, Chintanawat R. Enhancing self-management through geragogy-based education in older adults with uncontrolled hypertension: a randomized controlled trial. PRIJNR [internet]. 2022 Sep. 12 [cited 2025 Dec. 19];26(4):690-705. Available from: https://he02.tci-thaijo.org/index.php/PRIJNR/article/view/259276
Sarakshetrin A, Tongpeth J, Sriwongsa A. The effectiveness of health literacy enhancing and developing program on A1C, blood pressure level, health literacy and diabetes and hypertension control behaviors. JRTAN [Internet]. 2021 Apr 25 [cited 2025 Dec 10];24(1):333–43. Available from: https://he01.tci-thaijo.org/index.php/JRTAN/article/view/256198/173075
Sriklo M, Tamdee D, Aungwattana S, Kaewthummanukul T. Effects of enhanced health literacy through a transformative learning program on self-management and hemoglobin A1C levels among adults with uncontrolled type 2 diabetes: a randomized controlled trial. Pac Rim Int J Nurs Res. 2023;27(2):317–333. Available from: https://he02.tci-thaijo.org/index.php/PRIJNR/article/view/262041
Delavar F, Pashaeypoor S, Negarandeh R. The effects of self-management education tailored to health literacy on medication adherence and blood pressure control among elderly people with primary hypertension: A randomized controlled trial. Patient Educ Couns. 2020;103(2):336-42. doi:10.1016/j.pec.2019.08.028.
Walters R, Leslie SJ, Polson R, Cusack T, Gorely T. Establishing the efficacy of interventions to improve health literacy and health behaviours: a systematic review. BMC Public Health. 2020;20(1):1040. doi: 10.1186/s12889-020-08991-0
Visscher BB, Steunenberg B, Heijmans M, Hofstede JM, Devillé W, van der Heide I, Rademakers J. Evidence on the effectiveness of health literacy interventions in the EU: a systematic review. BMC Public Health. 2018;18(1):1414. doi: 10.1186/s12889-018-6331-7
Samsiana S, Russeng SS, Amiruddin R. Intervention based on integration of health literacy and health outcomes in hypertension “a systematic review”. Open Access Maced J Med Sci [Internet]. 2021 Oct. 12 [cited 2025 Dec. 18];9(F):486-91. Available from: https://oamjms.eu/index.php/mjms/article/view/6489
Shao Y, Hu H, Liang Y, Hong Y, Yu Y, Liu C, Xu Y. Health literacy interventions among patients with chronic diseases: a meta-analysis of randomized controlled trials. Patient Educ Couns. 2023;114:107829.doi: 10.1016/j.pec.2023.107829.
Seedacam C, Rhiantong J, Panuthai S. Effects of technology-based education on health literacy among elderly monks with hypertension. Nurs J CMU. 2024;51(4):133–145. Available from: https://he02.tci-thaijo.org/index.php/cmunursing/article/view/266012
Drake C, Lewinski AA, Rader A, Schexnayder J, Bosworth HB, Goldstein KM, et al. Addressing hypertension outcomes using telehealth and population health managers: adaptations and implementation considerations. Curr Hypertens Rep. 2022;24(8):267-84. doi: 10.1007/s11906-022-01193-6
Nutbeam D. The evolving concept of health literacy. Soc Sci Med. 2008;67(12):2072-8. doi: 10.1016/j.socscimed.2008.09.050.
Health Education Division. Handbook for health literacy promotion in schools [Internet]. Nonthaburi: ThaiHealth; 2018 [cited 2025 Dec 19]. Available from: https://resourcecenter.thaihealth.or.th/assets/mediadol/download_dol/4852e322-569e-eb11-80ec-00155d09b41f/downloaded_file_20240927151614.pdf
Tesamut L, Sungwan P, Somrit J. Health literacy and health behavior of hypertensive patients with controllable and uncontrollable blood pressure level. J Nurs Health Sci Res [Internet]. 2023 Jul–Dec [cited 2025 Dec 19];15(2):e262142. Available from: https://he01.tci-thaijo.org/index.php/unc/article/view/e262142
Sohrabi M, Karami M, Mirmoeini RS, Cheraghi Z. The relationship between health literacy and hypertension control: a cross-sectional study. J Tehran Heart Cent. 2022;17(4):243-8.doi: 10.18502/jthc.v17i4.11614.
Darvishpour A, Mansour-Ghanaei R, Mansouri F. The relationship between health literacy, self-efficacy, and self-care behaviors in older adults with hypertension in the north of Iran. Health Lit Res Pract. 2022;6(4):e262-9. doi: 10.3928/24748307-20221013-01.
Nongnuch W. Effect of health care program on new diabetic mellitus type 2 on health literacy, health care behavior and hemoglobin A1c (HbA1c). J Res Health Inno Dev [internet]. 2021 Jan. 31 [cited 2025 Dec. 19];2(1):29-36. Available from: https://he01.tci-thaijo.org/index.php/jrhi/article/view/252502
Milidonis M, Roberts S, Keehan J, McIntyre K. Health literacy tools: barriers, facilitators and benefits in physical therapy exercise interventions. Innov Aging. 2018 ;2(Suppl 1):131. doi:10.1093/geroni/igy023.479.
Davies MJ, Heller S, Skinner TC, Campbell MJ, Carey ME, Cradock S, et al. Effectiveness of the diabetes education and self-management for ongoing and newly diagnosed (DESMOND) programme for people with newly diagnosed type 2 diabetes: cluster randomised controlled trial. BMJ. 2008;336(7642):491-5. doi: 10.1136/bmj.39474.922025.BE
Sørensen K, Van den Broucke S, Pelikan JM, Fullam J, Doyle G, Slonska Z, et al. Measuring health literacy in populations: illuminating the design and development process of the European Health Literacy Survey Questionnaire (HLS-EU-Q). BMC Public Health. 2013;13:948.doi: 10.1186/1471-2458-13-948
Dickson VV. Self-care of high blood pressure inventory (SC-HI V3) [Internet]. Pless Center for Research, NYU Rory Meyers College of Nursing; n.d. [cited 2024 Oct 19]. Available from: https://self-care-measures.com/project/patient-version-sc-hi-english-2-2/
Suwanno J. Self-care of hypertension inventory – Thai patient version [Internet]. Self-Care Measures; n.d. [cited 2024 Oct 19]. Available from: https://self-care-measures.com/project/patient-version-sc-hi-english-2-2-2/
Dickson VV, Fletcher J, Riegel B. Psychometric testing of the self-care of hypertension inventory version 3.0. J Cardiovasc Nurs. 2021;36(5):411-9. doi: 10.1097/JCN.0000000000000827
Durukan BN, Sener YZ, Erkoc A, Calik-Kutukcu E, Guven AT. Reliability and validity of the Turkish version of the self-care of hypertension inventory version 3.0 in adults with hypertension. J Vasc Nurs. 2024;42(2):131-7. doi: 10.1016/j.jvn.2024.02.006.
Institute for Healthcare Improvement. Ask Me 3: good questions for your good health [Internet]. Cambridge (MA): Institute for Healthcare Improvement; [cited 2024 Oct 19]. Available from: https://www.ihi.org/library/tools/ask-me-3-good-questions-your-good-health
Lord J, Borkowski N, Weech-Maldonado R. Patient engagement in home health: the role of health literacy and “Ask Me Three®”. Home Health Care Manag Pract. 2021;33(3):202–9. doi:10.1177/1084822321996623.
Walther J, Promthong K. Communication skills to promote health literacy as perceived by nursing students in the Southern nursing college network. South Coll Netw J Nurs Public Health. 2021;8(2):13–25. Available from: https://he01.tci-thaijo.org/index.php/scnet/article/view/247038
Muñoz-Villaverde S, Martínez-García M, Serrano-Oviedo L, Gómez-Romero FJ, Sobrado-Sobrado AM, Cidoncha-Moreno MÁ, et al. Impact of telenurse-led intervention in clinical trials on health literacy, empowerment, and health outcomes in patients with solid tumours: a pilot quasi-experimental study. BMC Nurs. 2024;23(1):86.doi: 10.1186/s12912-023-01641-x
Williams B, Mancia G, Spiering W, Agabiti Rosei E, Azizi M, Burnier M, et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension. Eur Heart J. 2018;39(33):3021-104.doi: 10.1093/eurheartj/ehy339.
Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL, et al; Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure; National Heart, Lung, and Blood Institute; National High Blood Pressure Education Program Coordinating Committee. Seventh report of the Joint National Committee on prevention, detection, evaluation, and treatment of high blood pressure. Hypertension. 2003;42(6):1206–52. doi:10.1161/01.HYP.0000107251.49515.c2.
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