The Effectiveness of Health Literacy Promotion Program for Patients with Uncontrolled Type 2 Diabetes Mellitus in Mueang District, Trang Province

Abstract

This quasi-experimental study aimed to evaluate the effectiveness of a health literacy promotion program for patients with type 2 diabetes mellitus who were unable to control their blood glucose levels. The evaluation was conducted by measuring health literacy skills, health behavioral skills and fingertip blood glucose levels.

The participants were patients with type 2 diabetes mellitus who had uncontrolled blood glucose. The sample size was calculated using the G*Power 3.1.9.2 program to compare continuous variables between two independent groups, with an effect size of 0.80 and a confidence level of 95%. This resulted in 26 participants per group, which was increased to 30 per group to account for potential attrition. The total sample consisted of 59 participants: 29 in the experimental group and 30 in the control group, selected by simple random sampling. The experimental group participated in a 12-week health literacy promotion program, while the control group received routine education, advice, and standard care. The research instruments included the health literacy promotion program and review form, a situation-based health literacy skill assessment tool, a behavior assessment form, and a fingertip blood glucose record. Data were collected from May to August 2025 and analyzed using descriptive statistics, Independent t-test, Mann–Whitney U test, Paired t-test, and repeated measures ANOVA.

The results showed that the experimental group had significantly higher health literacy skill scores after receiving the program compared with before (16.55±1.68 and 8.21±3.62, respectively; p<.001). The health behavioral skill scores after receiving the program were also significantly higher than before (2.72±.34 and 2.18±.56, respectively; p=.018). In the control group, the mean fingertip blood glucose levels at weeks 1, 4, and 12 showed no significant differences (F=0.42, df=1.23, p=.56). In contrast, the experimental group showed a significant decrease in mean fingertip blood glucose levels across weeks 1, 4, and 12 (F=21.38, df=1.23, p<.001). The mean fingertip blood glucose levels between the control and experimental groups at weeks 1 and 4 were not significantly different, but they were significantly different at week 12 (145.40±13.02 and 128.86±10.49, respectively; p<.001).

In conclusion, the health literacy promotion program was effective in improving health literacy skills and promoting behavioral changes that led to appropriate health practices. The effectiveness was attributed to techniques such as “Teach,” “Show-me,” the use of “Checklists,” “Teach-back,” and “Questioning.” These techniques can be used as a guideline to support patients with type 2 diabetes mellitus in maintaining long-term blood glucose control.