[2026-01-26] Effects of a Health Literacy Enhancement Programs for COVID-19 Prevention on Health Literacy and COVID-19 Preventive Behaviors Among Caregivers of Dependent Older People

Phisit Yuyong; Supichaya Wangpitipanit; Phachongchit Kraithaworn

doi:10.33165/rmj.2026.e274008

Authors

Phisit Yuyong Community Nurse Practitioner Program, Ramathibodi School of Nursing, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand https://orcid.org/0009-0001-9034-6288
Supichaya Wangpitipanit Community Health Nursing, Ramathibodi School of Nursing, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand https://orcid.org/0000-0003-1304-7986
Phachongchit Kraithaworn Community Health Nursing, Ramathibodi School of Nursing, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand https://orcid.org/0000-0002-0611-0839

DOI:

https://doi.org/10.33165/rmj.2026.e274008

Keywords:

Caregivers, COVID-19 prevention, Dependent older people, Health literacy enhancement program

Abstract

Background: Older people with dependent conditions are highly vulnerable to COVID-19 due to exposure to respiratory droplets from talking, coughing, sneezing, or close contact with caregivers.

Objectives: To evaluate the effectiveness of a health literacy enhancement program on caregivers' health literacy and preventive behaviors.

Methods: This quasi-experimental study was conducted in Phak Hai district, Phra Nakhon Si Ayutthaya province, from September 2023 to January 2024. The study included 50 caregivers selected through simple random sampling and divided into the experimental group (n = 25) and control groups (n = 25). The experimental group participated in an 8-week COVID-19 prevention program based on Nutbeam's health literacy framework, while the control group received standard care. The instruments used for data collection included 3 components: a personal information questionnaire; the COVID-19 Health Literacy Questionnaire (content validity index [CVI] = 0.88, Cronbach a = 0.84); and the COVID-19 Preventive Behavior Questionnaire (CVI = 0.88, Cronbach a = 0.76). Statistical tests included t tests, the Wilcoxon signed rank test, the Mann-Whitney U test, and analyses of covariance (ANCOVA).

Results: The experimental group achieved significantly higher postintervention health literacy scores compared to their preintervention scores and the control group (P < .05). Improvements were observed in accessing information, decision-making, and health behavior changes (P < .05). Also, postintervention preventive behavior scores of the experimental group were significantly higher in the control group, even after adjusting for baseline differences (P < .05).

Conclusions: This study has reinforced the importance of health literacy programs in effectively empowering caregivers to prevent COVID-19. Primary healthcare units should implement this program to better protect dependent older people from COVID-19.

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