Effectiveness of a Health Literacy Enhancement Program for DM Remission and Prevention Service on Health Behaviors and Clinical Outcomes among Type 2 Diabetes Patients

Abstract

The objective of this study was to evaluate a health literacy enhancement program for diabetes remission and prevention service on health behaviors and clinical outcomes among type 2 diabetes patients. It employed a two-group pretest–posttest quasi-experimental design. The sample comprised 70 patients with type 2 diabetes mellitus whose HbA1c ranged from 6.5% to 10.0%, selected through purposive sampling and allocated to groups by simple random assignment. The experimental group (n=35) received the health literacy enhancement program integrating the six-dimensional framework of the Health Education Division, Department of Health Service Support, Ministry of Public Health; while the control group (n=35) received standard care. Data were collected from January to May 2026. The research instruments were verified for content validity by three experts (S-CVI/Ave=0.94) and for reliability with a pilot group of 30 participants (Cronbach’s alpha=0.81). Data were analyzed using paired t-test, independent t-test, and chi-square test at a significance level of 0.05. The results revealed that after the intervention, the experimental group had significantly higher health literacy scores than the control group (51.63±2.68 vs. 37.60±2.68; p<0.05), as well as significantly higher scores across allhealth behavior domains (p<0.001). HbA1c in the experimental group decreased from 8.23±0.96% to 6.65±1.00% (p<0.05); and after the intervention the experimental group had a significantly lower HbA1c than the control group (6.65% vs. 7.85%; p<0.05). Furthermore, the proportion of patients achieving diabetes remission in the experimental group was 25.7%, compared with 0% in the control group (p<0.05). In conclusion, the DM remission and prevention service program effectively enhanced health literacy, improved health behaviors, and improved clinical outcomes, with a DM remission rate of 25.7%, exceeding the national target, and should therefore be scaled up as a primary care service model.