Effectiveness of an IMB-based health education module in improving diabetes literacy and numeracy among older adults with type 2 diabetes mellitus in Malaysia

Introduction: Improving diabetes control does not only require diabetes education but also the patient’s ability to perform self-care activities. This study aimed to develop, implement and evaluate the effectiveness of an information-motivation-behavioral (IMB) skills-based health education intervention module related to type 2 diabetes mellitus (T2DM). Materials and methods: This is a single-blinded, cluster randomized control trial. Eight health clinics were randomly allocated into the study groups using cluster sampling. A health education module was developed, adapted from the Diabetes Literacy and Numeracy Education Toolkit (DLNET) and guided by the constructs of the IMB model. Data was collected using a set of questionnaire consists of seven sections namely sociodemographic factors, knowledge, attitude, self-efficacy, self-care behaviors, diabetes literacy and diabetes numeracy which were distributed at baseline, as well as immediately and at 4-week post intervention exposure. Results: Significant baseline comparisons between the study groups were observed for knowledge on diabetes (P = 0.036), attitude towards diabetes (P = 0.017) and diabetes health literacy score (P = 0.028), requiring the baseline measurement to be included as controlled variable in the repeated measure ANOVA analysis. The treatment effect analysis revealed significant difference of mean value only for knowledge on diabetes score (MD= -0.31, 95% CI: -0.56, -0.07, P = 0.011), with time-treatment interaction analysis illustrated significant changes for knowledge (Time 2), self-efficacy (Time 1 & 2) and diabetes numeracy (Time 1). Conclusion: The newly developed IMB-based health education intervention had significantly improved self-efficacy which eventually minimize the reduction of knowledge related to diabetes mellitus over time.

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