Developing and Evaluating a Health Literacy Training Model for Volunteer Elderly Caregivers to Prevent and Control NCDs in Thailand: An Action Research Study

Abstract

Background/Objectives: Limited health literacy among older adults with noncommunicable diseases (NCDs) remains a major challenge in community and primary-care settings. This action research aimed to develop and evaluate a community-based health literacy training model for volunteer caregivers for the elderly (VCEs) to support the prevention and control of diabetes and hypertension among older adults in the community. Materials and Methods: This study was conducted in a primary care-based community setting and comprised two phases: Phase 1 (model development) and Phase 2 (implementation and evaluation). The primary analytic sample consisted of 38 volunteer caregivers for the elderly, each providing home-based health education to one older adult (n = 38). The intervention combined structured health literacy education based on the K-shape framework (Knowledge, Comprehension, Thoughtful Inquiry, Decision-making, and Implementation) with SKT meditation/exercise. The program was delivered weekly over 8 weeks. Outcomes included health literacy (20-item scale) and disease prevention and control behaviors (12-item scale), assessed at baseline, immediately post-intervention, and 1 month after program completion. Results: Among VCEs, mean health literacy scores increased significantly from baseline to post-intervention and were further improved at 1-month follow-up (p < 0.001), indicating sustained gains in health literacy. Preventive behavior scores also increased significantly from baseline to post-intervention (p < 0.001); however, no additional improvement was observed at 1 month compared with immediately after the program (p > 0.05). The magnitude of improvement suggested a meaningful effect of the intervention on health literacy, while behavioral changes appeared to plateau after program completion. Conclusions: The community-based training model effectively and sustainably improved health literacy among volunteer caregivers for the elderly. Although preventive health behaviors improved immediately after the intervention, no further gains were observed at 1 month, suggesting that ongoing reinforcement may be required to sustain behavioral change. This model supports the role of community participation in primary care-based NCD prevention among older adults.