Educational comic book versus pamphlet for improvement of health literacy and medication adherence in older patients with type II diabetes mellitus: A randomised controlled trial

Background. This study aimed to compare the efficacy of an educational comic book versus a pamphlet in improving the health literacy and medication adherence of older patients with type II diabetes mellitus (T2DM) in Hong Kong. Methods. Between August and October 2016, T2DM patients aged ≥50 years were recruited from the Risk Assessment and Management Clinic of Tsan Yuk Hospital. Their health literacy and medication adherence were assessed using the Chinese Health Literacy Scale for Diabetes – Multiple Choice Version (CHLSD-MC) and the eight-item Morisky Medication Adherence Scale (MMAS-8), respectively. Those with an imperfect health literacy score were randomised to the intervention or control group and to read an educational comic book or a pamphlet, respectively. Health literacy and medication adherence were reassessed immediately and 1 week after the intervention, respectively. Results. A total of 165 patients were assessed. The mean CHLSD-MC score was 59.99 out of 68; health literacy was inadequate in 13.3% of patients. The mean MMAS-8 score was 6.52 out of 8; medication adherence was low, moderate, and high in 23.0%, 50.9%, and 26.1% of patients, respectively. Among patients with an imperfect CHLSD-MC score, 88 agreed to participate and were randomised to the intervention (n=42) or control (n=46) group. After the intervention, the intervention group had a significantly higher absolute change in CHLSD-MC score (3.48 vs. 0.93, t(80)=3.28, p=0.002) but not in MMAS-8 score (0.16 vs. 0.55, t(61)= –1.55, p=0.125). Conclusion. An educational comic book is more effective than a pamphlet in improving the health literacy of older patients with T2DM in Hong Kong.