Educational comic book versus pamphlet for improvement of health literacy 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 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 was assessed using the Chinese Health Literacy Scale for Diabetes - Multiple Choice Version (CHLSD-MC). 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 was reassessed immediately after the intervention. 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. 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). Conclusion. An educational comic book is more effective than a pamphlet in improving the health literacy of older patients with T2DM in Hong Kong.