Development of a Health Literacy Promotion Program (HeLPP) to Promote Self-Care Behaviors and Quality of Life among Rural Patients with Type 2 Diabetes: Preliminary Results

Document Type : Original Article


1 Department of Health Education & Promotion, Tabriz University of Medical Sciences, Tabriz, Iran.

2 Social Determinants of Health Research Center, Department of Health Education & Promotion, Tabriz University of Medical Sciences, Tabriz, Iran

3 Medical Education Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.

4 Department of Public Health, Neyshabur University of Medical Sciences, Neyshabur, Iran.

5 Department of Public Health, Urmia University of Medical Sciences, Urmia, Iran

6 Graduate student in Psychology, Islamic Azad University-Sanandaj Branch, Sanandaj, Iran

7 Faculty of Nursing and Midwifery, Mazandaran University of Medical Sciences, Sari, Iran

8 Department of Public Health, Sarab University of Medical Sciences, Sarab, Iran.


Background and Objective: We developed a protocol for a health literacy promotion program (HeLPP) to promote self-care behaviors and quality of life (QOL) among T2DM patients in Chaldoran County, Iran. To develop the educational program, we primarily conducted a behavioral and educational assessment on the pre-test data collected from the participants. In this paper, we report a summary of the protocol and the primary results of the pre-test findings. 

Materials and Methods: The HeLPP protocol is naturally developed for a randomized controlled trial with Solomon four-group design. Developing the HeLPP, we will conduct it for both test groups. To plan the HeLPP and to find the main predictors of self-care behaviors and QOL, we firstly conducted a cross-sectional study (as a needs assessment phase). So, applying simple random sampling, data on 160 patients were collected and analyzed. The validated scales (Health Literacy Questionnaire (HLQ), Self-care activities scale, and Diabetes QOL Brief Clinical Inventory) were used to collect data.

Results: The mean age of participants was 61.08 ± 11.35. The most significant determinants of self-care behaviors were understanding (β: 0.26), reading skills (β: 0.23), and knowledge (β: -0.19). Self-care behaviors (β: 0.29) and decision-making (β: 0.28) were significant predictors of QOL. 

Conclusion: Considering the predicting role of understanding, reading skills, and decision-making for self-care behaviors and QOL of the rural T2DM patients, the focus of HeLPP should be on clear communication, goal-setting, and teach back strategies. The developed protocol seems to be helpful in promoting the outcome variables of the study.


Acknowledgements: The authors thank the patients who completed their participation in the study.

Availability of data and materials: The authors confirm that the data generated and analyzed during this study are available per request.

Conflicts of interests: The authors declare no conflict of interest.

Consent for publication:  All respondents have given consent for publication, provided that anonymity was ensured.

Ethical approval and consent to participate: This study was approved by the ethics committee in Tabriz University of Medical Sciences (Ethics No: IR.TBZMED.REC.1397.459). The study was performed in line with the principles of Helsinki Declaration. 

Funding: This study was funded by Tabriz University of medical Sciences (Grant No: 60587).

Author contributions: HN, HA, and TB conceptualized the main idea and designed the project. HN acquired the funding. HH, SS, SN, and BF worked on data acquisition. LZ, HH, KP, HA, and SS conducted data curation and formal analysis. KP, HN and HA wrote the original draft. HN, SS, HH, and LZ reviewed and edited the draft. All author(s) read and approved the final manuscript.


Open Access Policy: This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. To view a copy of this licence, visit

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