title: Teach back and pictorial image educational strategies on knowledge about diabetes and medication/dietary adherence among low health literate patients with type 2 diabetes.
abstract: OBJECTIVE
  To explore the impact of pictorial image and teach back educational strategies on knowledge, adherence to medication and diet among patients with type 2 diabetes and low health literacy in Saqqez, Iran.
  
  
  METHODS
  In this randomized controlled trial, 127 patients with type 2 diabetes who had low health literacy were randomly allocated into three arms of the study (pictorial image, teach back, and control groups). The two intervention groups received education within three weekly sessions, each lasting 20 min. The level of functional health literacy in adults (TOFHLA), diabetes knowledge, and adherence to medication and diet were measured and compared in the three groups before and six weeks after the interventions. We used intention to treat analysis. Data were analyzed using ANOVA and Paired t test.
  
  
  RESULTS
  Mean scores of knowledge, adherence to medication and diet revealed significant differences between two intervention groups and control group (P<0/001) six weeks after intervention.
  
  
  CONCLUSIONS
  Both educational strategies increased knowledge, as well as adherence to medications and diet among patients with type 2 diabetes and low health literacy. Both educational strategies seem to be effective for patients with low health literacy and are recommended to be used according to patients' conditions.
authors.affiliation: School of Nursing and Midwifery, Nursing and Midwifery Care Research Center, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Reza
authors.initials: R
authors.lastname: Negarandeh
authors.forename: Hassan
authors.initials: H
authors.lastname: Mahmoodi
authors.forename: Hayedeh
authors.initials: H
authors.lastname: Noktehdan
authors.forename: Ramin
authors.initials: R
authors.lastname: Heshmat
authors.forename: Elham
authors.initials: E
authors.lastname: Shakibazadeh
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D001296:Audiovisual Aids; D016009:Chi-Square Distribution; D003924:Diabetes Mellitus, Type 2 / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D004032:Diet / Q000009:adverse effects; D005260:Female; D015438:Health Behavior; D007722:Health Knowledge, Attitudes, Practice; D057220:Health Literacy; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007492:Iran; D008297:Male; D008488:Medical Illustration; D055118:Medication Adherence; D008875:Middle Aged; D010353:Patient Education as Topic / Q000379:methods*; D012307:Risk Factors; D040242:Risk Reduction Behavior; D064871:Teach-Back Communication; D013997:Time Factors
chemical_list: D007004:Hypoglycemic Agents