Optimizing diabetes self-care in patients with limited health literacy: a randomized controlled trial (RCT) of SCT-based education with and without an AI-designed photo-novel.

BACKGROUND

Type 2 diabetes mellitus (T2DM) requires continuous self-care to prevent complications. Patients with limited health literacy often struggle to understand health information and adhere to treatment, resulting in poorer outcomes. Educational interventions tailored to improve self-care and health literacy arSCTe therefore essential. This study evaluated the effectiveness of a Social Cognitive Theory-based intervention, with and without health literacy strategies, in enhancing self-care among patients with T2DM and limited health literacy.

METHODS

This interventional study included 150 patients with T2DM and limited health literacy, randomly assigned to three equal groups (n = 50 each): a Social Cognitive Theory-based group (TBG), a theory-based group with an AI-designed photo-novel (TBG+AIPN), and a control group. At baseline, all participants completed questionnaires assessing diabetes knowledge, self-efficacy, outcome expectations, perceived social support, and self-care behaviors. Both intervention groups received five training sessions grounded in Social Cognitive Theory. In the TBG+AIPN group, additional health literacy strategies-such as an AI-designed photo-novel and plain language materials-were incorporated. Follow-up assessments were conducted one and three months post-intervention. Data were analyzed using SPSS version 24.

RESULTS

Longitudinal analyses revealed significant within-group improvements from baseline to follow-up across all measured constructs in both intervention groups (all p < 0.001). Between-group comparisons showed that the TBG+AIPN group achieved significantly greater improvements than the TBG group in self-care behaviors (p = 0.002), diabetes knowledge (p = 0.040), self-efficacy (p = 0.020), outcome expectations (p = 0.030), and self-regulation (p = 0.020). No statistically significant difference was observed between the groups in perceived social support (p = 0.800). These findings highlight the added value of integrating AI-designed visual literacy tools with SCT-based education in improving self-care-related outcomes among patients with T2DM.

CONCLUSION

An intervention based on Social Cognitive Theory, when combined with health literacy strategies including an AI-designed photo-novel, is more effective in improving self-care among patients with T2DM and limited health literacy. Such a comprehensive approach integrates psychological and communication strategies, offering a holistic solution for improving outcomes in this vulnerable group.

TRIAL REGISTRATION: Iranian Registry of Clinical Trials (IRCT), IRCT20240426061579N1. Registered on 12 May 2024.