The Effectiveness of Microlearning-Based Education on Medication Adherence and Health Literacy in Elderly Individuals: A Controlled Trial Study

The Effectiveness of Microlearning-Based Education on Medication Adherence and Health Literacy in Elderly Individuals: A Controlled Trial Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article The Effectiveness of Microlearning-Based Education on Medication Adherence and Health Literacy in Elderly Individuals: A Controlled Trial Study Hossein Poorcheraghi, Seyed Tayeb Moradian, Seyed Qasem Mousavi, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6752484/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background The global population is rapidly aging. Owing to their unique characteristics, older adults require innovative educational methods to optimize the effectiveness of behavioral change, and microlearning is a recent educational model. This study aimed to examine the impact of microlearning-based education on medication adherence and health literacy in the elderly population. Methods This randomized controlled trial was conducted in 2024, with a trial registration number of (IRCT20191231045966N2) (10/04/2024). A total of 118 elderly participants were selected on the basis of the inclusion criteria and allocated to the intervention and control groups via the block randomization method. The data collection tools included demographic questionnaires, the Morisky medication adherence scale and the health literacy scale. The intervention group received video clips designed via the microlearning method, whereas the control group received standard interventions. The participants completed the aforementioned questionnaires at baseline and after 8 weeks. The collected data were entered into SPSS software version 22 and analyzed via descriptive (frequency, percentage, mean, standard deviation) and inferential (chi-square, Fisher’s exact test, independent t test) statistics. Results No significant differences were found between the intervention and control groups in terms of age, sex, marital status, education level, income status, type of disease, method of obtaining medication information, medication adherence level, or health literacy before the intervention, confirming homogeneity. The post intervention results revealed a significant difference in the mean medication adherence score between the intervention group (6.71 ± 1.78) and the control group (5.66 ± 2.10) (P < 0.001), indicating a greater level of medication adherence in the intervention group. However, in the health literacy domain, despite an increase in the mean health literacy score in the intervention group (66.96 ± 14.41) compared with that in the control group (63.03 ± 15.74), no statistically significant difference was observed between the two groups (P = .498). Conclusion The microlearning training method is an effective educational approach for enhancing medication adherence in older adults. Proper medication use is likely to improve disease management and ensure a better quality of life for older adults. Therefore, the implementation of this educational method to increase health-related variables for this group is recommended. Elderly Microlearning Medication adherence Health literacy Video clip Figures Figure 1 Figure 2 Background In recent years, the global trend of aging has become a major public health challenge, with projections suggesting that the elderly population worldwide will double to one billion by 2050 ( 1 , 2 ). In Iran, the rise in the elderly population has been particularly notable, occurring at a faster rate than in other countries ( 3 ). As people age, they become more vulnerable to chronic conditions such as cardiovascular disease, cancer, respiratory disease, and diabetes, which pose significant health risks. The presence of multiple chronic diseases in the elderly is known as multimorbidity ( 4 , 5 ). Consequently, older adults represent the largest demographic of medication consumers across various societies ( 6 ), necessitating the management of complex medication regimens to facilitate treatment processes ( 7 ). Medication adherence refers to how well a patient follows the medication regimen prescribed by their doctor or healthcare professional ( 8 ). Research shows that proper adherence to medication can significantly lower treatment expenses, speed up recovery, stop the progression of diseases, and reduce the likelihood of hospital readmissions. ( 9 , 10 ). Health literacy is a crucial factor influencing medication adherence in elderly individuals ( 11 ). Health literacy encompasses an individual’s ability to comprehend health information and make informed decisions to enhance health outcomes ( 12 ). The key components of health literacy include reading, listening, experiential and analytical skills; decision-making; and the application of these skills in treatment and prevention processes at both the individual and societal levels ( 13 ). Enhancing health literacy can augment individuals’ capacity to make informed decisions, mitigate health risks, bolster disease prevention, improve medication adherence, and increase the quality of life of older adults ( 14 ). One study highlighted a direct correlation between health literacy and medication adherence, identifying the enhancement of health literacy as a primary component in improving medication adherence, particularly among the elderly ( 15 ). The World Health Organization has recognized health literacy as a crucial determinant of health in the 21st century ( 16 ). In light of the preceding discussion, it is imperative to educate older adults on maintaining, adhering to and complying with their medication regimens, as well as enhancing their health literacy to improve their quality of life. Aging is linked to changes in brain structure and function, as well as cognitive processes, which can hinder the ability to acquire new knowledge ( 17 ). Given the conditions and requirements of this life stage, various educational methods are employed, including lectures, role-playing, demonstrations, and group training, each possessing distinct advantages and disadvantages ( 18 ). In addition to these methods, microlearning has emerged as a novel and transformative concept in the educational process ( 19 ). This approach involves the continuous delivery of content to learners in small units, such as brief two- to three-minute videos, PowerPoint presentations, video clips and infographics ( 20 ). Microlearning represents one of the most innovative educational strategies, rendering the learning process enjoyable and mitigating the challenges and monotony associated with acquiring new knowledge ( 21 ). As the complexity of elderly care in society increases, there is a growing demand for specialists equipped with the requisite knowledge and skills in this domain, a role that nurses are well positioned to fulfill. Nurses, armed with a thorough understanding of age-related changes and the unique needs of older adults ( 22 , 23 ), are ideally positioned to greatly enhance the quality of life and health outcomes for this demographic. As a result, targeted interventions can be crafted based on the identified issues and needs of this group, leveraging existing knowledge and resources to achieve optimal health improvements. With the growing elderly population and the critical importance of medication adherence, appropriate medication use, and improved health literacy, this study aimed to assess the effectiveness of microlearning-based education on medication adherence and health literacy among older adults. The findings of this study are intended to guide strategies for enhancing the health of the elderly population. Methods Study design, sampling and data collection This randomized controlled trial study was conducted in community from August–September 2024. The research population consisted of older adults returning to a retirement center in Tehran, Iran. The inclusion criteria were age above 60 years, multimorbidity, ability to read and write and nonparticipation in similar programs. Furthermore, a history of cognitive disorders, the participant’s decision to withdraw from the study and death were considered exclusion criteria. The sample size for this study was calculated to be 59 participants per group on the basis of a statistical power of 90%, a type I error rate of 0.05, and an anticipated attrition rate of 10% (Fig. 1 ) ( 24 ). The recruitment process occurred among retirement center older adults. The researcher assessed the eligible elderly individuals on the basis of the inclusion and exclusion criteria checklist. Among these, 118 older adults who volunteered to participate in this study were assigned to the case and control groups via the block randomization method, with a block size of four. The allocation sequence was generated via www.randomization.com ( 25 ). An opaque envelope was used for allocation concealment. At the time of enrollment, according to the order by which the participants entered the study, one of the envelopes was opened in order, and the allocation group was determined. The researcher had no access to the random allocation sequence. This study utilized three instruments to assess the outcomes: a demographic questionnaire that included patient-related variables such as age, sex, marital status, educational level, income adequacy, place of residence, type of disease, and method of obtaining health-related information. The Morisky Medication Adherence Scale, developed by Morisky et al. in 2008 ( 26 ) to evaluate medication adherence. This scale was translated into Persian to align with Iranian culture and validated by Kooshyar et al. ( 27 ). It comprises eight questions, with the first seven requiring yes/no responses and the last one using a 5-point Likert scale ranging from never to always. A score of less than 6 indicates low adherence, a score between 6 and less than 8 indicates moderate adherence, and a score of 8 signifies high adherence. The Morisky questionnaire, with the aforementioned Cronbach’s alpha, was also employed in a study by Delavar et al. in 2022 ( 24 ). The Health Literacy Scale was developed to evaluate health literacy by Montazeri et al. in 2014 ( 28 ). The questionnaire comprised 33 items designed to assess health literacy across five dimensions: access (6 questions), reading (4 questions), understanding (7 questions), evaluation (4 questions), and decision-making and application of health information (12 questions). Each item was structured on a 5-point Likert scale. For each participant, the raw score in each dimension was calculated by summing their responses to the respective items. To obtain the total score, the sum of all item scores was divided by the number of dimensions ( 5 ). Scores from 0 to 50 were deemed inadequate, those from 50.1 to 66 were categorized as semi-sufficient, scores from 66.1 to 84 were considered sufficient, and scores from 84.1 to 100 were classified as excellent ( 28 ). This instrument’s Cronbach’s alpha could be considered acceptable (0.72 to 0.89) ( 29 ). Intervention In this study, an educational video clip package designed according to the microlearning method was delivered to the intervention group via the Eitaa (Iranian Messenger). The design and development of this educational package was based on an analysis of Morisky medication adherence and Montazeri health literacy questionnaires. Concepts within the questionnaires that exhibited similarity were grouped together to form the basis for each video clip design. On the basis of the content analyzed in these two questionnaires, nine thematic categories were identified (Table 1 ). To validate and ensure the alignment of the identified categories with the aforementioned questionnaires, this content was reviewed by ten faculty members from medical universities specializing in this field. Table 1 Content of educational sessions designed on the basis of the microlearning method for the elderly Session Content 1 Introduction to the importance of taking medications 2 Awareness of healthy eating habits in multimorbidity 3 Awareness of how to manage depression in multimorbidity 4 Awareness of the importance of quitting smoking and not using it to have a healthy lifestyle 5 Awareness of the information needed in case of multimorbidity 6 Reading and understanding health materials, written doctor’s orders, forms, and guide sheets 7 Determining the accuracy of health information available on social media 8 Familiarity with the place to go in case of symptoms, the need for periodic checkups 9 Familiarity with metabolic syndrome, its symptoms, and ways to prevent it Following the receipt of feedback and implementation of necessary revisions, each video clip was developed in accordance with the approved content. The characteristics of these video clips included three- to four-minute durations per video clip, the use of straightforward and age-friendly expressions to communicate the content effectively and the incorporation of infographics and engaging animations to capture the attention of elderly viewers. Upon completion of the video clip design, this educational package, along with the content validated by the two questionnaires, was again presented to faculty members for evaluation of the video clips’ alignment with the approved content. The package was subsequently prepared for delivery to participants in the intervention group. The study objectives and instructions for accessing and viewing the video clips were clearly communicated. The participants were provided with the researcher’s contact phone number, enabling them to raise any questions or concerns throughout the study with guidance readily available from the researcher. The intervention spanned a duration of two months, during which the participants were afforded the opportunity to view the video clips. Throughout this period, the researcher engaged in follow-up calls to monitor trial and confirm video clip viewing and gather feedback while also disseminating messages on health and hygiene topics to maintain participant engagement. Concurrently, participants in the control group continued to receive standard services at retirement centers, including periodical visits to evaluate the treatment process and required care. Upon the conclusion of the intervention, both groups again completed the medication adherence and health literacy questionnaires. To address ethical considerations, the educational video clips were subsequently made available to the control group at the end of the study. Data analysis The data were entered into SPSS software version 22 and analyzed per protocol via descriptive and inferential statistics. The demographic data of the control and intervention groups and the medication adherence and health literacy levels before and after the intervention in both groups were compared at baseline and 8 weeks. The study had no missing data. P values less than 0.05 were considered significant. The data analyst was blind to the study groups (A,B groups). Results This study was conducted in 2024 and involved 118 participants. Following the acquisition of informed consent, 118 participants were randomly allocated to the intervention and control groups via block randomization (Fig. 2 ). The demographic characteristics of the participants are presented in Table 2 . The mean age of participants in control and intervention group was 64/45 ± 3/37 and 64/3 ± 91/97 respectively. The results of the chi-square test, as presented in the table below, indicated that the two groups were comparable in terms of demographic characteristics, with no statistically significant differences observed (P value˃0.05). Table 2 Demographic information of the participants in the two groups Variable Control group (n = 59) N (%) Intervention group (n = 59) N (%) P value Sex b Female 30(50.8) 29(49.2) 25(42.4) 34(57.6) P = 0.356 Male Marital status c Single 0(0) 54(91.5) 2(3.4) 3(5.1) 0(0) 57(96.6) 1(1.7) 8(1.7) P = 0.493 Married Divorced widow Education level b Primary school 3(5.1) 7(11.9) 9(15.3) 22(37.3) 18(30.5) 2(3.4) 10(16.9) 8(13.6) 21(35.6) 18(30.5) P = 0.937 Junior school High school Diploma Academic education Income sufficiency b Independent 51(86.4) 8(13.6) 48(81.4) 11(18.6) P = 0.452 Dependent Health information acquisition method c Physician and health workers 20(33.9) 14(23.7) 12(20.3) 6(10.2) 4(6.8) 3(5.1) 15(25.4) 14(23.7) 11(18.6) 10(16.9) 6(10.2) 3(5.1) P = 0.827 Family and friends Books and pamphlets Media Other I don’t know how to acquire health information Type of disease b Cardiovascular disease 12(20.3) 20(33.9) 15(25.4) 8(13.6) 4(6.8) 14(23.7) 23( 39 ) 16(27.1) 4(6.8) 2(3.4) P = 0.663 Hypertetion Diabetes Respiratory disease Other * Chi-square test b , Fisher's exact test c According to the results in Table 3 , the independent t test revealed that the initial average scores for medication adherence and health literacy in both the intervention and control groups were not significantly different before the intervention (P value˃0.05). Post intervention analysis revealed a significant increase in average medication adherence scores in both groups (p˂0.0001). Although there was an increase in the average health literacy score among participants in the intervention group, this change was not statistically significant, resulting in no significant difference between the two groups (P = 0.418). Table 3 Means and standard deviations of medication adherence and health literacy scores in the intervention and control groups Variable Time Control group Mean ± STD Intervention group Mean ± STD P value Medication adherence Before intervention 5.07 ± 2.39 5.66 ± 2.10 4.76 ± 2.50 6.71 ± 1.78 P = 0.581 P = 0.001* After intervention Health literacy Before intervention 61.96 ± 15.58 63.03 ± 15.74 59.84 ± 12.54 66.96 ± 14.41 P = 0.418 P = 0.160 After intervention A comparison of the absolute and relative frequency distributions of medication adherence and health literacy levels in the control and intervention groups before the intervention (Table 4 ) also revealed no significant differences, indicating a similarity between the groups (P value ˃0.05). Post intervention analysis revealed that the percentage of participants with strong medication adherence in the intervention group increased significantly from 11.86–50.8% (p˂0.0001). Nonetheless, despite a 21.9% increase in health literacy levels in the intervention group to sufficient and excellent levels compared with pre intervention levels, this difference was not statistically significant, and no significant difference was observed between the two groups (P = 0.498). Table 4 Comparison of the absolute and relative frequency distributions of medication adherence and health literacy levels in the control and intervention groups pre- and post intervention Variable Time Level Control group (n = 59) N (%) Intervention group (n = 59) N (%) P value Medication adherence Before intervention Low Moderate High 29(49.15) 21(35.59) 9(15.25) 33(59.93) 19(32.20) 7(11.86) P = 0.738 After intervention Low Moderate High 25(42.4) 22(37.3) 12(20.3) 11(18.6) 18(30.5) 30(50.8) P = 0.001* Health literacy Before intervention Inadequate Semi sufficient Sufficient Excellent 14(23.7) 28(47.5) 8(13.5) 9(15.3) 11(18.6) 37(62.7) 7(11.9) 4(6.8) P = 0.309 After intervention Inadequate Semi sufficient Sufficient Excellent 11(18.6) 37(62.7) 7(11.9) 4(6.8) 6(10.2) 29(49.2) 10(16.9) 14(23.7) P = 0.498 Discussion This study aimed to examine the impact of microlearning-based education on medication adherence and health literacy in elderly individuals. It is essential to employ educational methods that align with the specific needs of elderly individuals, as traditional educational approaches may not yield effective outcomes ( 30 ). Factors such as the increased time required for information processing, necessity for repetition to ensure sustainable learning, age-related cognitive changes necessitating additional support, importance of designing studies in a simple and comprehensible manner, division of educational concepts into smaller units, and encouragement of the elderly to articulate and reiterate learned material are critical considerations. The findings of this study indicate that the microlearning method significantly improved medication adherence in the intervention group, although no significant change was observed in health literacy. Previous studies, such as Li X. et al., which explored the use of virtual reality and video game-based training on the cognitive status of elderly individuals ( 31 ), and the study by Carvell J. et al., which utilized short educational video clips ( 32 ), reported significant positive changes in similar variables. Consequently, this study employed a microlearning method to address these issues and enhance medication adherence and health literacy among elderly individuals. The results demonstrated significant improvement in medication adherence in the intervention group. However, despite the increase in health literacy scores, this change was not statistically significant. In a related context, Gomez et al. conducted a study ( 33 ) to inform elderly people about preventive measures at home and assess the effectiveness of educational packages on the basis of the mini-learning method delivered via a mobile application. The results of the study indicated that the elderly found this method relatively easy, with all participants agreeing that microlearning was beneficial and provided essential information. The participants expressed a strong desire to engage with similar learning methods in the future, suggesting positive acceptance and potential for ongoing educational initiatives by older adults. Although the variables examined in these two studies differed, Gomez et al. demonstrated that the microlearning method effectively conveyed educational concepts to the elderly and encouraged further learning. Consistent with the current study, research conducted by Dennis Yeung et al. ( 34 ) sought to increase medication adherence among elderly individuals with diabetes, heart failure, and hypertension through the use of flashcards and educational videos designed to promote health literacy. The findings indicated that elderly participants with multimorbidity who engaged in these health literacy-based educational video clip programs demonstrated a significant improvement in medication adherence. The outcomes of Yeung’s study align with those of the present study, as both studies employed novel educational methods and content tailored to the needs of elderly individuals, resulting in increased medication adherence. Several studies ( 24 , 35 , 36 ) have highlighted the correlation between health literacy and medication adherence in elderly individuals. This relationship is further underscored by a study conducted by Gamble et al. ( 15 ), which identified health literacy as a crucial factor in comprehending prescribed medication instructions, ultimately leading to increased medication adherence. This study demonstrated that elderly individuals with adequate health literacy are less likely to forget or neglect their medication, a key factor contributing to poor adherence among elderly individuals. Additionally, research by Jaimalai et al. ( 11 ) aimed at improving medication adherence through health literacy promotion revealed that elderly participants who received a health literacy education program experienced significant improvements in medication adherence. The ability to comprehend health-related issues provides elderly individuals with a valuable perspective that can positively influence various health-related variables, including medication adherence. Consequently, the promotion of health literacy is emphasized as a critical criterion for enhancing all health variables in elderly individuals, particularly medication adherence. Sartori et al. conducted an educational intervention using WhatsApp to enhance medication adherence among individuals with hypertension and diabetes. Participants in the intervention group received training through images, educational video clips, and audio files, all aimed at improving medication adherence via the WhatsApp platform, while those in the control group received only standard care. Analysis of the findings revealed that 67.5% of participants in the intervention group achieved a high level of medication adherence, compared to 58.5% in the control group (P = 0.07). Although the intervention did not produce statistically significant results, the intervention group showed an increase in medication adherence of more than ten percent compared to the control group ( 37 ). The findings of this study were not congruent with those of the present study, as the educational content provided did not result in a significant difference in medication adherence between the two groups. Although the training duration was identical in both studies, this discrepancy may be attributed to the lack of adaptation of the training package for the elderly individuals in the aforementioned study. In the present study, several considerations were made in the design of the video clips, including the use of very simple content to convey concepts and the incorporation of animation and motion graphics to capture the attention of the elderly and ensure effective communication. Hsieh et al. implemented a web-based program designed to increase medication adherence and quality of life as well as reduce readmissions among patients with atrial fibrillation. The intervention group received educational content emphasizing the importance of medication adherence and strategies for its improvement through digital and web-based platforms. The findings demonstrated a significant improvement in medication adherence and quality of life in the intervention group. Furthermore, the intervention group presented a significantly lower rate of readmission over a two-year period than did the control group ( 38 ). The study by Hsieh et al. is notable for its strengths, including the assessment of participants’ quality of life and the two-year follow-up on readmissions, in contrast to the present study. Despite the differing follow-up durations in the two studies, the results were consistent. Both the web-based program by Hsieh et al. and the microlearning method employed in the present study effectively enhanced medication adherence among the participants. In another study, Uemura et al. proposed enhancing health literacy among elderly individuals by implementing an active learning approach ( 39 ). Elderly participants in the intervention group underwent training in nutrition, physical activity, exercise, and cognitive activities for 90 min per week over a 24-week period. This method involved in-person training sessions, during which participants reinforced their learning by actively performing and practicing skills. The findings of this study diverge from those of the present study. In the present study, educational content aimed at improving health literacy among elderly people was delivered through short videos. However, integrating this training with face-to-face sessions, as conducted by Uemura et al., might have clarified existing ambiguities and led to significant changes in participants. Enhancing health literacy requires increased interaction with older adults to endure changes in their respective domains. In addition, the economic background of individuals warrants consideration. In developing countries, such as Iran, citizens face substantial economic challenges. Possessing health literacy and knowledge alone may not yield the desired outcomes or practical applications. Elderly individuals may recognize the importance of considering the nutritional value of products; however, economic constraints hinder their ability to select high-quality options. It appears that knowledge alone is insufficient to achieve the desired outcomes, as multiple factors, particularly economic ones, may play a role. Furthermore, to effect changes in variables that have developed over the years, including health literacy, a more extended period may be necessary for the effects and changes to manifest. The eight-week duration of this study may have been inadequate to produce the anticipated changes in this age group. Limitations A notable limitation of this study is the paucity of specific research on the application of microlearning in education for elderly individuals. In the Discussion section, efforts were made to incorporate the findings of the study alongside interventions utilizing educational videos, digital methods, and applications to educate elderly individuals, thereby facilitating a comprehensive analysis and discussion in this domain. Future research should explore the use of microlearning as an innovative educational method for elderly individuals. Furthermore, if microlearning is employed in subsequent studies, it should be complemented by face-to-face education to address the needs of elderly individuals. Additionally, conducting a qualitative study on the factors influencing medication adherence and optimal health literacy in elderly individuals could elucidate challenges in this area. Conclusion As previously discussed, effective education for the elderly necessitates the adoption of novel and innovative pedagogical approaches. The microlearning method has emerged as a particularly effective strategy for conveying concepts to this demographic, potentially yielding favorable outcomes. Nonetheless, it is important to acknowledge that in certain instances, reliance on this method alone may prove insufficient to address the unique needs of elderly individuals. Given their specific conditions and limitations, it is advisable to integrate this educational approach with face-to-face and practical training to optimize the results. Iran is experiencing a rapid demographic shift toward an aging society. Consequently, addressing the needs of this population and anticipating future requirements are imperative. Enhancing health literacy and ensuring proper medication adherence among elderly individuals can mitigate potential adverse effects within this age group. Application of Findings The present study demonstrated that the microlearning method can substantially enhance medication adherence in the elderly population. Considering that a fundamental objective of the healthcare system is to mitigate rising costs and alleviate the economic burden imposed by various societal groups, enhancing medication adherence in elderly individuals through educational strategies such as microlearning can significantly reduce adverse outcomes and improve their quality of life. Furthermore, given that nurses are primarily responsible for overseeing the correct consumption of medication by patients, the implementation of tools such as the educational method employed in this study can decrease their workload, thereby increasing the accuracy of medication use among the elderly and preventing numerous human errors. The findings of this study can serve as a foundation for future interventions and research, with the potential to explore and ascertain the impact of microlearning methods on other health-related outcomes and monitor elderly individuals in diverse healthcare domains. Declarations Supplementary Information Acknowledgments The researchers express their gratitude to the Research Vice-Chancellor of Baqiyatallah University of Medical Sciences, and the authors wish to thank all of the participants in this study. Authors’ contributions HP: design of the study, implementation of the study, drafting of the manuscript; STM: analysis and interpretation of the data, drafting of the manuscript; SQM: design of the study, analysis and interpretation of the data, drafting of the manuscript. JMN: designed the study, analyzed and interpreted the data, and drafted the manuscript. All the authors have read and approved the manuscript. Funding This research was approved and supported by Baqiyatallah University of Medical Sciences available at: www.bmus.ac.ir. The funder had no intervention in design, conduct, analysis, and reporting of trial. Data availability All the data generated in this study are included in the manuscript. The datasets are available upon reasonable request from the corresponding author. Mrs. Jamileh Mokhtari Nouri is available for data and materials availability. The available e-mail address is [email protected] . Ethical approval and consent to participate The study was approved by the Ethics Committee of Baqiyatallah University of Medical Sciences (IR.BMSU.BAQ.REC.1403.003). It was also registered in the Iranian Registry of Clinical Trials (code: IRCT20191231045966N2) (10/04/2024). The participants were assured of data confidentiality, and informed written consent was obtained from them by researcher. Moreover, on the basis of research ethics principles, the educational video clips were subsequently made available to the control group at the end of the study. All methods were carried out in accordance with relevant guidelines and regulations. Consent for publication The findings of this study will be disseminated through publication and made accessible to the public. 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Payesh (Health Monitor) 13(5):589–599 Chahardah-Cherik S, Gheibizadeh M, Jahani S, Cheraghian B (2018) The relationship between health literacy and health promoting behaviors in patients with type 2 diabetes. Int J community based Nurs midwifery 6(1):65 Nita AV, Kurniyanti MA, Sulaksono AD (2024) Effectiveness of Animation Video about Diabetes Mellitus Self-Care Management on The Level of Knowledge among Elderly. Health Technol J (HTechJ) 2(5):487–491 Li X, Niksirat KS, Chen S, Weng D, Sarcar S, Ren X (2020) The impact of a multitasking-based virtual reality motion video game on the cognitive and physical abilities of older adults. Sustainability 12(21):9106 Carvell J (2023) Health Literacy and the Feasibility of Using Video-Based Education in the Emergency Department. University of Nevada, Las Vegas Adler AB, Gutierrez IA, Gomez SA, Beymer MR, Santo TJ, Thomas JL et al (2022) US soldiers and the role of leadership: COVID-19, mental health, and adherence to public health guidelines. BMC Public Health 22(1):1–9 Yeung DL, Alvarez KS, Quinones ME, Clark CA, Oliver GH, Alvarez CA et al (2017) Low–health literacy flashcards & mobile video reinforcement to improve medication adherence in patients on oral diabetes, heart failure, and hypertension medications. J Am Pharmacists Association 57(1):30–37 Babazadeh T, Ranjbaran S, Pourrazavi S, Latifi A, Maleki Chollou K (2024) Impact of health literacy and illness perception on medication adherence among older adults with hypertension in Iran: a cross-sectional study. Front Public Health 12:1347180 Mohsen MM, Abd El-Aal BG, Hassan SS, El-Abbassy AA (2021) Effect of Health Literacy Intervention on Medication Adherence among Older Adults with Chronic Diseases. Indian J Forensic Med Toxicol 15(4):1662–1669 Sartori AC, Rodrigues Lucena TF, Lopes CT, Picinin Bernuci M, Yamaguchi MU (2020) Educational intervention using WhatsApp on medication adherence in hypertension and diabetes patients: a randomized clinical trial. Telemedicine e-Health 26(12):1526–1532 Hsieh H-L, Kao C-W, Cheng S-M, Chang Y-C (2021) A web-based integrated management program for improving medication adherence and quality of life, and reducing readmission in patients with atrial fibrillation: randomized controlled trial. J Med Internet Res 23(9):e30107 Uemura K, Yamada M, Okamoto H (2018) Effects of active learning on health literacy and behavior in older adults: a randomized controlled trial. J Am Geriatr Soc 66(9):1721–1729 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6752484","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":465890809,"identity":"2119c011-fe5b-4e36-b839-98c95f162f25","order_by":0,"name":"Hossein Poorcheraghi","email":"","orcid":"","institution":"Tehran University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Hossein","middleName":"","lastName":"Poorcheraghi","suffix":""},{"id":465890810,"identity":"6ea1a662-03b6-470c-9499-0177ffb1ec87","order_by":1,"name":"Seyed Tayeb Moradian","email":"","orcid":"","institution":"Baqiyatallah University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Seyed","middleName":"Tayeb","lastName":"Moradian","suffix":""},{"id":465890811,"identity":"1b48e9a3-3fa2-45c0-99ab-4266296f8497","order_by":2,"name":"Seyed Qasem Mousavi","email":"","orcid":"","institution":"Baqiyatallah University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Seyed","middleName":"Qasem","lastName":"Mousavi","suffix":""},{"id":465890812,"identity":"dda1a317-ada4-4839-8ae3-43fdee85a1dd","order_by":3,"name":"Jamileh Mokhtari Nouri","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA1klEQVRIiWNgGAWjYBACgwNsbCCah18CJsRMQIslSMsBoBbJGcRqsYdqYTC4QazDzI63pT3+UHNPxvh2d/JnHgY7eQZ23gf4tZw5dtzgwLFiHrM7Z7dJ8zAkGzYwsxvg13IjvU3iAFsCj9mN3G3MPAzMCQzMbPgdZgDW8i+Bx3hG7magw+qJ0ZJ2TOJgWwKPgUTuBqDDDhOh5cyxNImzfQk8EkC/SM4xOG7YRlDL8TYziYpvCfb8s3s3f3hTUS3Pz38MvxZ0ExgYCNgxCkbBKBgFo4AYAAAM7UA8ZgFVZAAAAABJRU5ErkJggg==","orcid":"","institution":"Baqiyatallah University of Medical Sciences","correspondingAuthor":true,"prefix":"","firstName":"Jamileh","middleName":"Mokhtari","lastName":"Nouri","suffix":""}],"badges":[],"createdAt":"2025-05-26 16:11:00","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6752484/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6752484/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":84220583,"identity":"7d18ece4-8d52-446f-9f40-b51b08dc5149","added_by":"auto","created_at":"2025-06-09 11:38:12","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":12615,"visible":true,"origin":"","legend":"\u003cp\u003eSample size calculation formula\u003c/p\u003e","description":"","filename":"Onlinefloatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-6752484/v1/5c29ff457affeb88de3179d2.png"},{"id":84219094,"identity":"175c6ef9-7bf1-45fe-8b29-6b9ac02fd74f","added_by":"auto","created_at":"2025-06-09 11:22:12","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":26312,"visible":true,"origin":"","legend":"\u003cp\u003eFlow chart of participants in the study (CONSORT flow diagram)\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-6752484/v1/ef541bb1f36b19ec1b0dbead.png"},{"id":85330481,"identity":"17d7bffc-aeb7-4b42-baaf-0d497a18df10","added_by":"auto","created_at":"2025-06-24 18:01:39","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":867716,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6752484/v1/73689c14-3225-47e9-b38f-56513609f21f.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"The Effectiveness of Microlearning-Based Education on Medication Adherence and Health Literacy in Elderly Individuals: A Controlled Trial Study","fulltext":[{"header":"Background","content":"\u003cp\u003eIn recent years, the global trend of aging has become a major public health challenge, with projections suggesting that the elderly population worldwide will double to one billion by 2050 (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). In Iran, the rise in the elderly population has been particularly notable, occurring at a faster rate than in other countries (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). As people age, they become more vulnerable to chronic conditions such as cardiovascular disease, cancer, respiratory disease, and diabetes, which pose significant health risks. The presence of multiple chronic diseases in the elderly is known as multimorbidity (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). Consequently, older adults represent the largest demographic of medication consumers across various societies (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e), necessitating the management of complex medication regimens to facilitate treatment processes (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eMedication adherence refers to how well a patient follows the medication regimen prescribed by their doctor or healthcare professional (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). Research shows that proper adherence to medication can significantly lower treatment expenses, speed up recovery, stop the progression of diseases, and reduce the likelihood of hospital readmissions. (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). Health literacy is a crucial factor influencing medication adherence in elderly individuals (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). Health literacy encompasses an individual\u0026rsquo;s ability to comprehend health information and make informed decisions to enhance health outcomes (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). The key components of health literacy include reading, listening, experiential and analytical skills; decision-making; and the application of these skills in treatment and prevention processes at both the individual and societal levels (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). Enhancing health literacy can augment individuals\u0026rsquo; capacity to make informed decisions, mitigate health risks, bolster disease prevention, improve medication adherence, and increase the quality of life of older adults (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). One study highlighted a direct correlation between health literacy and medication adherence, identifying the enhancement of health literacy as a primary component in improving medication adherence, particularly among the elderly (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). The World Health Organization has recognized health literacy as a crucial determinant of health in the 21st century (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn light of the preceding discussion, it is imperative to educate older adults on maintaining, adhering to and complying with their medication regimens, as well as enhancing their health literacy to improve their quality of life. Aging is linked to changes in brain structure and function, as well as cognitive processes, which can hinder the ability to acquire new knowledge (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). Given the conditions and requirements of this life stage, various educational methods are employed, including lectures, role-playing, demonstrations, and group training, each possessing distinct advantages and disadvantages (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). In addition to these methods, microlearning has emerged as a novel and transformative concept in the educational process (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). This approach involves the continuous delivery of content to learners in small units, such as brief two- to three-minute videos, PowerPoint presentations, video clips and infographics (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). Microlearning represents one of the most innovative educational strategies, rendering the learning process enjoyable and mitigating the challenges and monotony associated with acquiring new knowledge (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). As the complexity of elderly care in society increases, there is a growing demand for specialists equipped with the requisite knowledge and skills in this domain, a role that nurses are well positioned to fulfill.\u003c/p\u003e \u003cp\u003eNurses, armed with a thorough understanding of age-related changes and the unique needs of older adults (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e), are ideally positioned to greatly enhance the quality of life and health outcomes for this demographic. As a result, targeted interventions can be crafted based on the identified issues and needs of this group, leveraging existing knowledge and resources to achieve optimal health improvements. With the growing elderly population and the critical importance of medication adherence, appropriate medication use, and improved health literacy, this study aimed to assess the effectiveness of microlearning-based education on medication adherence and health literacy among older adults. The findings of this study are intended to guide strategies for enhancing the health of the elderly population.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy design, sampling and data collection\u003c/h2\u003e \u003cp\u003eThis randomized controlled trial study was conducted in community from August\u0026ndash;September 2024. The research population consisted of older adults returning to a retirement center in Tehran, Iran. The inclusion criteria were age above 60 years, multimorbidity, ability to read and write and nonparticipation in similar programs. Furthermore, a history of cognitive disorders, the participant\u0026rsquo;s decision to withdraw from the study and death were considered exclusion criteria. The sample size for this study was calculated to be 59 participants per group on the basis of a statistical power of 90%, a type I error rate of 0.05, and an anticipated attrition rate of 10% (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e) (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eThe recruitment process occurred among retirement center older adults. The researcher assessed the eligible elderly individuals on the basis of the inclusion and exclusion criteria checklist. Among these, 118 older adults who volunteered to participate in this study were assigned to the case and control groups via the block randomization method, with a block size of four. The allocation sequence was generated via \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ewww.randomization.com\u003c/a\u003e\u003c/span\u003e\u003cspan address=\"http://www.randomization.com\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e). An opaque envelope was used for allocation concealment. At the time of enrollment, according to the order by which the participants entered the study, one of the envelopes was opened in order, and the allocation group was determined. The researcher had no access to the random allocation sequence.\u003c/p\u003e \u003cp\u003eThis study utilized three instruments to assess the outcomes: a demographic questionnaire that included patient-related variables such as age, sex, marital status, educational level, income adequacy, place of residence, type of disease, and method of obtaining health-related information. The Morisky Medication Adherence Scale, developed by Morisky et al. in 2008 (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e) to evaluate medication adherence. This scale was translated into Persian to align with Iranian culture and validated by Kooshyar et al. (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e). It comprises eight questions, with the first seven requiring yes/no responses and the last one using a 5-point Likert scale ranging from never to always. A score of less than 6 indicates low adherence, a score between 6 and less than 8 indicates moderate adherence, and a score of 8 signifies high adherence. The Morisky questionnaire, with the aforementioned Cronbach\u0026rsquo;s alpha, was also employed in a study by Delavar et al. in 2022 (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe Health Literacy Scale was developed to evaluate health literacy by Montazeri et al. in 2014 (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e). The questionnaire comprised 33 items designed to assess health literacy across five dimensions: access (6 questions), reading (4 questions), understanding (7 questions), evaluation (4 questions), and decision-making and application of health information (12 questions). Each item was structured on a 5-point Likert scale. For each participant, the raw score in each dimension was calculated by summing their responses to the respective items. To obtain the total score, the sum of all item scores was divided by the number of dimensions (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). Scores from 0 to 50 were deemed inadequate, those from 50.1 to 66 were categorized as semi-sufficient, scores from 66.1 to 84 were considered sufficient, and scores from 84.1 to 100 were classified as excellent (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e). This instrument\u0026rsquo;s Cronbach\u0026rsquo;s alpha could be considered acceptable (0.72 to 0.89) (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eIntervention\u003c/h3\u003e\n\u003cp\u003eIn this study, an educational video clip package designed according to the microlearning method was delivered to the intervention group via the Eitaa (Iranian Messenger). The design and development of this educational package was based on an analysis of Morisky medication adherence and Montazeri health literacy questionnaires. Concepts within the questionnaires that exhibited similarity were grouped together to form the basis for each video clip design. On the basis of the content analyzed in these two questionnaires, nine thematic categories were identified (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). To validate and ensure the alignment of the identified categories with the aforementioned questionnaires, this content was reviewed by ten faculty members from medical universities specializing in this field.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eContent of educational sessions designed on the basis of the microlearning method for the elderly\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSession\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eContent\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e1\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIntroduction to the importance of taking medications\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e2\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAwareness of healthy eating habits in multimorbidity\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e3\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAwareness of how to manage depression in multimorbidity\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e4\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAwareness of the importance of quitting smoking and not using it to have a healthy lifestyle\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e5\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAwareness of the information needed in case of multimorbidity\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e6\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eReading and understanding health materials, written doctor\u0026rsquo;s orders, forms, and guide sheets\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e7\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDetermining the accuracy of health information available on social media\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e8\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFamiliarity with the place to go in case of symptoms, the need for periodic checkups\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e9\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFamiliarity with metabolic syndrome, its symptoms, and ways to prevent it\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eFollowing the receipt of feedback and implementation of necessary revisions, each video clip was developed in accordance with the approved content. The characteristics of these video clips included three- to four-minute durations per video clip, the use of straightforward and age-friendly expressions to communicate the content effectively and the incorporation of infographics and engaging animations to capture the attention of elderly viewers. Upon completion of the video clip design, this educational package, along with the content validated by the two questionnaires, was again presented to faculty members for evaluation of the video clips\u0026rsquo; alignment with the approved content.\u003c/p\u003e \u003cp\u003eThe package was subsequently prepared for delivery to participants in the intervention group. The study objectives and instructions for accessing and viewing the video clips were clearly communicated. The participants were provided with the researcher\u0026rsquo;s contact phone number, enabling them to raise any questions or concerns throughout the study with guidance readily available from the researcher. The intervention spanned a duration of two months, during which the participants were afforded the opportunity to view the video clips. Throughout this period, the researcher engaged in follow-up calls to monitor trial and confirm video clip viewing and gather feedback while also disseminating messages on health and hygiene topics to maintain participant engagement. Concurrently, participants in the control group continued to receive standard services at retirement centers, including periodical visits to evaluate the treatment process and required care. Upon the conclusion of the intervention, both groups again completed the medication adherence and health literacy questionnaires. To address ethical considerations, the educational video clips were subsequently made available to the control group at the end of the study.\u003c/p\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eData analysis\u003c/h2\u003e \u003cp\u003eThe data were entered into SPSS software version 22 and analyzed per protocol via descriptive and inferential statistics. The demographic data of the control and intervention groups and the medication adherence and health literacy levels before and after the intervention in both groups were compared at baseline and 8 weeks. The study had no missing data. P values less than 0.05 were considered significant. The data analyst was blind to the study groups (A,B groups).\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eThis study was conducted in 2024 and involved 118 participants. Following the acquisition of informed consent, 118 participants were randomly allocated to the intervention and control groups via block randomization (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eThe demographic characteristics of the participants are presented in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. The mean age of participants in control and intervention group was 64/45\u0026thinsp;\u0026plusmn;\u0026thinsp;3/37 and 64/3\u0026thinsp;\u0026plusmn;\u0026thinsp;91/97 respectively. The results of the chi-square test, as presented in the table below, indicated that the two groups were comparable in terms of demographic characteristics, with no statistically significant differences observed (P value˃0.05).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDemographic information of the participants in the two groups\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eControl group\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;59) N (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eIntervention group\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;59) N (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eSex\u003c/b\u003e\u003csup\u003e\u003cb\u003eb\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e30(50.8)\u003c/p\u003e \u003cp\u003e29(49.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e25(42.4)\u003c/p\u003e \u003cp\u003e34(57.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eP\u0026thinsp;=\u0026thinsp;0.356\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u003cb\u003eMarital status\u003c/b\u003e\u003csup\u003e\u003cb\u003ec\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSingle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e0(0)\u003c/p\u003e \u003cp\u003e54(91.5)\u003c/p\u003e \u003cp\u003e2(3.4)\u003c/p\u003e \u003cp\u003e3(5.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e0(0)\u003c/p\u003e \u003cp\u003e57(96.6)\u003c/p\u003e \u003cp\u003e1(1.7)\u003c/p\u003e \u003cp\u003e8(1.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eP\u0026thinsp;=\u0026thinsp;0.493\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDivorced\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ewidow\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003e\u003cb\u003eEducation level\u003c/b\u003e\u003csup\u003e\u003cb\u003eb\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePrimary school\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003e3(5.1)\u003c/p\u003e \u003cp\u003e7(11.9)\u003c/p\u003e \u003cp\u003e9(15.3)\u003c/p\u003e \u003cp\u003e22(37.3)\u003c/p\u003e \u003cp\u003e18(30.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003e2(3.4)\u003c/p\u003e \u003cp\u003e10(16.9)\u003c/p\u003e \u003cp\u003e8(13.6)\u003c/p\u003e \u003cp\u003e21(35.6)\u003c/p\u003e \u003cp\u003e18(30.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003eP\u0026thinsp;=\u0026thinsp;0.937\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eJunior school\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHigh school\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDiploma\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAcademic education\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eIncome sufficiency\u003c/b\u003e\u003csup\u003e\u003cb\u003eb\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIndependent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e51(86.4)\u003c/p\u003e \u003cp\u003e8(13.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e48(81.4)\u003c/p\u003e \u003cp\u003e11(18.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eP\u0026thinsp;=\u0026thinsp;0.452\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDependent\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"5\" rowspan=\"6\"\u003e \u003cp\u003e\u003cb\u003eHealth information acquisition method\u003c/b\u003e\u003csup\u003e\u003cb\u003ec\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePhysician and health workers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\" morerows=\"5\" rowspan=\"6\"\u003e \u003cp\u003e20(33.9)\u003c/p\u003e \u003cp\u003e14(23.7)\u003c/p\u003e \u003cp\u003e12(20.3)\u003c/p\u003e \u003cp\u003e6(10.2)\u003c/p\u003e \u003cp\u003e4(6.8)\u003c/p\u003e \u003cp\u003e3(5.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"5\" rowspan=\"6\"\u003e \u003cp\u003e15(25.4)\u003c/p\u003e \u003cp\u003e14(23.7)\u003c/p\u003e \u003cp\u003e11(18.6)\u003c/p\u003e \u003cp\u003e10(16.9)\u003c/p\u003e \u003cp\u003e6(10.2)\u003c/p\u003e \u003cp\u003e3(5.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"5\" rowspan=\"6\"\u003e \u003cp\u003eP\u0026thinsp;=\u0026thinsp;0.827\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFamily and friends\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBooks and pamphlets\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMedia\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eI don\u0026rsquo;t know how to acquire health information\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003e\u003cb\u003eType of disease\u003c/b\u003e\u003csup\u003e\u003cb\u003eb\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCardiovascular disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003e12(20.3)\u003c/p\u003e \u003cp\u003e20(33.9)\u003c/p\u003e \u003cp\u003e15(25.4)\u003c/p\u003e \u003cp\u003e8(13.6)\u003c/p\u003e \u003cp\u003e4(6.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003e14(23.7)\u003c/p\u003e \u003cp\u003e23(\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e16(27.1)\u003c/p\u003e \u003cp\u003e4(6.8)\u003c/p\u003e \u003cp\u003e2(3.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003eP\u0026thinsp;=\u0026thinsp;0.663\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHypertetion\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDiabetes\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRespiratory disease\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003e\u003cb\u003e*\u003c/b\u003e Chi-square test\u003csup\u003eb\u003c/sup\u003e, Fisher's exact test\u003csup\u003ec\u003c/sup\u003e\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eAccording to the results in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e, the independent t test revealed that the initial average scores for medication adherence and health literacy in both the intervention and control groups were not significantly different before the intervention (P value˃0.05). Post intervention analysis revealed a significant increase in average medication adherence scores in both groups (p˂0.0001). Although there was an increase in the average health literacy score among participants in the intervention group, this change was not statistically significant, resulting in no significant difference between the two groups (P\u0026thinsp;=\u0026thinsp;0.418).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMeans and standard deviations of medication adherence and health literacy scores in the intervention and control groups\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTime\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eControl group\u003c/p\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;STD\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eIntervention group\u003c/p\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;STD\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eMedication adherence\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eBefore intervention\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e5.07\u0026thinsp;\u0026plusmn;\u0026thinsp;2.39\u003c/p\u003e \u003cp\u003e5.66\u0026thinsp;\u0026plusmn;\u0026thinsp;2.10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e4.76\u0026thinsp;\u0026plusmn;\u0026thinsp;2.50\u003c/p\u003e \u003cp\u003e6.71\u0026thinsp;\u0026plusmn;\u0026thinsp;1.78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eP\u0026thinsp;=\u0026thinsp;0.581\u003c/p\u003e \u003cp\u003eP\u0026thinsp;=\u0026thinsp;0.001*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eAfter intervention\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eHealth literacy\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eBefore intervention\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e61.96\u0026thinsp;\u0026plusmn;\u0026thinsp;15.58\u003c/p\u003e \u003cp\u003e63.03\u0026thinsp;\u0026plusmn;\u0026thinsp;15.74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e59.84\u0026thinsp;\u0026plusmn;\u0026thinsp;12.54\u003c/p\u003e \u003cp\u003e66.96\u0026thinsp;\u0026plusmn;\u0026thinsp;14.41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eP\u0026thinsp;=\u0026thinsp;0.418\u003c/p\u003e \u003cp\u003eP\u0026thinsp;=\u0026thinsp;0.160\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eAfter intervention\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eA comparison of the absolute and relative frequency distributions of medication adherence and health literacy levels in the control and intervention groups before the intervention (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e) also revealed no significant differences, indicating a similarity between the groups (P value ˃0.05). Post intervention analysis revealed that the percentage of participants with strong medication adherence in the intervention group increased significantly from 11.86\u0026ndash;50.8% (p˂0.0001). Nonetheless, despite a 21.9% increase in health literacy levels in the intervention group to sufficient and excellent levels compared with pre intervention levels, this difference was not statistically significant, and no significant difference was observed between the two groups (P\u0026thinsp;=\u0026thinsp;0.498).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of the absolute and relative frequency distributions of medication adherence and health literacy levels in the control and intervention groups pre- and post intervention\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTime\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eLevel\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eControl group\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;59) N (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eIntervention group\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;59) N (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eMedication adherence\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBefore intervention\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eLow\u003c/p\u003e \u003cp\u003eModerate\u003c/p\u003e \u003cp\u003eHigh\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e29(49.15)\u003c/p\u003e \u003cp\u003e21(35.59)\u003c/p\u003e \u003cp\u003e9(15.25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e33(59.93)\u003c/p\u003e \u003cp\u003e19(32.20)\u003c/p\u003e \u003cp\u003e7(11.86)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eP\u0026thinsp;=\u0026thinsp;0.738\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAfter intervention\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eLow\u003c/p\u003e \u003cp\u003eModerate\u003c/p\u003e \u003cp\u003eHigh\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e25(42.4)\u003c/p\u003e \u003cp\u003e22(37.3)\u003c/p\u003e \u003cp\u003e12(20.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e11(18.6)\u003c/p\u003e \u003cp\u003e18(30.5)\u003c/p\u003e \u003cp\u003e30(50.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eP\u0026thinsp;=\u0026thinsp;0.001*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eHealth literacy\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBefore intervention\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eInadequate\u003c/p\u003e \u003cp\u003eSemi sufficient\u003c/p\u003e \u003cp\u003eSufficient\u003c/p\u003e \u003cp\u003eExcellent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14(23.7)\u003c/p\u003e \u003cp\u003e28(47.5)\u003c/p\u003e \u003cp\u003e8(13.5)\u003c/p\u003e \u003cp\u003e9(15.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e11(18.6)\u003c/p\u003e \u003cp\u003e37(62.7)\u003c/p\u003e \u003cp\u003e7(11.9)\u003c/p\u003e \u003cp\u003e4(6.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eP\u0026thinsp;=\u0026thinsp;0.309\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAfter intervention\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eInadequate\u003c/p\u003e \u003cp\u003eSemi sufficient\u003c/p\u003e \u003cp\u003eSufficient\u003c/p\u003e \u003cp\u003eExcellent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11(18.6)\u003c/p\u003e \u003cp\u003e37(62.7)\u003c/p\u003e \u003cp\u003e7(11.9)\u003c/p\u003e \u003cp\u003e4(6.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6(10.2)\u003c/p\u003e \u003cp\u003e29(49.2)\u003c/p\u003e \u003cp\u003e10(16.9)\u003c/p\u003e \u003cp\u003e14(23.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eP\u0026thinsp;=\u0026thinsp;0.498\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study aimed to examine the impact of microlearning-based education on medication adherence and health literacy in elderly individuals. It is essential to employ educational methods that align with the specific needs of elderly individuals, as traditional educational approaches may not yield effective outcomes (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e). Factors such as the increased time required for information processing, necessity for repetition to ensure sustainable learning, age-related cognitive changes necessitating additional support, importance of designing studies in a simple and comprehensible manner, division of educational concepts into smaller units, and encouragement of the elderly to articulate and reiterate learned material are critical considerations. The findings of this study indicate that the microlearning method significantly improved medication adherence in the intervention group, although no significant change was observed in health literacy. Previous studies, such as Li X. et al., which explored the use of virtual reality and video game-based training on the cognitive status of elderly individuals (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e), and the study by Carvell J. et al., which utilized short educational video clips (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e), reported significant positive changes in similar variables. Consequently, this study employed a microlearning method to address these issues and enhance medication adherence and health literacy among elderly individuals. The results demonstrated significant improvement in medication adherence in the intervention group. However, despite the increase in health literacy scores, this change was not statistically significant. In a related context, Gomez et al. conducted a study (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e) to inform elderly people about preventive measures at home and assess the effectiveness of educational packages on the basis of the mini-learning method delivered via a mobile application. The results of the study indicated that the elderly found this method relatively easy, with all participants agreeing that microlearning was beneficial and provided essential information. The participants expressed a strong desire to engage with similar learning methods in the future, suggesting positive acceptance and potential for ongoing educational initiatives by older adults. Although the variables examined in these two studies differed, Gomez et al. demonstrated that the microlearning method effectively conveyed educational concepts to the elderly and encouraged further learning. Consistent with the current study, research conducted by Dennis Yeung et al. (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e) sought to increase medication adherence among elderly individuals with diabetes, heart failure, and hypertension through the use of flashcards and educational videos designed to promote health literacy. The findings indicated that elderly participants with multimorbidity who engaged in these health literacy-based educational video clip programs demonstrated a significant improvement in medication adherence. The outcomes of Yeung\u0026rsquo;s study align with those of the present study, as both studies employed novel educational methods and content tailored to the needs of elderly individuals, resulting in increased medication adherence.\u003c/p\u003e \u003cp\u003eSeveral studies (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e) have highlighted the correlation between health literacy and medication adherence in elderly individuals. This relationship is further underscored by a study conducted by Gamble et al. (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e), which identified health literacy as a crucial factor in comprehending prescribed medication instructions, ultimately leading to increased medication adherence. This study demonstrated that elderly individuals with adequate health literacy are less likely to forget or neglect their medication, a key factor contributing to poor adherence among elderly individuals. Additionally, research by Jaimalai et al. (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e) aimed at improving medication adherence through health literacy promotion revealed that elderly participants who received a health literacy education program experienced significant improvements in medication adherence. The ability to comprehend health-related issues provides elderly individuals with a valuable perspective that can positively influence various health-related variables, including medication adherence. Consequently, the promotion of health literacy is emphasized as a critical criterion for enhancing all health variables in elderly individuals, particularly medication adherence.\u003c/p\u003e \u003cp\u003eSartori et al. conducted an educational intervention using WhatsApp to enhance medication adherence among individuals with hypertension and diabetes. Participants in the intervention group received training through images, educational video clips, and audio files, all aimed at improving medication adherence via the WhatsApp platform, while those in the control group received only standard care. Analysis of the findings revealed that 67.5% of participants in the intervention group achieved a high level of medication adherence, compared to 58.5% in the control group (P\u0026thinsp;=\u0026thinsp;0.07). Although the intervention did not produce statistically significant results, the intervention group showed an increase in medication adherence of more than ten percent compared to the control group (\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e). The findings of this study were not congruent with those of the present study, as the educational content provided did not result in a significant difference in medication adherence between the two groups. Although the training duration was identical in both studies, this discrepancy may be attributed to the lack of adaptation of the training package for the elderly individuals in the aforementioned study. In the present study, several considerations were made in the design of the video clips, including the use of very simple content to convey concepts and the incorporation of animation and motion graphics to capture the attention of the elderly and ensure effective communication.\u003c/p\u003e \u003cp\u003eHsieh et al. implemented a web-based program designed to increase medication adherence and quality of life as well as reduce readmissions among patients with atrial fibrillation. The intervention group received educational content emphasizing the importance of medication adherence and strategies for its improvement through digital and web-based platforms. The findings demonstrated a significant improvement in medication adherence and quality of life in the intervention group. Furthermore, the intervention group presented a significantly lower rate of readmission over a two-year period than did the control group (\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e). The study by Hsieh et al. is notable for its strengths, including the assessment of participants\u0026rsquo; quality of life and the two-year follow-up on readmissions, in contrast to the present study. Despite the differing follow-up durations in the two studies, the results were consistent. Both the web-based program by Hsieh et al. and the microlearning method employed in the present study effectively enhanced medication adherence among the participants.\u003c/p\u003e \u003cp\u003eIn another study, Uemura et al. proposed enhancing health literacy among elderly individuals by implementing an active learning approach (\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e). Elderly participants in the intervention group underwent training in nutrition, physical activity, exercise, and cognitive activities for 90 min per week over a 24-week period. This method involved in-person training sessions, during which participants reinforced their learning by actively performing and practicing skills. The findings of this study diverge from those of the present study. In the present study, educational content aimed at improving health literacy among elderly people was delivered through short videos. However, integrating this training with face-to-face sessions, as conducted by Uemura et al., might have clarified existing ambiguities and led to significant changes in participants. Enhancing health literacy requires increased interaction with older adults to endure changes in their respective domains. In addition, the economic background of individuals warrants consideration. In developing countries, such as Iran, citizens face substantial economic challenges. Possessing health literacy and knowledge alone may not yield the desired outcomes or practical applications. Elderly individuals may recognize the importance of considering the nutritional value of products; however, economic constraints hinder their ability to select high-quality options. It appears that knowledge alone is insufficient to achieve the desired outcomes, as multiple factors, particularly economic ones, may play a role. Furthermore, to effect changes in variables that have developed over the years, including health literacy, a more extended period may be necessary for the effects and changes to manifest. The eight-week duration of this study may have been inadequate to produce the anticipated changes in this age group.\u003c/p\u003e\n\u003ch3\u003eLimitations\u003c/h3\u003e\n\u003cp\u003eA notable limitation of this study is the paucity of specific research on the application of microlearning in education for elderly individuals. In the Discussion section, efforts were made to incorporate the findings of the study alongside interventions utilizing educational videos, digital methods, and applications to educate elderly individuals, thereby facilitating a comprehensive analysis and discussion in this domain. Future research should explore the use of microlearning as an innovative educational method for elderly individuals. Furthermore, if microlearning is employed in subsequent studies, it should be complemented by face-to-face education to address the needs of elderly individuals. Additionally, conducting a qualitative study on the factors influencing medication adherence and optimal health literacy in elderly individuals could elucidate challenges in this area.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eAs previously discussed, effective education for the elderly necessitates the adoption of novel and innovative pedagogical approaches. The microlearning method has emerged as a particularly effective strategy for conveying concepts to this demographic, potentially yielding favorable outcomes. Nonetheless, it is important to acknowledge that in certain instances, reliance on this method alone may prove insufficient to address the unique needs of elderly individuals. Given their specific conditions and limitations, it is advisable to integrate this educational approach with face-to-face and practical training to optimize the results. Iran is experiencing a rapid demographic shift toward an aging society. Consequently, addressing the needs of this population and anticipating future requirements are imperative. Enhancing health literacy and ensuring proper medication adherence among elderly individuals can mitigate potential adverse effects within this age group.\u003c/p\u003e\n\u003ch3\u003eApplication of Findings\u003c/h3\u003e\n\u003cp\u003eThe present study demonstrated that the microlearning method can substantially enhance medication adherence in the elderly population. Considering that a fundamental objective of the healthcare system is to mitigate rising costs and alleviate the economic burden imposed by various societal groups, enhancing medication adherence in elderly individuals through educational strategies such as microlearning can significantly reduce adverse outcomes and improve their quality of life. Furthermore, given that nurses are primarily responsible for overseeing the correct consumption of medication by patients, the implementation of tools such as the educational method employed in this study can decrease their workload, thereby increasing the accuracy of medication use among the elderly and preventing numerous human errors. The findings of this study can serve as a foundation for future interventions and research, with the potential to explore and ascertain the impact of microlearning methods on other health-related outcomes and monitor elderly individuals in diverse healthcare domains.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eSupplementary Information\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe researchers express their gratitude to the Research Vice-Chancellor of Baqiyatallah University of Medical Sciences, and the authors wish to thank all of the participants in this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eHP: design of the study, implementation of the study, drafting of the manuscript; STM: analysis and interpretation of the data, drafting of the manuscript; SQM: design of the study, analysis and interpretation of the data, drafting of the manuscript. JMN: designed the study, analyzed and interpreted the data, and drafted the manuscript. All the authors have read and approved the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research was approved and supported by Baqiyatallah University of Medical Sciences available at: www.bmus.ac.ir. The funder had no intervention in design, conduct, analysis, and reporting of trial.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll the data generated in this study are included in the manuscript. The datasets are available upon reasonable request from the corresponding author. Mrs. Jamileh Mokhtari Nouri is available for data and materials availability. The available e-mail address is [email protected].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was approved by the Ethics Committee of Baqiyatallah University of Medical Sciences (IR.BMSU.BAQ.REC.1403.003). It was also registered in the Iranian Registry of Clinical Trials (code: IRCT20191231045966N2) (10/04/2024). The participants were assured of data confidentiality, and informed written consent was obtained from them by researcher. Moreover, on the basis of research ethics principles, the educational video clips were subsequently made available to the control group at the end of the study. All methods were carried out in accordance with relevant guidelines and regulations.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe findings of this study will be disseminated through publication and made accessible to the public.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor details\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e1\u003c/sup\u003eStudent Research Committee, Baqiyatallah University of Medical Sciences, Tehran, Iran.\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e2\u003c/sup\u003eNursing Care Research Center, Clinical Sciences Institute, Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eMealy A, Sorensen J (2020) Effects of an aging population on hospital costs related to elective hip replacements. 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BMC Nurs 18(1):1\u0026ndash;9\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDelavar F, Pashaeypoor S, Negarandeh R (2020) The effects of self-management education tailored to health literacy on medication adherence and blood pressure control among elderly people with primary hypertension: A randomized controlled trial. Patient Educ Couns 103(2):336\u0026ndash;342\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003e[Available from: www.randomization.com\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMorisky DE, Ang A, Krousel-Wood M, Ward HJ (2008) Retracted: predictive validity of a medication adherence measure in an outpatient setting. J Clin Hypertens 10(5):348\u0026ndash;354\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKooshyar H, Shoorvazi M, Dalir Z, Hosseini M (2013) Health literacy and its relationship with medical adherence and health-related quality of life in diabetic community-residing elderly. 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BMC Public Health 22(1):1\u0026ndash;9\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYeung DL, Alvarez KS, Quinones ME, Clark CA, Oliver GH, Alvarez CA et al (2017) Low\u0026ndash;health literacy flashcards \u0026amp; mobile video reinforcement to improve medication adherence in patients on oral diabetes, heart failure, and hypertension medications. J Am Pharmacists Association 57(1):30\u0026ndash;37\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBabazadeh T, Ranjbaran S, Pourrazavi S, Latifi A, Maleki Chollou K (2024) Impact of health literacy and illness perception on medication adherence among older adults with hypertension in Iran: a cross-sectional study. Front Public Health 12:1347180\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMohsen MM, Abd El-Aal BG, Hassan SS, El-Abbassy AA (2021) Effect of Health Literacy Intervention on Medication Adherence among Older Adults with Chronic Diseases. Indian J Forensic Med Toxicol 15(4):1662\u0026ndash;1669\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSartori AC, Rodrigues Lucena TF, Lopes CT, Picinin Bernuci M, Yamaguchi MU (2020) Educational intervention using WhatsApp on medication adherence in hypertension and diabetes patients: a randomized clinical trial. Telemedicine e-Health 26(12):1526\u0026ndash;1532\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHsieh H-L, Kao C-W, Cheng S-M, Chang Y-C (2021) A web-based integrated management program for improving medication adherence and quality of life, and reducing readmission in patients with atrial fibrillation: randomized controlled trial. J Med Internet Res 23(9):e30107\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eUemura K, Yamada M, Okamoto H (2018) Effects of active learning on health literacy and behavior in older adults: a randomized controlled trial. J Am Geriatr Soc 66(9):1721\u0026ndash;1729\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Elderly, Microlearning, Medication adherence, Health literacy, Video clip","lastPublishedDoi":"10.21203/rs.3.rs-6752484/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6752484/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eThe global population is rapidly aging. Owing to their unique characteristics, older adults require innovative educational methods to optimize the effectiveness of behavioral change, and microlearning is a recent educational model. This study aimed to examine the impact of microlearning-based education on medication adherence and health literacy in the elderly population.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThis randomized controlled trial was conducted in 2024, with a trial registration number of (IRCT20191231045966N2) (10/04/2024). A total of 118 elderly participants were selected on the basis of the inclusion criteria and allocated to the intervention and control groups via the block randomization method. The data collection tools included demographic questionnaires, the Morisky medication adherence scale and the health literacy scale. The intervention group received video clips designed via the microlearning method, whereas the control group received standard interventions. The participants completed the aforementioned questionnaires at baseline and after 8 weeks. The collected data were entered into SPSS software version 22 and analyzed via descriptive (frequency, percentage, mean, standard deviation) and inferential (chi-square, Fisher\u0026rsquo;s exact test, independent t test) statistics.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eNo significant differences were found between the intervention and control groups in terms of age, sex, marital status, education level, income status, type of disease, method of obtaining medication information, medication adherence level, or health literacy before the intervention, confirming homogeneity. The post intervention results revealed a significant difference in the mean medication adherence score between the intervention group (6.71\u0026thinsp;\u0026plusmn;\u0026thinsp;1.78) and the control group (5.66\u0026thinsp;\u0026plusmn;\u0026thinsp;2.10) (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001), indicating a greater level of medication adherence in the intervention group. However, in the health literacy domain, despite an increase in the mean health literacy score in the intervention group (66.96\u0026thinsp;\u0026plusmn;\u0026thinsp;14.41) compared with that in the control group (63.03\u0026thinsp;\u0026plusmn;\u0026thinsp;15.74), no statistically significant difference was observed between the two groups (P\u0026thinsp;=\u0026thinsp;.498).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThe microlearning training method is an effective educational approach for enhancing medication adherence in older adults. Proper medication use is likely to improve disease management and ensure a better quality of life for older adults. Therefore, the implementation of this educational method to increase health-related variables for this group is recommended.\u003c/p\u003e","manuscriptTitle":"The Effectiveness of Microlearning-Based Education on Medication Adherence and Health Literacy in Elderly Individuals: A Controlled Trial Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-06-09 11:22:07","doi":"10.21203/rs.3.rs-6752484/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"dd8cec57-cce3-4da4-8606-1b600f10a2c6","owner":[],"postedDate":"June 9th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-08-28T13:53:27+00:00","versionOfRecord":[],"versionCreatedAt":"2025-06-09 11:22:07","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6752484","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6752484","identity":"rs-6752484","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}