Health Literacy for Prevention of Ischemic Heart Disease and Stroke in Thailand.

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Isaree Padphai, Wanida Sripromsa This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6174434/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 Ischemic heart disease (IHD) and Stroke is the leading cause of disability worldwide and the second leading cause of death. The experimental research was used in this research. The purposes of this study aimed to determine the effect of a health literacy (HL) intervention for the prevention of IHD and stroke among at-risk populations. This research employed an experimental pretest and posttest design, and participants were divided into an experimental group and a control group, each with thirty persons. The experimental group was provided by a researcher with a health literacy intervention, while the control group was given only normal activities. The data were collected through questionnaires during September–November 2024. The data were analyzed through a comparison of the means with analysis of covariance and a presentation of mean differences and 95% CI. The results showed that the experimental group had higher mean scores of HL than the control group at a significance level of 0.05. Health Economics & Outcomes Research Health literacy At-Risk Populations Ischemic Heart Disease Stroke Disease Intervention Figures Figure 1 1. INTRODUCTION The world’s biggest killer is ischemic heart disease and Stroke is a leading cause of death and disability. Among the top 10 causes of death, ischemic heart disease was found to be the number 1 cause of death, responsible for 13% of the world’s total deaths. Since 2000, the largest increase in deaths has been for this disease, rising by 2.7 million to 9.1 million deaths in 2021. COVID-19 is the second leading causes of death, stroke became the third in 2021, responsible for approximately 10% of total deaths, respectively. [ 1 ]. Cardiovascular disease (CVD), principally myocardial infarction (MI) and stroke, is the leading clinical and public health problem and is rapidly becoming so worldwide. Their primary prevention is promising, in theory, but difficult to achieve in practice. The principal modalities that have demonstrated efficacy include therapeutic lifestyle changes (TLCs) and adjunctive drug therapies under the guidance of the health-care provider and tailored to the individual patient. The prevention and treatment of the pandemic of overweight and obesity and lack of regular physical activity. prevention and treatment of hypertension, avoidance and cessation of cigarette smoking, adoption and maintenance of a healthy diet, and avoidance of heavy alcohol consumption all have proven benefits in decreasing the risks of a first MI and stroke. [ 2 ]. Most cardiovascular diseases can be prevented by addressing behavioural and environmental risk factors such as tobacco use, unhealthy diet and obesity, physical inactivity, harmful use of alcohol and air pollution. It is important to detect cardiovascular disease as early as possible so that management with counselling and medicines can begin. [ 3 ]. As stated above, myocardial infarction is closely associated with coronary artery disease. Risk factors for coronary artery disease: Smoking, Abnormal lipid profile/blood apolipoprotein, Hypertension, Diabetes mellitus, Abdominal obesity, Psychosocial factors such as depression, Lack of daily consumption of fruits or vegetables, Lack of physical activity, Alcohol consumption. Some non-modifiable risk factors for myocardial infarction include advanced age, male gender, genetics .[4] Stroke is the leading cause of disability worldwide and the second leading cause of death. The Global Stroke Factsheet released in 2022 reveals that lifetime risk of developing a stroke has increased by 50% over the last 17 years and now 1 in 4 people is estimated to have a stroke in their lifetime. This disproportionate burden experienced by lower and lower-middle income countries has posed an unprecedented problem to families with less resources. [5], [6]. The Global Burden of Disease (GBD) study revealed that ischemic heart disease (IHD) is the leading cause of CVD death worldwide, including in Thailand. [7]. Stroke is the second leading cause of death and disability worldwide. Hypertension is the most important modifiable risk factor for stroke overall. Non-modifiable risk factors : Age Sex Ethnicity Genetics and Modifiable risk factors: Hypertension Diabetes mellitus Cardiac factors Smoking Hyperlipidaemia Alcohol consumption and substance abuse Obesity and sedentary behaviour Inflammation. [8]. Stroke is a major health burden in Thailand. It is the leading cause of death and long term disability in both men and women. The mortality rate of stroke is still increasing during the past 5 years. The incidence of stroke in Thailand is now being studied in a large population based cohort. The prevalence of stroke is estimated to be 1.88% among adults 45 years and older. Stroke is more prevalent in men than in women and the mean age of stroke onset is 65 years. Hypertension, diabetes, dyslipidemia, metabolic syndrome, and atrial fibrillation are major risk factors of stroke in the Thai population. [9]. In order to develop guidelines for health promotion in the prevention of ischemic heart disease and stroke, the researcher is interested in studying effect of health literacy intervention for at-risk populations in Thailand. 2. METHOD The study design is experimental research, dividing the sample into 2 groups, namely the experimental group and the control group. Data were collected using questionnaires from September to December 2024. Sample size was calculated using a formula comparing the difference in means of two independent populations by Hemming et al. (2011) 10 There were experimental groups and a control group of 30 people each, totaling 60 people. Descriptive statistics by mean, standard deviation. Analysis of covariance: (ANCOVA) by mean difference and 95% CI. Controlling confounding variables by taking herbal. The project of the health literacy intervention includes: Providing knowledge using a handbook, brochures, Line programs, YouTube and follow-up results for the prevention of ischemic heart disease and stroke. Inclusion criteria At-risk populations of ischemic heart disease and stroke (diabetic patients uncontrollable HbA1c ≥ 7 and hypertensive patients uncontrollable blood pressure ≥ 140/90 mmhg) [ 11 ]. [ 12 ]. with poor cholesterol: high-density lipoprotein (HDL), and low-density lipoprotein (LDL) (HDL 100). [ 13 ], [ 14 ]. Research ethics This research protocol has been reviewed by the Boromarajonani College of Nursing Udon Thani. Institutional Review Board (BCNU.IRB). The ethical number was 16/2567 granted on March 20 th, 2024. 3. RESULTS AND DISCUSSION 3.1 General information The results of the study consisted of the experimental group, which totaled 30 samples. mostly female, 80%, age ≥ 45 years 60%, body mass index overweight 50%, dual family status 63.33%, education level secondary school 70%, disease diabetes mellitus 80%, disease High blood pressure 50%, non-smoking 80%, Do not drink alcoholic beverages 73.33%, do not use nonsteroidal anti-inflammatory drugs 100% and do not use herbal medicine 66.66%. The results of the control group had 30 samples. mostly female, 83.33%, age ≥ 45 years 66.66%, body mass index overweight 53.33%, dual family status 66.66%, education level secondary school 70%, disease diabetes mellitus 86.66%, disease High blood pressure 56.66%, non-smoking 83.33%, Do not drink alcoholic beverages 76.66%, do not use nonsteroidal anti-inflammatory drugs 96.67% and do not use herbal medicine 70%. 3.3 Health literacy before the experiment, it was found that both the experimental and control groups had average health literacy scores for the prevention of ischemic heart disease and stroke. There is no statistical significant difference at the 0.05 level. After the experiment, the experimental group had significantly higher average health literacy scores for the prevention of ischemic heart disease and stroke than the control group at the 0.05 level. in Table 1 Table 1 Health literacy level (experimental group = 30, control group = 30) Magnitude of effect pretest posttest Mean difference p-value Within group, (95%CI) 1. Access skill (Max = 25) Intervention (Mean, S.D.) 15.34 (4.51) 22.33 (2.69) 6.99 (4.58 to 7.38) < 0.001 Control (Mean, S.D.) 15.55 (4.38) 15.83 (4.14) 0.28 (0.18 to 0.42) 0.901 Mean difference Between groups, (95%CI) 0.21 (-1.15 to 2.13) 6.5 (3.75 to 6.59) p-value 0.520 < 0.001 Adjusted mean difference 5.78 95%CI 3.35 to 6.33 P-value < 0.001 2. Understand skill (Max = 10) Intervention (Mean, S.D.) 4.42 (1.76) 9.28 (0.84) 4.86 (3.57 to 5.05) < 0.001 Control (Mean, S.D.) 4.39 (1.57) 4.88 (1.51) 0.49 (0.21 to 0.58) 0.432 Mean difference Between groups, (95%CI) 0.03 (0.60 to 0.53) 4.40 (3.55 to 4.85) p-value 0.711 < 0.001 Adjusted mean difference 4.96 95%CI 3.95 to 5.56 P-value < 0.001 3. Appraise skill (Max = 25) Intervention (Mean, S.D.) 14.03 (4.33) 21.18 (3.75) 7.15 (5.16 to 7.89) < 0.001 Control (Mean, S.D.) 14.46 (4.01) 15.00 (4.10) 0.54 (-0.38 to 0.63) 0.903 Mean difference Between groups, (95%CI) 0.43 (-1.6 to 1.42) 6.18 (5.13 to 7.02) p-value 0.803 < 0.001 Adjusted mean difference 5.73 95%CI 4.06 to 7.11 P-value < 0.001 4. Apply skill (Max = 50) Intervention (Mean, S.D.) 30.11 (8.12) 42.08 (7.22) 11.97(8.56to 12.87) < 0.001 Control (Mean, S.D.) 30.16 (9.05) 31.00 (8.08) 0.16 (-0.57 to 0.67) 0.055 Mean difference Between groups, (95%CI) 0.05 (-1.21 to 1.51) 11.08 (8.12 to 12.96) p-value 0.576 < 0.001 Adjusted mean difference 8.67 95%CI 6.82 to 10.81 P-value < 0.001 3.4 Results of Blood Pressure HDL and LDL, There was no difference and no statistical significance at the level p ≤ 0.05 Table 2 HbA1c level (experimental group = 30, control group = 30) Magnitude of effect Pre experimental Post experimental Mean difference Within group, (95%CI) p-value 1. HbA1c) mg% Intervention (Mean, S.D.) 8.07 (0.15) 7.55 (0.68) 0.52 (0.68 to 0.94) 0.053 Control (Mean, S.D.) 8.16 (0.13) 8.22 (0.20) 0.16 (0.01 to 0.54) 0.066 Mean difference Between groups, (95%CI) 0.09 (0.75 to 0.95) 0.67 (0.54 to 1.44) p-value 0.182 0.037 Adjusted mean difference Between groups, (95%CI) 0.86 (0.70 to 0.92) p-value 0.567 3.5 Discussion The project of the health literacy promotion program includes providing knowledge using a handbook, brochures, Line programs, YouTube, and follow-up results for the prevention of ischemic heart disease and stroke. It is a guideline for promoting health through the application of integrated knowledge media. Taking into account the target group as the main focus. There is a form of providing knowledge through brochures. The results of the study found that after the experiment, the experimental group had an average score of health literacy for the prevention of ischemic heart disease and stroke. significantly more than the control group at the 0.05 level, consistent with studies that found Health literacy improved significantly after the intervention, increasing from a problematic level to a sufficient level, arising from health literacy as a social determinant of the basic health of populations. [ 15 ]. This is consistent with studies that found that following the health literacy enhancement program, the experimental group had a significantly higher score in CKD knowledge. [ 16 ]. consistent with education, the experimental group, which received the integrated health literacy and self-management model, led care for 6 months. The mean score of self-management behaviors in the experimental group increased compared with the control group. [ 17 ]. This is consistent with studies that found that the results indicated that participants in the intervention group with uncontrolled hypertension had significantly higher health literacy mean scores than those in the control group at immediately post-intervention and during the follow-up period. [ 18 ]. After the intervention and follow-up, the experimental group had the following mean scores: health literacy, self-care behaviors in healthy eating, and physical activities, all of which were significantly higher than the control group. [ 19 ]. This study The researcher has developed a handbook and brochures that are innovations created by the researcher. Using the Line application It is a communication program for smartphones. To say hello in line group activities and stimulate interest for the prevention of ischemic heart disease and stroke. By studying the results of using the program to promote health literacy according to the learning concept. For change through social media for patients with high blood pressure/diabetes. The results showed that the program that included stimulating interest in changing health behaviors had a better mean health literacy score for the experimental group than before the experiment using an independent t-test. (paired t-test) and ANCOVA Statistically significant at the .05 level, consistent with studies that found the use of health literacy intervention can suggest that this intervention may potentially improve diabetes self-management and prevention behaviors. [ 20 ]. [24–25]. Can appear Patients with limited health literacy may not have the requisite skills to effectively interact with the health system. [ 21 ]. Knowledge scores and health behaviors improved following both interventions. [ 22 ], [23]. Results of HDL and LDL examination in the experimental group found that HDL levels increased in 5 samples, and LDL levels decreased in 5 samples.This may be due to insufficient time. Together with the limitations of the period of research, therefore, it is still found that the levels of good and bad fats have not changed much. 4. CONCLUSION The results of this research indicate that the results of the intervention can improve the prevention behavior of ischemic heart disease and stroke in patients and especially developing health literacy. This helps reduce the disease burden of patients in Thailand. Declarations ACKNOWLEDGEMENTS The authors would like to thank the patients among type2 diabetic patients and hypertension patients who participated in this study. And this study was funded by the Fundamental Fund Science, research and innovation. fiscal year 2024. References The top 10 causes of death, “World Health Organization” [Online]. Available: https://www.who.int/news-room/fact-sheets/detail/the-top-10-causes-of-death (accessed Oct 11, 2023) M. Caldwell, L. Martinez, J. G. Foster, D. Sherling, and C. H. 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Poza-Méndez. “Effect of an mHealth Intervention to Improve Health Literacy in Immigrant Populations A Quasi-experimental Study” CIN: Computers,Informatics, Nursing vol. 37, no3, pp 142-150, Mar 2019 doi: 10.1097/CIN.0000000000000497. P. Inthaphalan, J. Lininger, and S. Terathongkum. “The effectiveness of a health literacy enhancement program on knowledge, self-management behaviors, and clinical outcomes in people with chronic kidney disease: A quasi-experimental study in Thailand” Belitung Nursing Journal, vol. 10 no.6 pp.635-643 Nov 2024. doi: 10.33546/bnj.3519 S. Visanuyothin, “EFFECTIVENESS OF INTEGRATED HEALTH LITERACY AND SELF-MANAGEMENT MODEL FOR HYPERTENSION CONTROL IN URBAN COMMUNITY, NAKHONRATCHASIMA PROVINCE, THAILAND” Chulalongkorn University Theses and Dissertations (Chula ETD) Doi : 10.58837/CHULA.THE.2017.499 [Online]. https://digital.car.chula.ac.th/chulaetd/989/ (accessed Dec 10, 2024) N. Janchai, W. Deoisres, and N. Chaimongkol, “A Improving Health Literacy using the Health Education and Health Empowerment Program in Thai Adults with Uncontrolled Hypertension: A Randomized Controlled Trial” Pacific Rim International Journal of Nursing Research, vol. 25 no.4. pp.600-613. October-December, 2021. P. Kakahthum, S. Lagampan, & K. Amnartsatsue, “Effects of health literacy improvement program on self-care behaviors and health outcomes in older adults with type 2 diabetes and hypertension comorbidi-ties.” Journal of Public Health and Development, vol.20. no.2. pp 32-42. doi:10.55131/jphd/2022/200203 K. Seangpraw, P. Ong-Artborirak, S. Boonyathee, S. Bootsikeaw, S. Kantow, P. Panta, & P. Winaiprasert, (2023). Effect of health literacy intervention on glycemic control and renal function among Thai older adults at risk of type 2 diabetes mellitus. Clinical Interventions in Aging, pp.1465-1476. September 2023. R.J. Jacobs, J.Q. Lou, R.L. Ownby, & J. Caballero. (2016). A systematic review of eHealth interventions to improve health literacy. Health informatics journal, Vol.22 No.2. pp.81-98. June 2014. doi.org/10.1177/146045821453409 M. H .Eckman, R.Wise, A. C Leonard, E. Dixon, C.Burrows, F. Khan, & E. Warm. (2012). Impact of health literacy on outcomes and effectiveness of an educational intervention in patients with chronic diseases. Patient education and counseling. Vol. 87 No.2. pp.143-151. May 2012. doi.org/10.1016/j.pec.2011.07.020 M. H. Larsen, A.M. Mengshoel, M. H Andersen, C. R Borge, B. Ahlsen, K.G.Dahl. & A.K. Wahl. (2022). “A bit of everything”: Health literacy interventions in chronic conditions–a systematic review. Patient education and counseling, Vol.105 No10. pp.2999-3016.October 2022. doi.org/10.1016/j.pec.2022.05.008 S.C. Bailey, A.G.Brega, T. M Crutchfield, T. Elasy, H. Herr, K. Kaphingst, & D. Schillinger. (2014). “Update on health literacy and diabetes.” The Diabetes Educator, Vol. 40 No.5 pp. 581-604. June 2014. doi.org/10.1177/0145721714540220 S. H Kim. & A. Lee. “Health‐literacy‐sensitive diabetes self‐management interventions: a systematic review and meta‐analysis.” (2016) Worldviews on Evidence‐Based Nursing, Vol 13. No.4, 324-333. April 2016. doi.org/10.1111/wvn.12157 Additional Declarations The authors declare no competing interests. Supplementary Files BIOGRAPHIESOFAUTHORS.docx 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. We do this by developing innovative software and high quality services for the global research community. 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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-6174434","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":425346153,"identity":"5fd0afbd-5761-452c-940e-68fcac08fae3","order_by":0,"name":"Isaree Padphai","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA3klEQVRIiWNgGAWjYBACCSjN2A9hScgQr2XmDAbGBiCfh3gtG26AtTAQ1iLZfvjw64qaO7Kbbzcff3SjxoKHgf3w0Q34tEjzpKVZnjn2zHjbnWOJzTnHgA4DitzAp0WOIcfMsIHtcOK2GzmGzTlsQC0SPGb4tfC/AWr5dzhx8wyQln9EaJGWyDF+2Nh2OHGDBFBLbhsRWiRnPEtjbOw7bDzjRlri7Nw+CR42Qn6ROJ98+GPDt8Oy/TOSD3zO+VYnx89++BheLUDAJoHKJaAcBJg/EKFoFIyCUTAKRjIAAM8CS+75fwQvAAAAAElFTkSuQmCC","orcid":"https://orcid.org/0000-0003-2182-2620","institution":"Public Health Department, Sirindhorn College of Public Health, Khon Kaen, Thailand","correspondingAuthor":true,"prefix":"","firstName":"Isaree","middleName":"","lastName":"Padphai","suffix":""},{"id":425346154,"identity":"f97acfdd-6a3d-41b2-8eb9-9f378edc8865","order_by":1,"name":"Wanida Sripromsa","email":"","orcid":"https://orcid.org/0009-0009-1903-6357","institution":"Community Nursing Department, Faculty of Nursing","correspondingAuthor":false,"prefix":"","firstName":"Wanida","middleName":"","lastName":"Sripromsa","suffix":""}],"badges":[],"createdAt":"2025-03-07 02:58:56","currentVersionCode":1,"declarations":{"humanSubjects":true,"vertebrateSubjects":false,"conflictsOfInterestStatement":false,"humanSubjectEthicalGuidelines":true,"humanSubjectConsent":true,"humanSubjectClinicalTrial":false,"humanSubjectCaseReport":false,"vertebrateSubjectEthicalGuidelines":false},"doi":"10.21203/rs.3.rs-6174434/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6174434/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":78226151,"identity":"f408acd6-588d-45a0-8bc9-4e8eef3b37ea","added_by":"auto","created_at":"2025-03-11 06:57:39","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":34904,"visible":true,"origin":"","legend":"\u003cp\u003eCONSORT diagram\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-6174434/v1/553718c6d9cad3e5d577ac5b.png"},{"id":78230776,"identity":"d424a3ae-601b-431f-8c65-0e0145c7e393","added_by":"auto","created_at":"2025-03-11 07:29:44","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":582312,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6174434/v1/a4801e1d-2854-44ce-bbf4-fab7847af041.pdf"},{"id":78226158,"identity":"45cc09ef-9cb1-4402-88a6-775f5d132d2f","added_by":"auto","created_at":"2025-03-11 06:57:40","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":213207,"visible":true,"origin":"","legend":"","description":"","filename":"BIOGRAPHIESOFAUTHORS.docx","url":"https://assets-eu.researchsquare.com/files/rs-6174434/v1/50118e553d3ca476dbc3e669.docx"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"\u003cp\u003e\u003cstrong\u003eHealth Literacy for Prevention of Ischemic Heart Disease\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eand Stroke in Thailand.\u003c/strong\u003e\u003c/p\u003e","fulltext":[{"header":"1. INTRODUCTION","content":"\u003cp\u003eThe world\u0026rsquo;s biggest killer is ischemic heart disease and Stroke is a leading cause of death and disability. Among the top 10 causes of death, ischemic heart disease was found to be the number 1 cause of death, responsible for 13% of the world\u0026rsquo;s total deaths. Since 2000, the largest increase in deaths has been for this disease, rising by 2.7\u0026nbsp;million to 9.1\u0026nbsp;million deaths in 2021. COVID-19 is the second leading causes of death, stroke became the third in 2021, responsible for approximately 10% of total deaths, respectively. [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eCardiovascular disease (CVD), principally myocardial infarction (MI) and stroke, is the leading clinical and public health problem and is rapidly becoming so worldwide. Their primary prevention is promising, in theory, but difficult to achieve in practice. The principal modalities that have demonstrated efficacy include therapeutic lifestyle changes (TLCs) and adjunctive drug therapies under the guidance of the health-care provider and tailored to the individual patient. The prevention and treatment of the pandemic of overweight and obesity and lack of regular physical activity. prevention and treatment of hypertension, avoidance and cessation of cigarette smoking, adoption and maintenance of a healthy diet, and avoidance of heavy alcohol consumption all have proven benefits in decreasing the risks of a first MI and stroke. [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eMost cardiovascular diseases can be prevented by addressing behavioural and environmental risk factors such as tobacco use, unhealthy diet and obesity, physical inactivity, harmful use of alcohol and air pollution. It is important to detect cardiovascular disease as early as possible so that management with counselling and medicines can begin. [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. As stated above, myocardial infarction is closely associated with coronary artery disease. Risk factors for coronary artery disease: Smoking, Abnormal lipid profile/blood apolipoprotein, Hypertension, Diabetes mellitus, Abdominal obesity, Psychosocial factors such as depression, Lack of daily consumption of fruits or vegetables, Lack of physical activity, Alcohol consumption. Some non-modifiable risk factors for myocardial infarction include advanced age, male gender, genetics .[4]\u003c/p\u003e \u003cp\u003eStroke is the leading cause of disability worldwide and the second leading cause of death. The Global Stroke Factsheet released in 2022 reveals that lifetime risk of developing a stroke has increased by 50% over the last 17 years and now 1 in 4 people is estimated to have a stroke in their lifetime. This disproportionate burden experienced by lower and lower-middle income countries has posed an unprecedented problem to families with less resources. [5], [6]. The Global Burden of Disease (GBD) study revealed that ischemic heart disease (IHD) is the leading cause of CVD death worldwide, including in Thailand. [7].\u003c/p\u003e \u003cp\u003eStroke is the second leading cause of death and disability worldwide. Hypertension is the most important modifiable risk factor for stroke overall. Non-modifiable risk factors : Age Sex Ethnicity Genetics and Modifiable risk factors: Hypertension Diabetes mellitus Cardiac factors Smoking Hyperlipidaemia Alcohol consumption and substance abuse Obesity and sedentary behaviour Inflammation. [8]. Stroke is a major health burden in Thailand. It is the leading cause of death and long term disability in both men and women. The mortality rate of stroke is still increasing during the past 5 years. The incidence of stroke in Thailand is now being studied in a large population based cohort. The prevalence of stroke is estimated to be 1.88% among adults 45 years and older. Stroke is more prevalent in men than in women and the mean age of stroke onset is 65 years. Hypertension, diabetes, dyslipidemia, metabolic syndrome, and atrial fibrillation are major risk factors of stroke in the Thai population. [9].\u003c/p\u003e \u003cp\u003e In order to develop guidelines for health promotion in the prevention of ischemic heart disease and stroke, the researcher is interested in studying effect of health literacy intervention for at-risk populations in Thailand.\u003c/p\u003e"},{"header":"2. METHOD","content":"\u003cp\u003eThe study design is experimental research, dividing the sample into 2 groups, namely the experimental group and the control group. Data were collected using questionnaires from September to December 2024.\u003c/p\u003e \u003cp\u003eSample size was calculated using a formula comparing the difference in means of two independent populations by Hemming et al. (2011)\u003csup\u003e10\u003c/sup\u003e There were experimental groups and a control group of 30 people each, totaling 60 people. Descriptive statistics by mean, standard deviation. Analysis of covariance: (ANCOVA) by mean difference and 95% CI. Controlling confounding variables by taking herbal.\u003c/p\u003e \u003cp\u003eThe project of the health literacy intervention includes: Providing knowledge using a handbook, brochures, Line programs, YouTube and follow-up results for the prevention of ischemic heart disease and stroke.\u003c/p\u003e \u003cp\u003e \u003cb\u003eInclusion criteria\u003c/b\u003e \u003c/p\u003e \u003cp\u003eAt-risk populations of ischemic heart disease and stroke (diabetic patients uncontrollable HbA1c\u0026thinsp;\u0026ge;\u0026thinsp;7 and hypertensive patients uncontrollable blood pressure\u0026thinsp;\u0026ge;\u0026thinsp;140/90 mmhg) [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. with poor cholesterol: high-density lipoprotein (HDL), and low-density lipoprotein (LDL) (HDL\u0026thinsp;\u0026lt;\u0026thinsp;50 mg/dl., and LDL\u0026thinsp;\u0026gt;\u0026thinsp;100). [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e13\u003c/span\u003e], [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e Research ethics This research protocol has been reviewed by the Boromarajonani College of Nursing Udon Thani. Institutional Review Board (BCNU.IRB). The ethical number was 16/2567 granted on March 20 th, 2024.\u003c/p\u003e "},{"header":"3. RESULTS AND DISCUSSION","content":"\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e3.1 General information\u003c/h2\u003e \u003cp\u003eThe results of the study consisted of the experimental group, which totaled 30 samples. mostly female, 80%, age\u0026thinsp;\u0026ge;\u0026thinsp;45 years 60%, body mass index overweight 50%, dual family status 63.33%, education level secondary school 70%, disease diabetes mellitus 80%, disease High blood pressure 50%, non-smoking 80%, Do not drink alcoholic beverages 73.33%, do not use nonsteroidal anti-inflammatory drugs 100% and do not use herbal medicine 66.66%.\u003c/p\u003e \u003cp\u003eThe results of the control group had 30 samples. mostly female, 83.33%, age\u0026thinsp;\u0026ge;\u0026thinsp;45 years 66.66%, body mass index overweight 53.33%, dual family status 66.66%, education level secondary school 70%, disease diabetes mellitus 86.66%, disease High blood pressure 56.66%, non-smoking 83.33%, Do not drink alcoholic beverages 76.66%, do not use nonsteroidal anti-inflammatory drugs 96.67% and do not use herbal medicine 70%.\u003c/p\u003e \u003cp\u003e \u003cb\u003e3.3 Health literacy\u003c/b\u003e before the experiment, it was found that both the experimental and control groups had average health literacy scores for the prevention of ischemic heart disease and stroke. There is no statistical significant difference at the 0.05 level. After the experiment, the experimental group had significantly higher average health literacy scores for the prevention of ischemic heart disease and stroke than the control group at the 0.05 level. in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e\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\u003eHealth literacy level (experimental group\u0026thinsp;=\u0026thinsp;30, control group\u0026thinsp;=\u0026thinsp;30)\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\u003eMagnitude of effect\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003epretest\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" morerows=\"1\" nameend=\"c4\" namest=\"c3\" rowspan=\"2\"\u003e \u003cp\u003eposttest\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eMean difference\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eWithin group, (95%CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003e1. Access skill (Max\u0026thinsp;=\u0026thinsp;25)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntervention (Mean, S.D.)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15.34 (4.51)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e22.33 (2.69)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6.99 (4.58 to 7.38)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eControl (Mean, S.D.)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15.55 (4.38)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e15.83 (4.14)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.28 (0.18 to 0.42)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.901\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMean difference\u003c/p\u003e \u003cp\u003eBetween groups, (95%CI)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.21\u003c/p\u003e \u003cp\u003e(-1.15 to 2.13)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e6.5 (3.75 to 6.59)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.520\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAdjusted mean difference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e5.78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e95%CI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e3.35 to 6.33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e2. Understand skill (Max\u0026thinsp;=\u0026thinsp;10)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntervention (Mean, S.D.)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e4.42 (1.76)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9.28 (0.84)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4.86 (3.57 to 5.05)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eControl (Mean, S.D.)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e4.39 (1.57)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.88 (1.51)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.49 (0.21 to 0.58)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.432\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMean difference\u003c/p\u003e \u003cp\u003eBetween groups, (95%CI)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e0.03\u003c/p\u003e \u003cp\u003e(0.60 to 0.53)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.40\u003c/p\u003e \u003cp\u003e(3.55 to 4.85)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e0.711\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAdjusted mean difference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e4.96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e95%CI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e3.95 to 5.56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003e3. Appraise skill (Max\u0026thinsp;=\u0026thinsp;25)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntervention (Mean, S.D.)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e14.03 (4.33)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21.18 (3.75)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7.15 (5.16 to 7.89)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eControl (Mean, S.D.)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e14.46 (4.01)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15.00 (4.10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.54 (-0.38 to 0.63)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.903\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMean difference\u003c/p\u003e \u003cp\u003eBetween groups, (95%CI)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e0.43 (-1.6 to 1.42)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6.18 (5.13 to 7.02)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e0.803\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAdjusted mean difference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e5.73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e95%CI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e4.06 to 7.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e4. Apply skill (Max\u0026thinsp;=\u0026thinsp;50)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntervention (Mean, S.D.)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e30.11 (8.12)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e42.08 (7.22)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e11.97(8.56to 12.87)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eControl (Mean, S.D.)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e30.16 (9.05)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e31.00 (8.08)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.16 (-0.57 to 0.67)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.055\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMean difference\u003c/p\u003e \u003cp\u003eBetween groups, (95%CI)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e0.05\u003c/p\u003e \u003cp\u003e(-1.21 to 1.51)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11.08 (8.12 to 12.96)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e0.576\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAdjusted mean difference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e8.67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e95%CI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e6.82 to 10.81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e3.4 Results of Blood Pressure HDL and LDL, There was no difference and no statistical significance at the level p\u0026thinsp;\u0026le;\u0026thinsp;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\u003eHbA1c level (experimental group\u0026thinsp;=\u0026thinsp;30, control group\u0026thinsp;=\u0026thinsp;30)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\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 \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMagnitude of effect\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003ePre experimental\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePost experimental\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003eMean difference\u003c/p\u003e \u003cp\u003eWithin group, (95%CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003e1. HbA1c) mg%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003eIntervention (Mean, S.D.) 8.07 (0.15) 7.55 (0.68)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.52 (0.68 to 0.94)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.053\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003eControl (Mean, S.D.) 8.16 (0.13) 8.22 (0.20)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.16 (0.01 to 0.54)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.066\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eMean difference\u003c/p\u003e \u003cp\u003eBetween groups, (95%CI)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003e0.09 (0.75 to 0.95) 0.67 (0.54 to 1.44)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003e0.182 0.037\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eAdjusted mean difference\u003c/p\u003e \u003cp\u003eBetween groups, (95%CI)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003e0.86 (0.70 to 0.92)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003e0.567\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e3.5 \u003cb\u003eDiscussion\u003c/b\u003e\u003c/h2\u003e \u003cp\u003eThe project of the health literacy promotion program includes providing knowledge using a handbook, brochures, Line programs, YouTube, and follow-up results for the prevention of ischemic heart disease and stroke. It is a guideline for promoting health through the application of integrated knowledge media. Taking into account the target group as the main focus. There is a form of providing knowledge through brochures. The results of the study found that after the experiment, the experimental group had an average score of health literacy for the prevention of ischemic heart disease and stroke. significantly more than the control group at the 0.05 level, consistent with studies that found Health literacy improved significantly after the intervention, increasing from a problematic level to a sufficient level, arising from health literacy as a social determinant of the basic health of populations. [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. This is consistent with studies that found that following the health literacy enhancement program, the experimental group had a significantly higher score in CKD knowledge. [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. consistent with education, the experimental group, which received the integrated health literacy and self-management model, led care for 6 months. The mean score of self-management behaviors in the experimental group increased compared with the control group. [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. This is consistent with studies that found that the results indicated that participants in the intervention group with uncontrolled hypertension had significantly higher health literacy mean scores than those in the control group at immediately post-intervention and during the follow-up period. [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. After the intervention and follow-up, the experimental group had the following mean scores: health literacy, self-care behaviors in healthy eating, and physical activities, all of which were significantly higher than the control group. [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. This study The researcher has developed a handbook and brochures that are innovations created by the researcher. Using the Line application It is a communication program for smartphones. To say hello in line group activities and stimulate interest for the prevention of ischemic heart disease and stroke. By studying the results of using the program to promote health literacy according to the learning concept. For change through social media for patients with high blood pressure/diabetes. The results showed that the program that included stimulating interest in changing health behaviors had a better mean health literacy score for the experimental group than before the experiment using an independent t-test. (paired t-test) and ANCOVA Statistically significant at the .05 level, consistent with studies that found the use of health literacy intervention can suggest that this intervention may potentially improve diabetes self-management and prevention behaviors. [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. [24\u0026ndash;25]. Can appear Patients with limited health literacy may not have the requisite skills to effectively interact with the health system. [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Knowledge scores and health behaviors improved following both interventions. [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e22\u003c/span\u003e], [23]. Results of HDL and LDL examination in the experimental group found that HDL levels increased in 5 samples, and LDL levels decreased in 5 samples.This may be due to insufficient time. Together with the limitations of the period of research, therefore, it is still found that the levels of good and bad fats have not changed much.\u003c/p\u003e \u003c/div\u003e"},{"header":"4. CONCLUSION","content":"\u003cp\u003eThe results of this research indicate that the results of the intervention can improve the prevention behavior of ischemic heart disease and stroke in patients and especially developing health literacy. This helps reduce the disease burden of patients in Thailand.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eACKNOWLEDGEMENTS\u003c/h2\u003e \u003cp\u003eThe authors would like to thank the patients among type2 diabetic patients and hypertension patients who participated in this study. And this study was funded by the Fundamental Fund Science, research and innovation. fiscal year 2024.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eThe top 10 causes of death, \u0026ldquo;World Health Organization\u0026rdquo; [Online]. Available: https://www.who.int/news-room/fact-sheets/detail/the-top-10-causes-of-death (accessed Oct 11, 2023)\u003c/li\u003e\n \u003cli\u003eM. Caldwell, L. Martinez, J. G. Foster, D. Sherling, and C. H. Hennekens. \u0026ldquo;Prospects for the primary prevention of myocardial infarction and stroke\u0026rdquo; Journal of cardiovascular pharmacology and therapeutics, vol.24, no.3, pp. 207-214, 2019, doi: 10.1177/1074248418817344. Epub 2018 Dec 18.\u003c/li\u003e\n \u003cli\u003eCardiovascular diseases (CVDs) \u0026ldquo;World Health Organization\u0026rdquo; [Online]. 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Amnartsatsue, \u0026ldquo;Effects of health literacy improvement program on self-care behaviors and health outcomes in older adults with type 2 diabetes and hypertension comorbidi-ties.\u0026rdquo; Journal of Public Health and Development, vol.20. no.2. pp 32-42. doi:10.55131/jphd/2022/200203\u003c/li\u003e\n \u003cli\u003eK. Seangpraw, P. Ong-Artborirak, S. Boonyathee, S. Bootsikeaw, S. Kantow, P. Panta, \u0026amp; P. Winaiprasert, (2023). Effect of health literacy intervention on glycemic control and renal function among Thai older adults at risk of type 2 diabetes mellitus. Clinical Interventions in Aging, pp.1465-1476. September 2023.\u003c/li\u003e\n \u003cli\u003eR.J. Jacobs, J.Q. Lou, R.L. Ownby, \u0026amp; J. Caballero. (2016). A systematic review of eHealth interventions to improve health literacy. Health informatics journal, Vol.22 No.2. pp.81-98. June 2014. doi.org/10.1177/146045821453409\u003c/li\u003e\n \u003cli\u003eM. H .Eckman, R.Wise, A. C Leonard, E. Dixon, C.Burrows, F. Khan, \u0026amp; E. Warm. (2012). Impact of health literacy on outcomes and effectiveness of an educational intervention in patients with chronic diseases. Patient education and counseling. Vol. 87 No.2. pp.143-151. May 2012. doi.org/10.1016/j.pec.2011.07.020\u003c/li\u003e\n \u003cli\u003eM. H. Larsen, A.M. Mengshoel, M. H Andersen, C. R Borge, B. Ahlsen, K.G.Dahl. \u0026amp; A.K. Wahl. (2022). \u0026ldquo;A bit of everything\u0026rdquo;: Health literacy interventions in chronic conditions\u0026ndash;a systematic review. Patient education and counseling, Vol.105 No10. pp.2999-3016.October 2022. doi.org/10.1016/j.pec.2022.05.008\u003c/li\u003e\n \u003cli\u003eS.C. Bailey, A.G.Brega, T. M Crutchfield, T. Elasy, H. Herr, K. Kaphingst, \u0026amp; D. Schillinger. (2014). \u0026ldquo;Update on health literacy and diabetes.\u0026rdquo; The Diabetes Educator, Vol. 40 No.5 pp. 581-604. June 2014. doi.org/10.1177/0145721714540220\u003c/li\u003e\n \u003cli\u003eS. H Kim. \u0026amp; A. Lee. \u0026ldquo;Health‐literacy‐sensitive diabetes self‐management interventions: a systematic review and meta‐analysis.\u0026rdquo; (2016) Worldviews on Evidence‐Based Nursing, Vol 13. No.4, 324-333. April 2016. doi.org/10.1111/wvn.12157\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"Praboromarajchanok Institute of Heath Workforce Development","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":"Health literacy, At-Risk Populations, Ischemic Heart Disease, Stroke Disease, Intervention","lastPublishedDoi":"10.21203/rs.3.rs-6174434/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6174434/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eIschemic heart disease (IHD) and Stroke is the leading cause of disability worldwide and the second leading cause of death. The experimental research was used in this research. The purposes of this study aimed to determine the effect of a health literacy (HL) intervention for the prevention of IHD and stroke among at-risk populations. This research employed an experimental pretest and posttest design, and participants were divided into an experimental group and a control group, each with thirty persons. The experimental group was provided by a researcher with a health literacy intervention, while the control group was given only normal activities. The data were collected through questionnaires during September–November 2024. The data were analyzed through a comparison of the means with analysis of covariance and a presentation of mean differences and 95% CI. The results showed that the experimental group had higher mean scores of HL than the control group at a significance level of 0.05.\u003c/p\u003e","manuscriptTitle":"Health Literacy for Prevention of Ischemic Heart Disease\nand Stroke in Thailand.","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-03-11 06:57:35","doi":"10.21203/rs.3.rs-6174434/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":"83264856-aed9-4e28-ac4c-a1df17e7e14f","owner":[],"postedDate":"March 11th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":45333673,"name":"Health Economics \u0026 Outcomes Research"}],"tags":[],"updatedAt":"2025-03-11T06:57:35+00:00","versionOfRecord":[],"versionCreatedAt":"2025-03-11 06:57:35","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6174434","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6174434","identity":"rs-6174434","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}