Effectiveness of a Health Literacy Program for Enhancing Self-Care Behavior and Diabetes Prevention Among Pre-Diabetic Buddhist Monks in Upper Northeastern Thailand

Background: Buddhist monks in Thailand experience distinctive lifestyle constraints—such as dependence on alms-based diets and restrictions on strenuous physical activity—that heighten their vulnerability to type 2 diabetes. This study examined the effectiveness of a structured health literacy program in improving diabetes-preventive self-care behaviors among pre-diabetic Buddhist monks in upper northeastern Thailand. Methods: A quasi-experimental study was conducted with 72 pre-diabetic monks, evenly allocated to intervention and comparison groups. The intervention group completed a 24-week structured health literacy program. Health literacy and self-care behaviors were assessed using validated questionnaires before and after the intervention, and the data were analyzed using descriptive statistics, paired and independent t-tests, and effect size calculations. Results: The intervention group showed significant improvements in health literacy scores (3.71 to 4.69; p < 0.001) and self-care behavior scores (3.54 to 4.23; p < 0.001), while the comparison group exhibited no meaningful changes. Effect sizes indicated substantial program impacts, with a large effect on health literacy (d = 2.21) and a very large effect on self-care behaviors (d = 2.80). Conclusions: The structured health literacy program effectively enhanced diabetes-preventive self-care behaviors among pre-diabetic monks. These findings highlight the importance of culturally appropriate, literacy-focused public health interventions for populations with lifestyle-related constraints. Integrating health literacy into community and religious health initiatives may strengthen chronic disease prevention and support sustainable behavior change in hard-to-reach groups. Keywords: Health literacy, Buddhist monks, Self-care behavior, Diabetes prevention, Public health