The effects of a leaflet-based health guide on health literacy, self-efficacy, and satisfaction among older Japanese-Brazilian adults living in Brazil: A quasi-experimental study

This study assessed the effects of a Japanese leaflet-based health guide for older Japanese-Brazilian adults living in Brazil, on health literacy, self-efficacy, and satisfaction with the health guide and participants’ subjective health status.

The study followed a one-group pretest-posttest design and was set in the Japanese-Brazilian community in South Brazil. The 21 participants were Japanese-Brazilian individuals aged over 65 years, living in Brazil, and able to converse in Japanese. During the annual health checkup of 2016, we provided about 20 min of health guidance in Japanese using our leaflet, which included information about lifestyle-related diseases, recommended salt and sugar intake levels, and graphical charts. Participants’ health literacy (HL) was the primary outcome; self-efficacy and satisfaction with the leaflet-based health guide and participants’ subjective health status were secondary outcomes. We assessed the effect after completion of the health checkups in 2016 and 2017. Data were analyzed using repeated measures of ANOVA and the Bonferroni multiple comparison test as required.

There were no statistical significant differences in HL (functional HL: p-value = 0.22; communicative HL: p-value = 0.17; critical HL: p-value = 0.40; total HL score: p-value = 0.12) and self-efficacy (p-value = 0.28) across the three assessment points. We detected a statistical significant difference in satisfaction with the health guide, post-intervention in 2016 and 2017 (baseline score: 86.7±20.4; post-intervention score in 2016: 92.5±12.2; post-intervention score in 2017: 76.2±21.9; p-value of repeated ANOVA < 0.01, η_p² = 0.28; p-value of the multiple comparison in 2016 and 2017 = 0.01, 95% CI 4.09–28.51). However, the Bonferroni multiple comparison test did not show pairwise difference during multiple comparisons of participants’ satisfaction with their subjective health status (scores: baseline, 69.6±24.2; post-intervention in 2016, 78.5±21.1; post-intervention in 2017, 58.0±31.1; p-value of repeated ANOVA = 0.02, η_p² = 0.21; p-values of the multiple comparisons> 0.05). Scores of all outcomes, except self-efficacy, increased from baseline to post-intervention in 2016, but declined at post-intervention in 2017.

The leaflet-based intervention appeared to have short-term effects. The findings suggest that direct intervention in older adults’ native language may improve their satisfaction when living in non-native countries.

The UMIN-CTR unique registration ID is UMIN000032443. Retrospectively registered on May 1, 2018, at: https://​upload.​umin.​ac.​jp/​cgi-open-bin/​ctr_​e/​ctr_​view.​cgi?​recptno=​R000036999.