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Transformative Learning Interventions to Improve Health Literacy and
Self-management in Non-communicable Diseases: An Integrative Review

U. Sasang, D. Tamdee, S. Aungwattana, and C. Tachaudomdach 1
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Faculty of Nursing, Chiang Mai, Thailand
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Background: Non-communicable diseases are serious medical conditions causing premature
death worldwide, including Thailand. To achieve disease control, patients need to modify their health
behaviors, especially through self-management. However, inadequate health literacy is an important
factor inhibiting patients’ ability to access, understand, and apply health information to critically
analyze and make health decisions. Transformative learning is a key learning theory that allows
development of health literacy for proper self-management, which leads to disease control.

Objective: This paper aims to determine the strategies of transformative learning that enhance
health literacy and self-management in non-communicable diseases.

Methods: This paper was conducted based on the integrative review methodology of Whittemore
and Knafl with five steps of problem identification, literature search, data evaluation, data analysis,
and presentation. Data were obtained from PubMed, Scopus, ScienceDirect, ProQuest, Cumulative
Index to Nursing and Health Literature (CINAHL), and Google Scholar.

Results: Eight intervention studies were included: three randomized controlled trials (Level II) and five
quasi-experimental studies (Level III). Among them, one was carried out in uncontrolled hypertension,
two in hypertension and diabetes patients, three in diabetes, one in people with cardiovascular disease,
hypertension, diabetes mellitus, and one in people at risk of non-communicable diseases. The transformative
learning theory applied to conduct the interventions was based on Mezirow, which consists of disoriented
dilemma (experience), critical reflection, discourse, and action. The common strategies were sharing lived
experiences, reflection, providing information, and group discussion. Moreover, the interventions included
specific skill training such as communication skill, health literacy skill, and self-management skill. The
intervention outcomes were health literacy, self-efficacy, self-care, self-management, attitude, and clinical
outcomes such as blood pressure and blood sugar.

Conclusion: This review provides knowledge on effective intervention strategies based on
transformative learning that can be applied in developing nursing interventions to enhance health
literacy and self-management in non-communicable diseases.

Keywords: transformative learning, health literacy, self-management, non-communicable disease,
integrative review
Poster Presentation Abstracts

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Correspondence: Decha Tamdee, Nursing, Chiang Mai, Thailand
E-mail: decha.t@cmu.ac.th

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