# Effectiveness of a behaviour change intervention on health literacy for behavioural risk factors of non-communicable diseases among health care assistants of government hospitals in Colombo District: a cluster-randomized controlled trial

## TL;DR

A behavior change program improved health literacy and reduced risk factors for non-communicable diseases among healthcare assistants in Sri Lanka.

## Contribution

A cluster-randomized trial demonstrated the effectiveness of a behavior change intervention in improving health literacy among healthcare assistants.

## Key findings

- The intervention significantly improved health literacy scores and levels among healthcare assistants.
- Positive behavior changes were observed in diet, physical activity, and tobacco avoidance.
- Age under 35 was a positive predictor of health literacy improvement.

## Abstract

Non-communicable diseases (NCDs) are a major public health challenge in Sri Lanka, driven by behavioural risk factors. Healthcare Assistants (HCAs) play a key role in NCD prevention, but limited health literacy (HL) reduces their effectiveness. Strengthening HL among HCAs can reduce their own NCD risk, enhance their role as health promoters, and improve patient education and hospital-based health initiatives.

This study aimed to assess the effectiveness of a behaviour change intervention package (BCIP) to improve HL on behavioural risk factors of NCDs among HCAs in Colombo district.

A cluster Randomized Controlled Trial (cRCT) was conducted with 240 HCAs from 20 hospitals in the Colombo district, 10 hospitals each for the control and intervention arms. The 16 sessions of the BCIP were conducted over eight weeks. The HL-NCD tool and STEPS questionnaire were administered two weeks before and after the intervention. HL score was analyzed as a continuous variable, while HL level was categorized as inadequate or adequate based on predefined HL score cutoffs. Analyses included unadjusted, cluster-level, and Generalized Estimating Equations (GEE) models to account for clustering effects.

The intervention group showed significant improvements in HL score (unadjusted p < 0.001; cluster p = 0.005; GEE OR = 7.80, 95% CI: 7.38–8.22, p < 0.001) and HL level (unadjusted p = 0.003; cluster p = 0.011; GEE OR = 3.80, 95% CI: 1.59–9.11, p = 0.003). Age < 35 years was a significant positive predictor of HL score and educated only up to O/Ls was a significant negative predictor of HL level. The GEE analysis revealed significant improvement in behaviour change related to diet, physical activity, avoiding smokeless tobacco, and non-exposure to secondhand smoking except avoiding smoking tobacco and alcohol intake.

The BCIP was effective in improving HL and reducing behavioural risk factors of NCDs among HCAs, highlighting its potential for broader implementation.

SLCTR/2023/023, https://slctr.lk/trials/slctr-2023-023, 11th December 2023, Sri Lanka Clinical Trial Registry.

The online version contains supplementary material available at 10.1186/s12889-025-26110-9.