# Development and validation of a behaviour change intervention package to improve health literacy on behavioural risk factors of non-communicable diseases among health care assistants of government hospitals in Sri Lanka - exploratory research

## TL;DR

This study developed and tested an intervention to improve health literacy among healthcare assistants in Sri Lanka, aiming to reduce non-communicable disease risk behaviors.

## Contribution

A novel behavior change intervention package was developed and validated using a structured, theory-driven approach for Sri Lankan healthcare assistants.

## Key findings

- Health literacy among healthcare assistants was limited by factors at multiple levels including individual, family, and organizational.
- The intervention package was found to be feasible and acceptable based on expert validation and pilot testing.
- The BCIP focused on four domains of health literacy and showed potential for integration into training programs.

## Abstract

Non-communicable diseases (NCDs) are the leading cause of premature deaths globally, largely driven by modifiable behavioural risk factors such as unhealthy diet, physical inactivity, tobacco use, and alcohol consumption. Health literacy (HL) plays a vital role in modifying these behaviours. Evidence shows that Healthcare Assistants (HCAs) in Sri Lanka despite working in hospitals often demonstrate limited HL and high rates of risk behaviours. Enhancing HL among HCAs is therefore essential both for their own health and for enabling them to serve as credible health advocates in NCD prevention.

This study aimed to develop and validate a Behaviour Change Intervention Package (BCIP) to improve HL related to NCD behavioural risk factors among HCAs in government hospitals in Sri Lanka.

A Behaviour Change Intervention Package (BCIP) was developed using the Intervention Mapping (IM) approach, informed by the Calgary Charter HL framework. Steps included assessment of the logic model of the problem, setting objectives, intervention design, expert content validation, pilot testing, and planning for implementation and evaluation. The BCIP comprised a curriculum, facilitator guide, participant handbook, and PowerPoint presentations, for 16 two-hour sessions across eight weeks. Sessions employed lectures, role-play, group discussions, brainstorming, and m-health tools. Content validity was assessed by a 10-member expert panel, while pilot testing in selected hospitals evaluated feasibility and acceptability.

Findings revealed that HL among HCAs was limited by factors at individual, family, organizational, community, and policy levels. The BCIP addressed these determinants by focusing on HL’s four domains- finding, understanding, comparing, and applying health information. Expert review confirmed high relevance and appropriateness (mean scores > 3.0), while pilot testing showed feasibility and participant satisfaction with content, delivery methods, and session duration.

The validated BCIP provides a structured, theory-driven approach to improving HL and reducing NCD risk behaviours among HCAs. Pilot findings support its feasibility for integration into routine induction or in-service training. Future studies will evaluate its effectiveness, with potential adaptation for broader workplace health promotion in Sri Lanka.

The online version contains supplementary material available at 10.1186/s12889-025-26177-4.