Abstract
Objective: This interventional cohort study evaluates the effectiveness of a nurse-led educational intervention designed to improve health literacy and self-management in glaucoma patients and examines correlations with demographic factors (sex, age, education level) and comorbidities. Material and Methods: A convenience sample of 312 glaucoma patients was recruited from the University General Hospital of Heraklion, Crete, between November 2022 and November 2023. The patients were randomly assigned to an intervention group (receiving nurse-led education) or a control group (receiving standard care). Health literacy was measured using the HLS-EU-16 questionnaire, while self-management levels were assessed with the Patient Activation Measure (PAM-13). Two-way repeated measures ANOVA analyzed intervention effects over time. Moreover, multiple linear regression analysis was used to test for potential correlations between variables. Results: Significant improvements were observed in both HLS-EU-16 and PAM-13 scores in the intervention group over time compared to the control group. In the post-test, the intervention group showed statistically higher health literacy scores (12.79 ± 2.64) than the control group (10.52 ± 3.60), with a mean difference in -2.27 (p < 0.001). Similarly, the PAM-13 scores were significantly higher in the intervention group (49.35 ± 10.36) compared to the control group (41.33 ± 24.12) post-test, with a mean difference of -8.01 (p < 0.001). The pre-intervention PAM-13 score was positively associated with both the HLS-EU16 score (B = 3.307, p < 0.001) and education level (B = 3.863, p = 0.037). Meanwhile, higher post-intervention PAM-13 was positively associated with greater post-intervention HLS-EU16 scores (B = 1.26, 95% CI [0.61, 1.91]). Furthermore, the participants of the intervention group exhibited significantly higher post-intervention PAM-13 scores than the control group (B = 5.36, 95% CI [1.03, 9.68]). Conclusions: The nurse-led educational intervention significantly enhanced health literacy and self-management in glaucoma patients, indicating its potential value in patient education strategies for chronic diseases.