Peer-Led Education Improves Health Literacy More Than Lectures for Patients With MS

Evidence has shown health literacy to play a role in disease self-management and quality of life. Studies have demonstrated the impact of health literacy skills on improving clinical outcomes and reducing psychological problems associated with chronic diseases. Additionally, low health literacy can lead to a lack of understanding of health care training and recommendations, poorer health status, and higher medical costs.

Most MS education is presented in lecturers, pamphlets, and booklets that lack the opportunity for questioning and answering and interpersonal interaction. Further, this type of education doesn’t account for individual differences between patients and often take place with large patient groups and a small staff size.

Peer-led education consists of educational materials that are provided by persons who share the same experiences as the participants. Peer-led education can give patients relief and assurance to overcome their diseases, which could increase life expectancy.

Ali Dehghani, PhD, the study researcher and an assistant professor from the Department of Nursing, School of Nursing and Paramedical at Jahrom University of Medical Sciences in Iran, conducted the quasi-experimental study from December 2018 to November 2019 by distributing specialized MS health literacy questionnaires (MSHLQ) to patients in MS Society Jahrom.

A physician and psychiatrist from MS Society selected 3 peer educators from the patients with MS who participated in the study and were trained over the course of 3 training sessions prior to conducting the 6 sessions for the intervention group. For the control group, Dehghani, who has a MS degree in nursing, performed the lectures.

Peer educators were required to have a diploma and higher education, have been living with MS for at least 5 years, have a high health literacy level as determined by the MSHLQ, and have appropriate social communication skills. All of the peer educators had a master’s degree and had a disease duration between 10 and 15 years.

Ninety patients were selected to participate and were assigned to either the control group, where they would receive lecture-based education, or the intervention group, where they would receive peer-led education. The intervention group would receive a lot of group discussion, question and answer segments, and interpersonal interaction but were still given educational information similar to what was given to the control group.

Each group had 45 patients and received their education over the course of 6 weeks, with 1 session per week. Patients were given the questionnaire before and 1 month after completing all of the sessions. The mean age of participants was 33.62 (8.03) in the control group and 31.64 (7.10) in the intervention group. The mean length of disease was 8.15 (5.50) years in the control group and 6.45 (5.50) years in the intervention group.

Health literacy prior to completing the sessions showed no significant differences between groups (P = .24). However, results from the questionnaire after session completion revealed that health literacy was higher in the intervention group (effect size 0.68 vs 0.28; P = .001).

Dehghani said that the impact on learning could have to do with patients being in the same social group and believing that their peers are similar to them in terms of ability.

The quality of the peer educator was noted by Dehghani as an important aspect of peer-led education, saying that, “the effectiveness of peer-led educational interventions goes back to the suitable peer educator who has sufficient ability and experience in teaching.”

Dehghani identified a short-term follow-up period and lack of knowledge on whether any peer education occurred at the end of training sessions in the control group as study limitations.


Dehghani A. A comparative study of the effect of peer-led and lecture-based education on health literacy in patients with multiple sclerosis. Int J Community Based Nurs Midwifery. 2021;9(1):76-85. doi: 10.30476/IJCBNM.2020.85816.1298

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