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Patients with limited health literacy often struggle to understand health information and adhere to treatment, resulting in poorer outcomes. Educational interventions tailored to improve self-care and health literacy arSCTe therefore essential. This study evaluated the effectiveness of a Social Cognitive Theory-based intervention, with and without health literacy strategies, in enhancing self-care among patients with T2DM and limited health literacy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      This interventional study included 150 patients with T2DM and limited health literacy, randomly assigned to three equal groups (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200950 each): a Social Cognitive Theory-based group (TBG), a theory-based group with an AI-designed photo-novel (TBG+AIPN), and a control group. At baseline, all participants completed questionnaires assessing diabetes knowledge, self-efficacy, outcome expectations, perceived social support, and self-care behaviors. Both intervention groups received five training sessions grounded in Social Cognitive Theory. In the TBG+AIPN group, additional health literacy strategies\u2014such as an AI-designed photo-novel and plain language materials\u2014were incorporated. Follow-up assessments were conducted one and three months post-intervention. Data were analyzed using SPSS version 24.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Longitudinal analyses revealed significant within-group improvements from baseline to follow-up across all measured constructs in both intervention groups (all\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). Between-group comparisons showed that the TBG+AIPN group achieved significantly greater improvements than the TBG group in self-care behaviors (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.002), diabetes knowledge (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.040), self-efficacy (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.020), outcome expectations (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.030), and self-regulation (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.020). No statistically significant difference was observed between the groups in perceived social support (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.800). These findings highlight the added value of integrating AI-designed visual literacy tools with SCT-based education in improving self-care\u2013related outcomes among patients with T2DM.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>An intervention based on Social Cognitive Theory, when combined with health literacy strategies including an AI-designed photo-novel, is more effective in improving self-care among patients with T2DM and limited health literacy. Such a comprehensive approach integrates psychological and communication strategies, offering a holistic solution for improving outcomes in this vulnerable group.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration<\/jats:title>\n                    <jats:p>Iranian Registry of Clinical Trials (IRCT), IRCT20240426061579N1. Registered on 12 May 2024.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12913-026-14849-9","type":"journal-article","created":{"date-parts":[[2026,6,5]],"date-time":"2026-06-05T02:17:31Z","timestamp":1780625851000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Optimizing diabetes self-care in patients with limited health literacy: a randomized controlled trial (RCT) of SCT-based education with and without an AI-designed photo-novel"],"prefix":"10.1186","volume":"26","author":[{"given":"Tooba","family":"Chekav","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Homamodin","family":"Javadzade","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marzieh","family":"Mahmoodi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mahnoush","family":"Reisi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,6,5]]},"reference":[{"key":"14849_CR1","unstructured":"International diabetes federation (IDF). 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This study was registered with the Iranian Registry of Clinical Trials (IRCT) under the number IRCT20240426061579N1on 2024-05-12. All participants provided written informed consent before enrollment, and all of them were informed that they could withdraw from the study at any time without any effect on their usual care. The study was conducted in full accordance with the ethical standards of the institutional and\/or national research committee and with the 1964 Helsinki Declaration and its later amendments. Participant confidentiality was strictly maintained by anonymizing the data and restricting access to identifiable information to authorized study personnel only.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"792"}}