In this cross-sectional study of 509 Chinese stroke survivors, health literacy was below threshold and positively associated with quality of life, and out-of-hospital adherence statistically mediated about 21.3% of that association.
Stroke survivors in this sample had low overall health literacy, with analysis skills scoring lowest.
Health literacy was positively correlated with stroke-specific quality of life.
Health literacy was positively correlated with out-of-hospital adherence.
Out-of-hospital adherence was positively correlated with quality of life.
Out-of-hospital adherence statistically mediated the association between health literacy and quality of life, accounting for about one fifth of the total association.
The authors conclude that strategies targeting health literacy and post-discharge adherence may be relevant for older stroke survivors, especially disadvantaged subgroups, but require implementation research.
This study surveyed 509 people who had survived a stroke and were being treated at four traditional Chinese medicine hospitals in Shanghai. It looked at how well they could find, understand, and use health information (health literacy), how well they followed their care plans after leaving the hospital (adherence), and their stroke-related quality of life. On average, participants' health literacy was low, and they were weakest at analyzing health information. People with higher health literacy tended to have better quality of life, and they also tended to stick to their care plans more closely. Those who followed their care plans better also reported better quality of life. Statistical analysis suggested that about 21% of the link between health literacy and quality of life ran through how well people followed their post-discharge care, while the rest was linked in other ways. This research suggests that helping stroke survivors understand health information and follow through with care after hospital discharge might be worth exploring, particularly for older people, those with less education, and rural residents. However, because the data were collected at a single point in time from a convenience sample, the study cannot show that improving health literacy or adherence causes better quality of life. The authors note that further research is needed to test whether community-based programs would work.
Sun H, Cao J, Qu J, Wu M, Lu J. (2026). The mediating role of out-of-hospital adherence between health literacy and quality of life in Chinese stroke survivors: a cross-sectional study.. Frontiers in public health. https://doi.org/10.3389/fpubh.2026.1917398