Work

The mediating role of out-of-hospital adherence between health literacy and quality of life in Chinese stroke survivors: a cross-sectional study

Year: 2026

Type: article

Abstract: Background: Stroke, the second foremost cause of mortality globally, imposes a considerable disease burden in China. Limited health literacy and difficulties adhering to post-discharge care may be associated with poorer quality of life among stroke survivors. However, the extent to which out-of-hospital adherence statistically accounts for the association between health literacy and quality of life remains insufficiently characterized. Objective: To examine associations among health literacy, out-of-hospital adherence, and quality of life, and to assess whether out-of-hospital adherence statistically mediates the association between health literacy and quality of life in a cross-sectional sample of stroke survivors. Methods: A cross-sectional study included 509 participants recruited through convenience sampling from four traditional Chinese medicine hospitals in Shanghai. Health literacy, out-of-hospital adherence, and stroke-specific quality of life were assessed using Chinese-language instruments. Statistical mediation was examined using PROCESS Model 4 with 5,000 bootstrap resamples. Results: < 0.001). The standardized indirect effect through adherence was 0.087 (bootstrap 95% CI: 0.048-0.134), corresponding to approximately 21.3% of the total association in the specified model. Conclusion: These cross-sectional findings carry public-health-relevant implications for older adult stroke survivors, a fast-growing vulnerable subgroup amid China's population aging. Population-level targeted strategies to improve health literacy and post-discharge adherence may advance healthy aging by mitigating stroke-related health disparities among older adults, particularly for socio-economically disadvantaged subgroups including those with low educational attainment and rural residence. Further implementation research is required to translate these observational associations into community-tailored preventive interventions for aging populations.

Source: Frontiers in Public Health

DOI: 10.3389/fpubh.2026.1917398

Authors: Hui Jun Sun, Jia Lu Cao, Jia Yan Qu, Mei Ting Wu, Jian Ping Lu

Institutions: ShanghaiTech University, Tongji University, Shanghai First Maternity and Infant Hospital, Yueyang Hospital, Shanghai University of Medicine and Health Sciences

Language: English

Topic: Health Literacy and Information Accessibility

Subfield: General Health Professions

Field: Health Professions

Domain: Health Sciences

SDGs: Good health and well-being, Reduced inequalities

Open Access status: gold

Estimated APC paid: $3,801