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

Authors

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

Published in

Frontiers in public health. Volume 14. Pages 1917398. Epub Oct 07, 2026.

Abstract

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.
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.
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.
Stroke survivors' health literacy averaged 31.40 ± 6.78 (below threshold), with analysis skills scoring lowest (5.37 ± 1.17); Health literacy was positively correlated with quality of life (r = 0.409, p < 0.001) and out-of-hospital adherence (r = 0.223, p < 0.001). Adherence was also positively correlated with quality of life (r = 0.461, p < 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.
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.

PMID:
42908663
Bibliographic data and abstract were imported from PubMed on 23 Oct 2026.

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