The mediating role of out-of-hospital adherence between health literacy and quality of life in Chinese stroke survivors: a cross-sectional study.
5 affiliations
- 1Shanghai Clinical Research and Trial Center, ShanghaiTech University, Shanghai, China.
- 2Nursing Department, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, China.
- 3Department of Vascular Surgery, Yueyang Hospital of Integrated Traditional Chinese Medicine, Shanghai, China.
- 4School of Nursing and Health Management, Shanghai University of Medicine & Health Sciences, Shanghai, China.
- 5Nursing Department, Gushengtang Holdings Co., Ltd., Shanghai, China.
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
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.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.
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BibTeX
@article{sun2026mediating,
title = {{The mediating role of out-of-hospital adherence between health literacy and quality of life in Chinese stroke survivors: a cross-sectional study.}},
author = {Hui Jun Sun and Jia Lu Cao and Jia Yan Qu and Mei Ting Wu and Jian Ping Lu},
journal = {Frontiers in public health},
year = {2026},
month = oct,
doi = {10.3389/fpubh.2026.1917398},
url = {https://europepmc.org/article/MED/42908663},
note = {CC BY},
}
RIS
TY - JOUR
TI - The mediating role of out-of-hospital adherence between health literacy and quality of life in Chinese stroke survivors: a cross-sectional study.
AU - Hui Jun Sun
AU - Jia Lu Cao
AU - Jia Yan Qu
AU - Mei Ting Wu
AU - Jian Ping Lu
PY - 2026
DA - 2026/10/07
JO - Frontiers in public health
DO - 10.3389/fpubh.2026.1917398
UR - https://europepmc.org/article/MED/42908663
AB - 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 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.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.
SN - 2296-2565
ER -