Supporting survival rates after a stroke: why health literacy matters in preventing a recurrence

A stroke can be devasting, even deadly. It’s a condition of which many of us are aware, and we may even know the symptoms to spot. But that may not be true of the whole patient population. Spotting the symptoms, surviving a stroke, and recovering forms just part of the story. So why is health literacy so important? Because the effects of a stroke go beyond the patient.

Health literacy is defined as the ability to obtain, process, and understand basic health information and services needed to make appropriate decisions,¹ and numerous studies have demonstrated significant correlations between the level of health literacy and outcomes for patients with chronic diseases.^2–6

The right rehabilitation and understanding of what happens after a stroke falls not just on the survivor, but also their family and caregivers. All members of a patient’s connected inner circle will face challenges. Roles are reassessed, finances may be adversely affected, and new skills need to be learnt. Adapting can be difficult, and both the survivor and their loved ones need to be equipped to handle the changes that follow.⁷

At AXON we are committed to championing improvements in health literacy among “in-need” patient populations across the globe and are calling on our wider community to raise much needed awareness of this cause. Stroke survivors certainly could be catagorized as “in need” within the patient population. Results from several studies show that the health literacy of stroke survivors and their caregivers is often low,^8–13 leading to poor outcomes.

Lack of health literacy increases risk of recurrence

Results from a study of 100 stroke survivors indicated that 59% had marginal to inadequate health literacy at the time of discharge from acute care. In addition, results from this cohort indicated that only 12% of patients could identify the different warning signs for a stroke, 43% knew their personal stroke risk factors, 76% knew their medications prescribed for stroke prevention, and 53% knew their type of stroke.¹² This lack of awareness regarding risk factors for stroke and requirements for self-management may result in continuation of habits that place patients at high risk for stroke recurrence.¹⁴

Effectiveness of rehabilitation can be compromised by low health literacy

Health literacy is also important in the context of rehabilitation post-stroke. Rehabilitation is linked to health literacy because of the importance of: (1) capacities, functioning, participation, and empowerment of clients; (2) holistic approach; (3) client-centered practice; (4) teaching of information and methods; and (5) access to services and equity issues.¹⁵ The effectiveness of rehabilitation interventions could be compromised if patients have limited ability to understand, evaluate, and communicate information.

AXON continues to support Health Literacy Month, an awareness-raising initiative which started more than 20 years ago. It aims to elevate people’s levels of health literacy to create a more equitable world in which all people can access high-quality care and attain positive health outcomes.

Decision-making can be impaired with limited health literacy

Good health literacy is essential for patient participation in decision-making in regard to the large number of options available for rehabilitation post-stroke. Patients are encouraged to work with their physicians and make wide-ranging decisions on their treatment. This can include whether to undertake classical physiotherapy and occupational therapy, the types of pharmacologic agents to take, and the types of medical devices to use. Understanding these options requires a high level of health literacy and achieving this is essential. Multiple studies have shown that shared decision-making has numerous positive effects in stroke care, including improved understanding, satisfaction, trust, treatment adherence, and health outcomes.^16,17

Higher health literacy is linked to improved adherence to rehabilitation programs

Adherence to the rehabilitation program is an important determinant of outcomes for post-stroke patients,¹⁸ and results from many studies have shown that higher health literacy is significantly associated with improved adherence to pharmacologic therapy and lifestyle changes.^19,20 Although this relationship has not been investigated extensively, results from one large-scale study indicated significant relations among health literacy, adherence to rehabilitation, and outcomes. This survey study included 1,317 post-stroke patients who were evaluated for education, health literacy, and implementation of rehabilitation. The patients were followed for 18 months with evaluations at baseline and every 6 months thereafter. Study results indicated a significant correlation between adherence to rehabilitation and the level of health literacy. The study also indicated that patients who completed rehabilitation had better neurologic outcomes.²¹

Health literacy, a critical component of the care pathway

In summary, higher health literacy has been shown to be significantly associated with better overall health and individual measures of physical, mental, and social health in post-stroke patients.¹⁰ Therefore, it is vital that we take steps together to improve stroke patients’ health literacy. This could be something small, such as sharing our infographic on the ‘F.A.S.T. Stroke Warning Signs’ with your social media community, or something larger such as undertaking further research to understand the patient beyond the clinical picture and adapting care accordingly. Whatever your contribution may be, we as a healthcare community should all feel the responsibility of raising levels of health literacy, and thus ensure that all people are able to access high-quality care and attain positive health outcomes. What steps will you take to support improving health literacy now and in the future?

Test yourself today: Do you know the warning signs of a stroke? Share our infographic with your teams and help promote greater understanding of a global health issue.

References

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18. Gunnes M, Indredavik B, Langhammer B, et al. Associations between adherence to the physical activity and exercise program applied in the LAST study and functional recovery after stroke. Arch Phys Med Rehabil 2019;100(12):2251–2259.

19. Patzer RE, Serper M, Reese PP, et al. Medication understanding, non-adherence, and clinical outcomes among adult kidney transplant recipients. Clin Transplant 2016;30(10):1294–1305.

20. Bottcher MR, Marincic PZ, Nahay KL, et al. Nutrition knowledge and Mediterranean diet adherence in the southeast United States: Validation of a field-based survey instrument. Appetite 2017;111:166–176.

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