Evaluation of the health literacy in patients with stroke and relationship between health literacy and functional status on quality of life in patients with stroke

Abstract

Aims: This study was aimed to evaluate the health literacy in patients with stroke and relationship between health literacy and functional status on quality of life. Methods: This cross-sectional study was studied on 50 participants with stroke (mean age: 59.4±10.6 years) and 50 healthy controls (mean age: 61.7±10.1 years). Clinical and demographic and characteristics were recorded. Health literacy levels of the participants were assessed with the Turkish version of European Health Literacy Scale (EHLS-TR), Motor development for hand, upper and lover extremity with Brunnstrom staging, evaluation of health-related quality of life with Notthingham Health Profile (NHP), pain with assessed with numeric rating scale (NRS). Results: Age, gender, marital status, education, job and residential area were similar between the groups. The EHLS-TR scores were significantly lower, in patients with stroke compared to the control group (p=0.041δ). There was a statistically significant negative correlation between EHLS-TR scores, age and positive correlation with educational status. EHLS-TR scores were found to be higher in patients younger than 60 years old and university graduates. Health releated quality of life levels are similar between the groups. EHLS-TR scores were found to be statistically effective on Nottingham Health Profile (NHP) total scores (rho:-0,357 and p=0,011) and also physical activity sub domain and energy level sub domains. There was moderate negative correlation between the EHLS-TR scores and NHP energy sub domain (p=0.002, r:-0.436) and weak negative correlation between the EHLS-TR scores and NHP emotional, sleep, physical activity sub domains (r:-0.279 p=0.049, r:-0.344 p=0.015, r:-0.288 p=0.043). There was no correlation between the EHLS-TR scores and Brunnstrom staging, Functional ambulation and pain levels in patients with stroke. Conclusion: Our study results suggest that healthy literacy level is lower in patients with stroke compared to healthy controls. In addition, healthy literacy is associated with age and education. Health literacy has been found to have an impact on quality of life and energy, emotional, sleep and physical activity subdomains of NHP. There was no association found between functional status on health literacy in this patient population.

Keywords

• Stroke
• health literacy
• functional status
• quality of life

References

1. Kong KH, Yang SY. Health-related quality of life among chronic stroke survivors attending a rehabilitation clinic. Singapore Med J. 2006;47(3):213-218.
2. Tobin C, Hevey D, Horgan NF, Coen RF, Cunningham CJ. Healthrelated quality of life of stroke survivors attending the volunteer stroke scheme. Ir J Med Sci. 2008;177(1):43-47.
3. Ramos-Lima MJM, Brasileiro IC, Lima TL et al. Quality of life after stroke: impact of clinical and sociodemographic factors. Clinics. 2018;73:e418.
4. Geyh S, Cieza A, Stucki G. Evaluation of the German translation of the Stroke Impact Scale using Rasch analysis. Clin Neuropsychol. 2009;23(6):978-995.
5. Nutbeam D. Health promotion glossary. Health Promot Int.1998;13(4):349-364.
6. Toobert DJ, Hampson SE, Glasgow RE. The summary of diabetes self-care activities measure: results from 7 studies and a revised scale. Diabetes Care. 2000;23(7):943-950.
7. Dunn P,Conard S. Improving health literacy in patients with chronic conditions: a call to action. Int J Cardiol. 2018;273:249-251.
8. Chew LD, Bradley KA, Boyko EJ. Brief questions to identify patients with inadequate health literacy. Fam Med. 2004;36(8):588-594

9. Kleindorfer DO, Towfighi A, Chaturvedi S, et al. Guideline for the prevention of stroke in patients with stroke and transient ischemic attack: a guideline from the American Heart Association/American Stroke Association. Stroke. 2021;52(7):364-467.
10. Barakou I, Hackett KL, Finch T, et al. Self-regulation of effort for a better health-related quality of life: a multidimensional activity pacing model for chronic pain and fatigue management. Ann Med. 2023;55(2):2270688.
11. Okyay P, Abacıgil F. Türkiye sağlık okuryazarlığı ölçekleri güvenilirlik ve geçerlilik çalışması. Mayıs 2016, Sağlık Bakanlığı Yayın No: 1025.
12. Sawner K, Lavigne J. Brunnstrom’s Movement Therapy in Hemiplegia: A Neurophysiological Approach. 2nd ed. Philadelphia: Lippincott. 1992.
13. Küçükdevecı AA, McKenna S, Kutlay S, Gürsel Y, Whalley D, Arasıl T. The development and psychometric assessment of the Turkish version of the Nottingham Health Profile. Int J Rehabil Res. 2000;23(1):31-38.
14. Hjermstad MJ, Fayers PM, Haugen DF, Caraceni A, Hanks GW, Loge JH, et al. European Palliative Care Research Collaborative (EPCRC). Studies comparing Numerical Rating Scales, Verbal Rating Scales, and Visual Analogue Scales for assessment of pain intensity in adults: a systematic literature review. J Pain Symptom Manage. 2011;41(6):1073-1093
15. Li M, Xu G, Xie J, Chen C. A review: motor rehabilitation after stroke with control based on human intent. Proc Inst Mech Eng H. 2018;232(4):344-360.
16. Feigin VL, Stark BA, Johnson CO, Roth GA, Bisignano C, Abady GG, et al. Global, regional, and national burden of stroke and ıts risk factors, 1990-2019: a systematic analysis for the global burden of disease study 2019. Lancet Neurol. 2021;20(10):795-820.
17. Meschia JF, Bushnell C, Boden-Albala B, et al. Guidelines for the primary prevention of stroke: a statement for healthcare professionals from the American heart association /American stroke association. Stroke. 2014;45(12):3754-3832.
18. Öhgren B, Weinehall L, Stegmayr B, Boman K, Hallmans G, Wall S. What else adds to hypertension in predicting stroke? an incident case-referent study. J Intern Med. 2000;248(6):475-482.
19. Maalouf E, Hallit S, Salameh P, Hosseini H. Eating behaviors, lifestyle, and ischemic stroke: a Lebanese case-control study. Int J Environmental Res Pub Health. 2023;20(2):1487.
20. Honjo K, Iso H, Nakaya T, et al. Impact of neighborhood socioeconomic conditions on the risk of stroke in Japan. J. Epidemiol. 2015;25(3):254-260.
21. Kumar A, Prasad M, Kathuria P, et al. Low socioeconomic status is an independent risk factor for ischemic stroke: a case-control study in north Indian population. Neuroepidemiol. 2015;44(3):138-143.
22. Büyükşireci D, Demirsoy ÜN. Evaluation of the health literacy level of female fibromyalgia patients and relationship between health literacy level and disease activity. Arch Rheumatol. 2021;36(2):274-279.
23. Feigin VL, Krishnamurthi RV, Parmar P, et al. Update on the global burden of ıschemic and hemorrhagic stroke in 1990-2013: the GBD 2013 study. Neuroepidemiol. 2015;45(3):161-176.
24. O'Donnell MJ, Xavier D, Liu L, et al. Risk factors for ischaemic and intracerebral haemorrhagic stroke in 22 countries (the INTERSTROKE study): a case-control study. Lancet. 2010;376(9735):112-123.
25. Institute of Medicine (US) Committee on Health Literacy. Health Literacy: A Prescription to End Confusion. Nielsen-Bohlman L, Panzer AM, Kindig DA, editors. Washington (DC): National Academies Press (US); 2004. PMID: 25009856.
26. Šedová L, Bártlová S, Hudáčková A, Havierniková L, Dolák F, Ostrý S. Health literacy and modifiable risk factors of a stroke. KONTAKT-J Nurs Soc Sci Health Illness. 2021;23(3):149-156.
27. Aran N, Tregobov N, Kooij K, Harris D Goel G, Poureslami I. Health literacy and health outcomes in stroke management: a systematic review and evaluation of available measures. J Huma Soc Sci. 2022;5(2):172-191.
28. Pien LC, Cheng WJ, Chang WP, Chen SR, Chou KR, Wang CH. Relationships between stroke prevalence, health literacy, and oral health-related quality of life in middle-aged and older adults: a national survey study. BMC Geriatrics. 2023;23(1):1-8.
29. Jeong J, Cha J. Factors affecting health behavior of patients with stroke: focusing on health literacy of patients and family caregivers. Korean J Adult Nurs. 2020;32(6):632-641.
30. Sanders K, Schnepel L, Smotherman C, Livingood W, Dodani S, Antonios N, et al. Assessing the impact of health literacy on education retention of stroke patients. Preventing Chron Dis. 2014;11(11):130259.
31. Baumann M, Le Bihan E, Chau K, Chau N. Associations between quality of life and socioeconomic factors, functional impairments and dissatisfaction with received information and home-care services among survivors living at home two years after stroke onset. BMC Neurol. 2014;14:1-12.
32. American Heart Association. (2003). Get with Guidelines. https://www.heart.org/en/professional/quality-improvement/get-with-the-guidelines (Access Date: 25.09.2023)
33. Flink M, Lindblom S, von Koch L, Carlsson AC, Ytterberg C. Health literacy is associated with less depression symptoms, higher perceived recovery, higher perceived participation, and walking ability one year after stroke-a cross-sectional study. Topics Stroke Rehab. 2023;30(8):865-871.
34. Çiftçi N, Yıldız M, Yıldırım Ö. The effect of health literacy and health empowerment on quality of life in the elderly. Psychogeriatr. 2023;23(4):609-620.
35. Faul F, Erdfelder E, Lang F et al. G*Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Meth. 2007;39(2):175-191.
36. Huang Y, Chen T, Lin T. Evaluating the European health literacy survey questionnaire in patients with stroke: a latent trait analysis using Rasch modeling. Pat-Pat-Cent Outc Res. 2018;11(1):83-96.