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

BackgroundStroke, 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.ObjectiveTo 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.MethodsA 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.ResultsStroke 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.ConclusionThese 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.