Health Literacy in Patients with Acute Stroke and its Associated with Post-Discharge Step Count: A Prospective Cohort Study

Ryota Ashizawa, Yuto Kameyama, Yoshinobu Yoshimoto, Keisuke Ikeda, Hiroya Honda
Purpose:

This study aimed to determine whether health literacy affect physical activity levels and sedentary behaviors in patients with acute stroke.


Methods:

This prospective cohort study included 44 patients with first-ever stroke (excluding subarachnoid hemorrhage), hospitalized in an acute-care hospital from December 2021 to May 2024. All patients were discharged home with a Mini Mental State Examination score of 24 points or higher (mean age 67.3 ± 10.1 years). The exposure factor was health literacy during hospitalization, assessed using the European Health Literacy survey questionnaire 16 (HLS-EU-Q16). The HLS-EU-Q16 employs a 4-point Likert scale, with scores ranging from 0 to 50, calculated using the formula: (mean of responses - 1) × (50/3). Higher scores indicate higher health literacy. The primary outcomes were physical activity levels and sedentary behavior, measured 3 months post-discharge. Sedentary behavior, light physical activity, moderate-to-vigorous physical activity (MVPA), and the step count were measured using a 3-axis accelerometer. Statistical analysis was performed to examine the association between health literacy and outcomes using Spearman's rank correlation coefficient. The dependent variable was the outcome with a significant difference, while health literacy was the independent variable. Confounding factors included sex, age, and National Institute of Health Stroke Scale, and multiple regression analysis was also performed.

Results:

The median HLS-EU-Q16 score was 28.6 points. The HLS-EU-Q16 revealed a significant negative correlation with sedentary behavior (%) (r=-0.307, p=0.042) and a significant positive correlation with MVPA (%) (r=0.310, p=0.041) and step count (r=0.411, p=0.006). In multiple regression analysis, health literacy was extracted as an independent factor of number of steps in (β=0.311, B=126.5, 95% confidence interval 10.3–242.6, p=0.034). However, health literacy was not extracted as an independent factor for sedentary behavior (β=-0.242, B=-0.363, 95% confidence interval -0.801–0.075, p=0.101) and MVPA (β=0.142, B=0.073, 95% confidence interval -0.087-0.232 p=0.363).

Conclusion(s):

Health literacy of patients with acute stroke during hospitalization was found to affect the number of steps taken by them; 3 months post-discharge. Patients with high health literacy may have been efficient in obtaining information related to increasing the number of steps and implementing it into practice.

Implications:

The findings of this study highlight the need to improve health literacy to increase physical activity levels in patients with stroke.

Funding acknowledgements:
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Keywords:
Health Literacy
Physical activity
Stroke
Primary topic:
Health promotion and wellbeing/healthy ageing/physical activity
Second topic:
Neurology: stroke
Did this work require ethics approval?:
Yes
Name the institution and ethics committee that approved your work:
Seirei Mikatahara Hospital
Provide the ethics approval number:
22-66
Has any of this material been/due to be published or presented at another national or international conference prior to the World Physiotherapy Congress 2025?:
No

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