Assessing the impact of health literacy on education retention of stroke patients.
BACKGROUND
Inadequate health literacy is a pervasive problem with major implications for reduced health status and health disparities. Despite the role of focused education in both primary and secondary prevention of stroke, the effect of health literacy on stroke education retention has not been reported. We examined the relationship of health literacy to the retention of knowledge after recommended stroke education.


METHODS
This prospective cross-sectional study was conducted at an urban safety-net hospital. Study subjects were patients older than 18 admitted to the hospital stroke unit with a diagnosis of acute ischemic stroke who were able to provide informed consent to participate (N = 100). Health literacy levels were measured by using the short form of Test of Functional Health Literacy in Adults. Patient education was provided to patients at an inpatient stroke unit by using standardized protocols, in compliance with Joint Commission specifications. The education outcomes for poststroke care education, knowledge retention, was assessed for each subject. The effect of health literacy on the Stroke Patient Education Retention scores was assessed by using univariate and multivariate analyses.


RESULTS
Of the 100 participating patients, 59% had inadequate to marginal health literacy. Stroke patients who had marginal health literacy (mean score, 7.45; standard deviation [SD], 1.9) or adequate health literacy (mean score, 7.31; SD, 1.76) had statistically higher education outcome scores than those identified as having inadequate health literacy (mean score, 5.58; SD, 2.06). Results from multivariate analysis indicated that adequate health literacy was most predictive of education outcome retention.


CONCLUSIONS
This study demonstrated a clear relationship between health literacy and stroke education outcomes. Studies are needed to better understand the relationship of health literacy to key educational outcomes for primary or secondary prevention of stroke and to refine stroke education for literacy levels of high-risk populations.
580 W. 8th St, Tower 1, 9th Floor, Jacksonville, FL 32209. E-mail: kalina.sanders@jax.ufl.edu.
Kalina
K
Sanders
University of Florida, College of Medicine, Gainesville, Florida.
Loretta
L
Schnepel
the Center for Health Equity and Quality Research, Jacksonville, Florida.
Carmen
C
Smotherman
University of Florida, College of Medicine, Gainesville, Florida, and the Center for Health Equity and Quality Research, Jacksonville, Florida.
William
W
Livingood
University of Florida, College of Medicine, Gainesville, Florida, and the Center for Health Equity and Quality Research, Jacksonville, Florida.
Sunita
S
Dodani
University of Florida, College of Medicine, Gainesville, Florida.
Nader
N
Antonios
the Center for Health Equity and Quality Research, Jacksonville, Florida.
Katryne
K
Lukens-Bull
the Center for Health Equity and Quality Research, Jacksonville, Florida.
Joyce
J
Balls-Berry
University of Florida Health Jacksonville, Jacksonville, Florida.
Yvonne
Y
Johnson
University of Florida Health Jacksonville, Jacksonville, Florida.
Terri
T
Miller
University of Florida, College of Medicine, Gainesville, Florida.
Wayne
W
Hodges
University of Florida, College of Medicine, Gainesville, Florida.
Diane
D
Falk
University of Florida, College of Medicine, Gainesville, Florida, and the Center for Health Equity and Quality Research, Jacksonville, Florida.
David
D
Wood
University of Florida, College of Medicine, Gainesville, Florida.
Scott
S
Silliman
D005260:Female; D005431:Florida / Q000453:epidemiology; D057220:Health Literacy; D006801:Humans; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic; D020521:Stroke / Q000453:epidemiology