Health Literacy and Health Outcomes in Stroke Management: A Systematic Review and Evaluation of Available Measures

Low health literacy (HL) increases the risk of adverse stroke-related health outcomes. The aim of this review was to identify 1. what the quality and what the limitations to educational materials used to improve HL in stroke patients are 2. what the levels of HL among stroke patients and stroke survivors are, and 3. how HL and stroke literacy levels affect health-related behaviours and outcomes of stroke patients. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. 6 computerized databases and gray literature sources were searched: MEDLINE, OVID, EMBSE, CINAHL, Cochrane library, Web of Science, and Health and Psychosocial Instruments, and Google Scholar. Papers published in English between January 01, 2000 and August 01, 2020 were included. Five themes were identified across the 26 studies regarding the education and measurement of stroke with relevance to HL. This review concludes that current instruments used to improve HL in stroke are inadequate as they fail to provide a holistic assessment of health literacy, especially concerning stroke patients and stroke literacy. This review identified a paucity of literature on HL in relation to stroke management and outcomes. Therefore, the authors are in strong favour of future research prioritizing the development of effective tools to assess HL and develop best-practice guidelines for stroke education materials.