Impact of health literacy and illness perception on rehabilitation adherence among patients with stroke

Purpose: This study explored the level of Rehabilitation Adherence (RA) in patients with stroke receiving rehabilitation treatment and identified the impact of health literacy and illness perception on RA. Methods: A total of 163 patients with stroke were recruited during hospitalization for rehabilitation treatment in a descriptive cross-sectional study. Data were collected from August 25, 2018 to October 30, 2018 using self-report structured questionnaires and analyzed using descriptive statistics and hierarchical regression analysis with SPSS/WIN 26.0 program. Results: The mean score for RA in participants was 3.02±0.49 (range 1~4). Men (t=2.12, p=.035), family caregiver (F=6.59, p=.002), hemorrhagic stroke (t=-2.78, p=.006), shorter period in disease diagnosis (≤12 month) (F=7.49, p=.001) and need of someone's help for activities of daily living (F=5.20, p=.006) were associated with higher RA. Hierarchical regression analysis showed that health literacy and emotional illness perception explained RA by additional 26%p and 3%p, respectively. Higher health literacy, higher perception about concern and emotional response about disease were effective factors of higher RA in stroke patients. Health literacy was the strongest variable to explain RA among patients with stroke. Conclusion: The study provides insight into how health literacy and emotional illness perception promote RA in stroke patients. It suggests that health literacy and illness perception need to be considered in developing a nursing intervention to increase RA for patients with stroke receiving rehabilitation treatment.