The Development of the Translational System of Health Literacy in Stroke Rehabilitation (Healer): a Study of Prediction Model Validation and Interventional Effectiveness Assessment

Background: Health literacy (HL) is the ability of a person to access, understand, appraise, and apply health information and services. People with good HL take actions for their health by obtaining knowledge and applying skills to promote every aspect of health. In the settings of stroke rehabilitation and health promotion, stroke rehabilitation HL is important for stroke patients because it can increase the likelihood of accepting early and proper diagnosis, therapy, nursing and rehabilitation programs, enhance adherence to comorbidities/disability prevention, and promote healthy behaviors and lifestyles during acute, subacute, and chronic stages of stroke. Moreover, patients with good stroke rehabilitation HL can also improve their disease self-management and clinical decision-making. However, efforts to promote HL in patients with stroke face four obstacles: (1) The HL of patients is commonly insufficient and difficult to improve due to cognitive impairment; (2) The lack of a validated theoretical framework of HL has hampered clinical practice and research to promote stroke rehabilitation HL; (3) No efficient and effective intervention protocols are currently available for promoting rehabilitation HL in patients with stroke; (4) No patient-centered computerized adaptive tests and adaptive education systems exist, so the administrative efficiency of stroke rehabilitation HL intervention is limited. Purposes: To overcome the aforementioned obstacles, this project has two purposes. The first purpose is to develop a multimedia translational system of the Computerized Adaptive Testing and Educating System of the HEALth Literacy in strokE Rehabilitation (HEALER). The second and ultimate purpose is to translate this novel system to the promotion of stroke rehabilitation HL across the 3 health domains of healthcare/rehabilitation, disability prevention, and health promotion in for both clinical settings and policy making; and therefore facilitate the quality and effectiveness of healthcare in patients with stroke. Methods: In the first year of the 3-year project, we will use Delphi expert conferences and cognitive interviews to develop the multimedia core educational materials. In the second year, we will adapt the computer adaptive system developed from the previous research project to construct a patient-centered translational system of HEALER by the methods of data simulation, item analyses and structural equation modeling. We will also conduct a 200-patient pilot study to test the HEALER during this stage. In the third year, we will recruit 140 stroke patients in a double blinded, randomized controlled trial (RCT) to examine the immediate, short-term, and long-term beneficial effects of the HEALER in promoting stroke rehabilitation HL during the stages of healthcare/rehabilitation, disability prevention, and health promotion in patients with stroke. Expected results: We expect that the HEALER translational system will significantly improve stroke rehabilitation HL among the 3 domains of healthcare/rehabilitation, disability prevention, and health promotion, and then efficiently and effectively promote stroke rehabilitation healthcare and long-term care outcomes (e.g., participation in decision-making, health behavior, activities of daily living, re-admission) in patients with stroke. Expected impacts on the society, economy, and academic developments: The HEALER will be an efficient and effective way to facilitate the administrative efficiency for improving the stroke rehabilitation HL, and therefore promote health and long-term care outcomes in patients with stroke. No translational system of the computerized adaptive stroke rehabilitation HL test or computerized adaptive education system exists yet. Thus, our system would be the first in the world. Thus, the prediction model and intervention effectiveness of the HEALER does not only impact academic research, but will also reduce the economic and labor burden on stroke rehabilitation in our society.