Effect of Health Literacy–Based Intervention on Stroke Recurrence Prevention: A Scoping Review
Harit Sianghwong, Kevin Brazil, Gillian PrueBackground
Stroke recurrence contributes substantially to long‐term disability, mortality and healthcare burden. Effective secondary prevention requires sustained self‐management, treatment adherence and risk‐factor control, all of which may be influenced by health literacy (HL). However, evidence on HL‐based interventions for stroke recurrence prevention remains fragmented.
Aim
To map and synthesise evidence on HL‐based interventions for stroke recurrence prevention, including intervention characteristics, delivery approaches, outcomes and implementation‐related barriers and facilitators.
Design
Scoping review.
Methods
The review followed Joanna Briggs Institute methodology and was reported in accordance with PRISMA‐ScR. Six electronic databases were searched for studies published from January 2014 to December 2025. Quantitative, qualitative and mixed‐methods primary studies involving adult stroke survivors including older adults, and HL‐based interventions relevant to secondary prevention were eligible. Two reviewers independently screened titles and abstracts, and data were extracted using a predefined form.
Results
Nine studies from eight countries were included, spanning randomised and quasi‐experimental studies, feasibility and intervention‐development studies, and qualitative research. Interventions used digital, audiovisual, face‐to‐face and hybrid approaches and commonly incorporated education, medication‐adherence support, self‐management, risk‐factor monitoring, reminders and behaviour‐change strategies. Improvements were reported in stroke knowledge, medication adherence, selected self‐management behaviours and some vascular risk indicators. However, HL was inconsistently conceptualised and measured; several studies incorporated HL‐related components without explicitly defining or directly assessing HL. Follow‐up ranged from several weeks to 12 months, and only one study assessed stroke recurrence as a primary outcome. Facilitators included culturally and linguistically appropriate materials, professional support, personalised feedback and caregiver involvement, whereas technology‐related challenges, limited digital literacy and stroke‐related physical or cognitive limitations were identified as barriers.
Conclusion
HL‐based interventions may support stroke knowledge, self‐management, medication adherence and selected risk‐factor outcomes, but the evidence base remains heterogeneous. Greater conceptual clarity, consistent and validated HL measurement and more robust evaluation of long‐term clinical and implementation outcomes are needed.
Impact
The review identifies key intervention features, measurement gaps and implementation considerations that can inform the development and evaluation of more consistent, context‐sensitive HL interventions for secondary stroke prevention.