Nutritional literacy in young and middle-aged patients with ischemic stroke: a mixed-methods study with IMB...

Stroke incidence is rising among young and middle-aged adults, who bear major social and family responsibilities. Poor nutritional literacy is linked to unhealthy dietary behaviors and may increase stroke recurrence risk. However, evidence on nutritional literacy in this population remains limited, particularly under a validated theoretical framework.

To evaluate nutritional literacy and explore its influencing factors among young and middle-aged patients with ischemic stroke using an explanatory mixed-methods design guided by the Information-Motivation-Behavioral Skills (IMB) model.

A sequential explanatory mixed-methods study was conducted. Quantitative data were collected from 224 inpatients using the Chinese Nutrition Literacy Assessment Instrument (CHI-NLit). Univariate analysis was performed to identify associated factors. Qualitative data were obtained through semi-structured interviews with 16 purposively selected patients and analyzed using Colaizzi's method under the IMB framework.

The mean nutritional literacy score was 18.24 ± 4.85 (scoring proportion 48%). 76.3% of patients scored below the adequacy threshold. Nutritional skill scores were significantly lower than cognitive scores; notably, 79.9% of patients scored zero in the food label calculation subscale. Univariate analysis showed that lower nutritional literacy was associated with middle age, low education, rural residence, low income, and manual occupation (all p < 0.05). Multivariable linear regression identified middle age (41-59 years, β = -0.239, p < 0.001) and high school education or above (vs. primary school or below, β = 0.351, p < 0.001) as independent determinants, whereas junior high school education was not significant (p = 0.067). Qualitative findings identified three core themes: fragmented information acquisition and poor knowledge-to-practice translation, complex motivation involving family responsibility and negative emotions, and multiple behavioral skill deficits including food label interpretation, workplace social dilemmas, and dynamic self-efficacy.

This mixed-methods study reveals that nutritional literacy is insufficient among young and middle-aged patients with ischemic stroke, with particularly severe deficits in practical skills. The IMB model effectively identifies barriers across information, motivation, and behavioral skills domains. The integration of quantitative and qualitative findings provides a comprehensive evidence base for designing targeted interventions. However, longitudinal and interventional studies are needed to determine whether improving nutritional literacy reduces stroke recurrence or improves clinical outcomes.