Health literacy and recurrence risk perception among stroke patients: insights from a cognitive resource perspective

To examine the association between health literacy and recurrence risk perception among stroke patients and to explore the relationships of social support and coping styles with recurrence risk perception.

A cross-sectional study was conducted among 200 young and middle-aged stroke patients recruited from three tertiary hospitals in Chengdu, China, between December 2025 and April 2026. Data were collected using the Health Literacy Scale for Stroke Patients (HLSSP), Stroke Recurrence Risk Perception Scale, Social Support Rating Scale (SSRS), and Medical Coping Modes Questionnaire (MCMQ). Pearson correlation, multiple linear regression, and mediation analysis using the PROCESS macro (Model 4) were performed.

Health literacy was positively correlated with recurrence risk perception (r = 0.397, P < 0.01) and social support (r = 0.269, P < 0.01). In multivariable regression analyses, both health literacy (β = 0.169, P = 0.013) and social support (β = 0.168, P = 0.008) were significant positive predictors after adjusting for demographic variables. Age was negatively associated (β = -0.205, P = 0.002), whereas education level showed a positive association (β = 0.286, P < 0.001). The model explained 32.6% of the variance. Mediation analysis indicated that coping styles did not have significant indirect effects (95% bootstrap CI included zero).

Health literacy and social support are key determinants of recurrence risk perception among stroke patients. The findings are consistent with a cognitive resource perspective and suggest that health literacy and social support may be associated with recurrence risk perception among stroke patients. Further longitudinal studies are needed to clarify the underlying mechanisms. Coping styles did not mediate this relationship. These results highlight the importance of integrating health literacy and social support interventions into community-based stroke management to promote appropriate risk perception and secondary prevention.