OTRNSurveyThe journal of nursing research : JNR2026

Associations Among Health Literacy, Decision Self-Efficacy, and Decisional Conflict in Stroke Survivor-Caregiver Dyads.

Ya-Ting Liu, Si-Xun Zhang, Mei-Sin Chong and 9 others

PMID 42363954

WHAT IT FOUND

Among 305 stroke survivor and caregiver pairs, survivors with higher health literacy and decision confidence reported less decisional conflict.

Caregiver confidence was part of a pathway to less survivor conflict but associated with more caregiver conflict. This is association, not proof that training helps.

Key findings

01Stroke survivors with higher health literacy reported lower decisional conflict, and their decision self-efficacy partly explained this association.

02Caregiver health literacy was associated with lower survivor decisional conflict through caregiver decision self-efficacy.

03Caregiver decision self-efficacy showed a mixed pattern: higher caregiver self-efficacy was associated with higher caregiver decisional conflict, but it was part of a pathway associated with lower survivor conflict.

STILL TO COME

How it was doneWhat they foundWhat it means for OTsWhat it means for RNs

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What it does not show

The design measured everything once, so it cannot show whether health literacy or decision confidence caused less conflict, or how conflict changed over time. Survivors had to have normal language and cognition, so findings may not apply to stroke survivors with aphasia or cognitive impairment. Participants came from six hospitals in Henan Province, China, and the authors note possible selection bias and limited generalisability. The study relied on questionnaires, not observed behaviour or clinical outcomes, and the proposed coaching and decision aids were not tested here.

Declared interests

The paper states the funder was the National Natural Science Foundation of China.

The easy way to misread this

Do not read these associations as proof that raising health literacy or decision confidence will reduce decisional conflict. The study measured people once, and higher caregiver decision self-efficacy was associated with higher caregiver decisional conflict, not lower.

Read it on PubMed →