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

Project: A - Government Institutionb - Ministry of Science and Technology

Project Details


Background: Health literacy (HL) is the ability of a person to access, understand, appraise, and apply health information and services. Rehabilitation Medicine has the similar mindset in enhancing disabled people's self-care and self-management. People with good HL take actions for their health by obtaining knowledge and applying skills to promote every aspect of their health. In the system of stroke healthcare, 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 clinical decision-making, self-management, and quality-of-life. 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 stroke 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: 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 conduct a randomized controlled trial (RCT) for the predictive model of the relevant determinant factors and the effectiveness of related outcome indicators. We hope through the translation system can promote stroke rehabilitation HL across the 3 health domains of healthcare/rehabilitation, disease/disability prevention, and health promotion in both clinical settings and policy making; and therefore provide evidence-based quality care in patients with stroke. Methods: In the first year of the 3-year project, we will conduct a 210-patient pilot study to test the HEALER through adapting a patient-centered translational system of HEALER developed from two previous research projects by the methods of item analyses and data simulation. In the second to third year, we will recruit 210 stroke patients in a double blinded RCT to examine the immediate, short-term, and long-term beneficial effects of the HEALER in promoting stroke rehabilitation HL, shared decision-making, health behaviors, and health outcomes during the stages of healthcare/rehabilitation, disease/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 domains of healthcare/rehabilitation, disease/disability prevention, and health promotion, and then efficiently and effectively promote stroke rehabilitation healthcare and long-term care outcomes (e.g., shared decision-making, health behavior, activities of daily living, health outcomes, and quality-of-life) 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 and intervention effectiveness for stroke rehabilitation HL, and therefore promote other health 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 for the stroke population. We hope that the prediction model and intervention effectiveness of the HEALER will not only impact academic research, but also reduce the economic and labor burden on stroke rehabilitation in our society.
Effective start/end date8/1/177/31/18


  • Stroke rehabilitation
  • Health literacy
  • Computer adaptive testing
  • Shared decision-making
  • Translation system