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

BACKGROUND: The cognitive and physical impairments often experienced by stroke survivors make health care decisions challenging for both survivors and their caregivers. Although poststroke care decision-making involves complex factors such as health literacy and decision self-efficacy, research on the interactions among health literacy, decision self-efficacy, and decisional conflict within stroke survivor-caregiver dyads remains limited. PURPOSE: This study was designed to explore the inter-relationships among health literacy, decision self-efficacy, and decisional conflict in stroke survivor-caregiver dyads. METHODS: This cross-sectional study, conducted from September 2023 to April 2024, included 305 pairs of Chinese stroke survivor-caregiver dyads. The All Aspects of Health Literacy Scale, Decision Self-Efficacy Scale, and Decisional Conflict Scale were used to collect data from both stroke survivors and their caregivers. A dyadic analysis was conducted using the actor-partner interdependent mediation model. RESULTS: In terms of actor effects, decision self-efficacy was found to respectively mediate health literacy and decisional conflict in stroke survivors (β = -0.511, p < .001) and their caregivers (β = 0.212, p = .006). In terms of the partner effect, caregiver decision self-efficacy was found to relate negatively to survivor decisional conflict and to mediate the relationship between caregiver health literacy and survivor decisional conflict (β = -0.236, p = .019). CONCLUSIONS: The results of this study indicate that, in stroke survivors, higher health literacy has a direct reducing effect on perceived decisional conflict. In light of this, dyadic-based intervention strategies should be developed. Examples include joint workshops designed to improve stroke survivor-caregiver shared information interpretation and comprehension, and the development of dyadic-oriented decision aids to help both dyad partners achieve information symmetry and consensus in their health care decision-making.