Top Things to Know: Health Literacy and Communication in Stroke Prevention, Management, and Recovery
Updated: October 15, 2026
Prepared by Kevin J. Mercer, PharmD, MPH, FCCM, Science & Medicine Advisor
- Health literacy is framed not as a patient deficit but as a shared, system-level responsibility, with healthcare systems, not individual patients, expected to redesign communication through plain language, tailored materials, and team-based care.
- Health literacy is strongly linked to functional outcomes, psychological burden, and mortality across the entire stroke continuum, yet it remains underappreciated, particularly among survivors with cognitive or language impairments, limited English proficiency, or limited digital literacy.
- Population-level stroke literacy, including recognition of B.E. F.A.S.T. warning signs and timely activation of emergency medical services, is a foundational but often underutilized pillar of prevention, and limited health literacy is linked to delayed symptom recognition and delayed EMS activation.
- Up to two-thirds of stroke survivors experience communication deficits such as aphasia or dysarthria, and the statement is explicit that these are neurologically distinct from limited health literacy, though the two compound one another and are easily missed when deficits are masked.
- The FRAME model offers a structured, evidence-based approach to communicating with patients who have aphasia or other communication challenges: build Familiarity with how the patient communicates, Reduce the rate of speech, Assist comprehension, Mix communication methods, and Engage the patient directly to preserve autonomy.
- Health literacy support is not distributed equitably: patients from underrepresented racial and ethnic groups, those with limited English proficiency, and those with fewer socioeconomic resources are more likely to receive less intensive postacute care and encounter communication that does not match their needs.
- Randomized trials of nurse-led teach-back education, patient-caregiver coaching, and hospital-to-home health coaching have improved stroke knowledge, self-efficacy, and quality of life, though the evidence base remains limited by small samples, heterogeneous measures, and short follow-up.
- Care transitions after stroke hospitalization are a high-risk period for health literacy breakdowns. While several single-site nurse-led coaching trials reduced readmissions, a large safety-net trial testing a coordinated chronic care model found no significant improvement in literacy outcomes or blood pressure control.
- Translating health literacy principles into practice depends on organizational investment, including dedicated stroke nurse navigator roles, standardized teach-back protocols, reliable interpreter access, and protected time for patient education built into nursing staffing models rather than treated as an afterthought.
- Emerging AI and digital tools could improve the readability of stroke education, but algorithmic bias and unequal digital access could widen disparities, and most current health literacy measurement tools were not designed for survivors with aphasia, cognitive impairment, or limited English proficiency.
Citation
Mogos MF, Maynard S, Perrin S, Nguyen-Huynh M, Bahouth MN, Torrington Eaton C, Feinberg I, Sampson J, Magnani JW, Keigher K; on behalf of the American Heart Association CVSN Stroke and Neurovascular Nursing Science Committee of the Council on Cardiovascular and Stroke Nursing; Council on Clinical Cardiology; and Stroke Council. Health literacy and communication in stroke prevention, management, and recovery: a scientific statement from the American Heart Association. Stroke. Published online October 15, 2026. doi: 10.1161/STR.0000000000000537