Digital Health Literacy and Social Participation in Individuals With Hemiplegia

Stroke-related hemiplegia may affect not only motor function and independence in activities of daily living but also individuals' ability to participate in family, social, and community life. With the increasing use of online health information, mobile health applications, and electronic health services, digital health literacy may play an important role in access to health information, self-management, and engagement in rehabilitation.

This study is designed as a single-center, cross-sectional observational study. It will include 250 adults aged 18 years or older who have hemiplegia following a stroke that occurred at least 6 months previously. Participants must be able to communicate, provide written informed consent, and have a Mini-Mental State Examination score of 24 or higher.

Sociodemographic and clinical characteristics, including age, sex, education level, employment status, stroke duration, affected side, assistive device use, functional ambulation level, smartphone use, internet use, and use of electronic health services, will be recorded.

Digital health literacy will be evaluated using the eHealth Literacy Scale (eHEALS). Social participation, the primary outcome of the study, will be evaluated using the Reintegration to Normal Living Index (RNLI). Anxiety and depressive symptoms will be assessed using the Hospital Anxiety and Depression Scale (HADS), functional independence using the Barthel Index, fatigue using the Fatigue Severity Scale (FSS), and cognitive status using the Mini-Mental State Examination.

The primary analysis will examine the association between the eHEALS total score and the RNLI total score. Multiple linear regression analysis will be used to investigate whether digital health literacy is independently associated with social participation after accounting for relevant sociodemographic and clinical variables.

Inclusion criteria

Age 18 years or older Diagnosis of hemiplegia following stroke History of stroke at least 6 months before enrollment Ability to communicate sufficiently to complete the study assessments Mini-Mental State Examination score of 24 or higher Ability and willingness to provide written informed consent

Exclusion criteria

Severe aphasia preventing completion of the assessments Advanced cognitive impairment Severe psychiatric disorder that may interfere with participation or completion of the assessments Visual or hearing impairment that prevents completion of the questionnaires