Men with low health literacy were 71% less likely to maintain ≥80% rehab adherence after prostatectomy, per a Chinese single-center study of 1,615.
Journal: Frontiers in Public Health | Published: 2026-03-20 | Type: Cross-sectional survey | PMID: 41938943 Authors: Wei Lihan, Wu Ye, Wei Fei, Yi Yongxiang (Urinary Surgery, Third Affiliated Hospital of Zhejiang University of Traditional Chinese Medicine) Funding/COI: Funding not disclosed. Authors declared no commercial or financial conflicts of interest.
This single-center Chinese survey of 1,615 men after radical prostatectomy found that health literacy — measured by the validated HLS19-Q12 instrument — was independently associated with virtually every metric of sexual rehabilitation engagement: PDE5 inhibitor use, injection therapy, multimodal treatment, and adherence. The gap between high- and low-literacy patients was not subtle: digital health resource use varied fourfold (61.2% vs. 27.0%) and adherence rates differed by 14.7 percentage points. Cross-sectional design means causality cannot be established, and the single-center Chinese sample limits generalizability, but the dose-response pattern across literacy tertiles is consistent and statistically robust.
N = 1,615 is substantial for a KAP (Knowledge-Attitudes-Practices) survey, and the 88% response rate is high. The HLS19-Q12 is a validated instrument, and the analytical stack — hierarchical logistic regression, mediation analysis, latent class modeling — is appropriate for the questions asked. The authors correctly stratified by literacy tertiles rather than treating it as a continuous variable, and they adjusted for clinically plausible confounders including nerve-sparing status, education, and age.
That said, the cross-sectional design is the central limitation, and the authors acknowledge it clearly: correlation does not establish that low literacy causes worse adherence. The low-literacy group was older and less educated, and older men may face more comorbidities, more embarrassment, or different partner dynamics — factors that partially overlap with literacy but weren't fully disentangled. Mediation analysis on cross-sectional data remains methodologically contested; the "31% mediated" figure is an association-based estimate, not causal evidence.
This is a well-executed observational study that does what it says on the label: it documents a large, consistent association between health literacy and post-prostatectomy sexual rehabilitation engagement in a Chinese hospital cohort. The methodology is solid and the reporting is honest about causal limits. What it cannot tell you — and doesn't claim to, in the fine print — is whether improving health literacy actually improves rehabilitation outcomes, or whether literacy is proxying for something else entirely (age, education, socioeconomic stability, partner support). The "modifiable lever" framing in the discussion is the paper getting ahead of its evidence. Worth reading for the descriptive epidemiology; not worth citing as proof that literacy interventions will close the adherence gap until an RCT says so.