Understanding the relationship between eHealth literacy, self-efficacy, social support, and patient activation in breast cancer patients: a chain mediation analysis

Background: Patient activation is essential for effective self-management among breast cancer patients, yet the mechanisms through which eHealth literacy contributes to it remain incompletely understood. Objective: This investigation sought to delineate the chain mediating roles of self-efficacy and social support linking eHealth literacy to patient activation among breast cancer populations. Methods: 316 breast cancer patients were recruited into a cross-sectional survey framework. Each participant underwent an evaluation of their levels of patient activation, perceived social support, self-efficacy, and eHealth literacy. After controlling relevant factors, model 6 in PROCESS 4.1 was applied to construct a chain mediation model; the bootstrapping procedure was subsequently applied to verify the mediating pathways. Results: < 0.01). Chain mediation analysis revealed that social support and self-efficacy acted as sequential intermediaries transmitting the influence of eHealth literacy onto patient activation. The aggregate indirect effect accounted for 35.7%, with all pathway confidence intervals excluding zero. Conclusion: Among breast cancer patients, eHealth literacy was associated with patient activation through sequential mediation by social support and self-efficacy. These findings suggest that strategies to strengthen patients' eHealth literacy, mobilize social support, and build self-efficacy may hold promise for promoting active participation in health self-management, although the effectiveness of such interventions warrants confirmation in future longitudinal or intervention studies.