The serial mediating role of self-esteem and health literacy in the relationship between self-efficacy and benefit finding among Chinese systemic lupus erythematosus patients

Abstract

Objective: To investigate the serial mediating roles of self-esteem and health literacy in the relationship between self-efficacy and benefit finding among patients with systemic lupus erythematosus (SLE), and to provide empirical evidence for developing targeted clinical interventions. Methods: A cross-sectional study was conducted using convenience sampling. A total of 207 patients with SLE were recruited from the rheumatology outpatient department of a tertiary Grade-A hospital in Zhejiang Province. Data were collected using the General Information Questionnaire, the Rosenberg Self-Esteem Scale (RSES), the Self-Efficacy for Managing Chronic Disease Scale, the Health Literacy Scale, and the Benefit Finding Scale (BFS). Pearson correlation analysis and Hayes' Process macro, were used to analyze the data. Results: < 0.001). Path analysis indicated that self-efficacy had a significant direct effect on benefit finding (β = 0.339, 95% CI: 0.041-0.636). The mediating effects of self-esteem (effect = 0.636, 95% CI: 0.234-1.067) and health literacy (effect = 0.506, 95% CI: 0.200-0.819) were also significant. Furthermore, the serial mediating pathway of "self-efficacy → self-esteem → health literacy → benefit finding" was significant (effect = 0.212, 95% CI: 0.042-0.577). The moderation analysis indicated that the indirect effect of self-efficacy on benefit finding via the chain mediation of self-esteem and health literacy was stronger in younger patients (β = -0.080, 95% CI: -0.120 to -0.039). Conclusion: Self-efficacy is positively associated with benefit finding in patients with SLE directly and indirectly through self-esteem and health literacy. Age moderates the relationship between self-efficacy and self-esteem. Clinical nursing staff should adopt age-specific interventions to improve patients' self-esteem and health literacy, which may help promote their benefit finding.

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