The association between health literacy and Health Information-Seeking Behavior among pulmonary nodule patients

A serial mediation of illness perception and self-efficacy

Bibliographic Data

ID22076585
AuthorsJinting Sun (0009-0002-5407-4403, Soochow University), Qian Zhao (0000-0003-1760-249X, Department of Pulmonology, The First Affiliated Hospital of Soochow University), Yanxia Han (0000-0003-2280-693X, Soochow University), Chang Zhu (0000-0002-0057-275X, Department of General Surgery, The First Affiliated Hospital of Soochow University), Chaohui Zhu (Soochow University), Hongying Qian (Soochow University), Rui Liu (0000-0002-1489-731X, Soochow University, corresponding author), Siying Zhou (Department of General Surgery, The First Affiliated Hospital of Soochow University), Shilin Zhou (Soochow University, corresponding author)
Year2026
Volume14
Pages1773518-1773518
Publication date2026-03-18
Peer ReviewedYes
Open AccessYes
TypeARTICLE
VenueFrontiers in Public Health (JOURNAL)
Journal identifiersISSN: 2296-2565 • E-ISSN: 2296-2565
PublisherFrontiers Media SA (PUBLISHER • CH)
DOI10.3389/fpubh.2026.1773518
PMID41929889
OpenAlexW7139052081
LanguageEN
References cited41

Objective This study aimed to examine the association between health literacy and Health Information-Seeking Behavior (HISB) among patients with pulmonary nodules (PNs). It further assessed whether illness perception and self-efficacy were associated with this relationship using a theoretically specified serial mediation model informed by the Information-Motivation-Behavioral Skills (IMB) framework. Methods This cross-sectional study was conducted from February to June 2024. Patients with PNs were recruited from two tertiary hospitals in Suzhou, China, using convenience sampling. Structural equation modeling (SEM) was applied to test hypothesized associations among variables. Bias-corrected bootstrapping was used to estimate direct and indirect effects, including serial indirect effects consistent with the hypothesized ordering. Multi-group analysis examined whether model estimates differed by educational level. Reporting followed the STROBE guidelines. Results Overall, 321 patients completed the survey. The mean score of HISB was 131.85 (SD = 34.96). HISB showed modest positive correlations with health literacy ( r = 0.464, p < 0.01) and self-efficacy ( r = 0.497, p < 0.01), and negative correlation with illness perception ( r = −0.429, p < 0.01). The SEM showed excellent fit ( χ 2 /df = 1.46, RMSEA = 0.038, CFI = 0.982). Health literacy showed association with HISB ( β = 0.477, p < 0.001). Indirect associations were observed via self-efficacy [ β = 0.110, 95% CI (0.062, 0.173)] and illness perception [ β = 0.065, 95% CI (0.035, 0.108)]. A statistically significant but modest serial indirect effect was observed [ β = 0.021, 95% CI (0.009, 0.040)], consistent with the hypothesized model. Multi-group analysis supported configural invariance across education levels, although the strength of some associations varied. Conclusion This study found both direct and indirect associations between health literacy and HISB among patients with PNs. The findings suggest that interventions that providing literacy-sensitive support, address maladaptive illness perception, and strengthen self-efficacy may help foster adaptive information-seeking and improve long-term surveillance adherence and psychological outcomes

Health literacy · Literacy · Mediation · Perception · Structural equation modeling · Health Literacy and Information Accessibility · Health Sciences Research and Education · Patient-Provider Communication in Healthcare

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