The Mediating Role of Self-Efficacy Between Health Literacy and Chronic Disease Self-Management

Abstract Background Health literacy is a key determinant of health outcomes and chronic disease management in older adults. Low health literacy limits access to care, medication adherence, and disease control. Self-management involves tracking symptoms, following treatment, and lifestyle changes. Self-efficacy-the belief in one's ability to succeed-may mediate the link between health literacy and disease self-management. Methods This cross-sectional study involved 183 hospital-based patients aged 65+ with chronic conditions. Data were collected using the Health Literacy Scale for Older Adults, the General Self-Efficacy Scale, and the Chronic Disease Self-Management Scale. Mediation was tested via PROCESS macro for SPSS (Model 4). Results Mean age was 71.63 years (SD = 6.98). Self-management correlated positively with health literacy (r = 0.347, p < 0.001) and self-efficacy (r = 0.380, p < 0.001). Health literacy and self-efficacy were also strongly correlated (r = 0.781, p < 0.001). Mediation analysis showed a partial mediating effect of self-efficacy. The direct effect of health literacy on self-management was β = 0.226 (95% CI: 0.171-0.275), and the indirect effect through self-efficacy was β = 0.058 (95% CI: 0.034-0.086). Conclusions Self-efficacy partially mediates the effect of health literacy on disease self-management in older adults. Interventions to improve chronic disease outcomes should address both health literacy and self-efficacy to strengthen behavior change capacity. Key messages • Self-efficacy mediates the effect of health literacy on chronic disease self-management in older adults. • Enhancing self-efficacy and health literacy together may improve chronic disease outcomes.