The impact of health beliefs on treatment decision conflict through treatment expectations mediation in patients with lumbar disc herniation

Low back pain is a leading cause of disability worldwide. Lumbar disc herniation (LDH), a prevalent etiology of low back pain, has various treatment options. This study investigated the impact of health beliefs on decision conflict regarding treatment choices in patients with LDH. A cross-sectional survey was administered to 737 patients with LDH. Three key constructs were assessed using validated instruments: health beliefs (Health Belief Scale), decision conflict (Decision Conflict scale), and treatment expectations (Treatment Expectation Questionnaire). The goodness-of-fit of the hypothesized theoretical framework was evaluated through structural equation modeling. Subsequently, descriptive statistics and Pearson correlation analyses were conducted to examine inter-variable relationships. Finally, the mediation effect of treatment expectations was tested using bias-corrected bootstrap procedures. Health beliefs demonstrated a significant negative association with decision conflict (r = - 0.660, p < 0.001), indicating that stronger health beliefs correlated with reduced decision-making difficulties. Similarly, treatment expectations exhibited a moderate inverse relationship with decision conflict (r = - 0.322, p < 0.001). Mediation analysis identified that treatment expectations were associated with a partial mediating pattern in the relationship between health beliefs and decision conflict (B = - 0.013, SE = 0.005, 95% CI: -0.024 to - 0.006), reflecting an observed correlational pathway that accounted for 19.7% of the total effect of health beliefs on decision conflict. This study found that health beliefs and treatment expectations influence the treatment decisions of patients with lumbar disc herniation (LDH) and reduce decision conflict.