Social support and self-efficacy mediate the link between health literacy and fear of disease progression in Chinese lung cancer patients

Fear of disease progression (FOP) has emerged as one of the most prevalent and distressing unmet needs among lung cancer patients in recent years. This study aimed to explore the associations between health literacy (HL), social support (SS), self-efficacy (SE) and FOP, and to examine the mediating roles of SS and SE in the relationship between HL and FOP in lung cancer patient population. A cross-sectional design with convenience sampling was employed to survey cancer inpatients in two general hospitals in Chongqing and Chengdu, two major cities in southwestern China. Data were collected via validated scales for HL, SE, SS and FOP. A structural equation model (SEM) was then constructed, P ≤ 0.05 was considered statistically significant. The mean FOP score FOP was 31.20 ± 9.28; 162 patients (43.09%) exceeded cutoff for psychological dysfunction (≥ 34). Correlation analysis revealed that FOP was significantly negative correlated with all variables except for objective support (OS) and subjective support (Subs) (p < 0.01). The SEM of the FOP exhibited good fit (GFI = 0.949, NFI = 0.964, CFI = 0.978, IFI = 0.978, AGFI = 0.918, RMSEA = 0.064). The model indicated that HL had the strongest correlation with FOP (β = -0.300, p < 0.05), followed by SE (β =-0.281, p < 0.05). Notably, SE mediated the association between HL and FOP (contribution effect: 40.67%). SS positively influence SE (β = 0.131, p < 0.05) but had no statistically significant effect on FOP (p > 0.05). HL exerted the strongest protective effect on FOP, both directly and indirectly via enhanced SE. Utilization of support Subs (US) was clinically more significant than OS and Subs. Clinical interventions should prioritize improving health literacy through targeted education, psychological support, and coping skills training to strengthen patients' use of available support and foster psychological adaptation.