The moderating effect of power distance among high-risk groups of stroke on health literacy and self-management behaviors

To explore the moderating effect of patient power distance on the association between health literacy and self-management behaviors in individuals at high risk of stroke. Accumulating evidence indicates that health literacy positively influences self-management behaviors, yet self-management remains unsatisfactory among stroke high-risk populations. Although patient power distance is closely linked to patients’ medical behaviors, its moderating role in the above relationship has not been fully clarified. Purposive sampling was used to recruit participants from four community health service centers in Pudong New Area, Shanghai, China. Eligible subjects were selected from outpatient clinics, contracted physical examinations, and stroke high-risk screening programs in line with the predefined inclusion and exclusion criteria. The measurement tools included the Self-Management Behavior Scale for High-Risk Stroke Populations (SMB), the Health Literacy Scale for Patients with Chronic Diseases (HeLMES), and the Patient Power Distance Scale (PPDS). The Johnson-Neyman technique and SPSS macro procedure were utilized to analyze the moderating effect of power distance and its effective value range. The average scores of health literacy, self-management behaviors and patient power distance were 2.15 ± 0.40, 2.24 ± 0.39 and 3.34 ± 0.23, respectively. Patient power distance showed a non-significant direct effect on self-management behaviors ( B = − 0.065, p = 0.188), but significantly weakened the positive association between health literacy and self-management behaviors. Johnson-Neyman analysis indicated that the positive effect of health literacy was statistically significant only when power distance scores ranged from 2.2 to 3.7, and turned non-significant outside this range. Interventions for stroke high-risk populations should prioritize health literacy improvement. Meanwhile, medical staff need to adjust doctor-patient power cognition, build equal and collaborative doctor-patient relationships, and reduce patients’ perceived power gaps. These strategies can strengthen the facilitating effect of health literacy on self-management and ultimately improve population health outcomes.