Health information literacy patient activation and health outcomes in cardiac patients using PLS SEM analysis

The study aims to investigate the relationship among prior knowledge, health information literacy, patient activation and health related behavior and outcomes, and guided by the framework of health literacy skills (HLS) and (integrated theory of health behaviour change) ITHBC model. The aim of the present research was to investigate the structural correlations between HIL, PK, PA, and HRBO in patients with cardiac conditions based on partial least squares structural equation modelling (PLS-SEM). A cross-sectional survey was carried out adapted structured questionnaire to collect data from 324 cardiac patients at Mayo Hospital, Lahore Pakistan. The sample was taken from the targeted population, using convenience sampling method. The measures were validated HIL, PK, PA, and HRBO rating scales that were used to collect the data. SmartPLS was used to evaluate the measurement and structural models. Among 324 cardiac patients, the sample was predominantly male (71.3%), with 23.5% aged > 60 years and 59.0% reporting a monthly income below PKR 32,000. Most participants had limited formal education. Family members were the primary source of social support. The measurement model had acceptable reliability and validity whereas all the indicators that were retained had an outer loading of at least 0.70 and had an HTMT of less than 0.85. HIL was positively associated with PA (β = 0.284) and PK (β = 0.301). There was a positive correlation between PA and PK (= 0.198) and the one between PA and HRBO (= 0.342), but PK exhibited the most significant association with HRBO (= 0.441). The model explained 40.6% of the variance in PA (R² = 0.406), 9.2% in PK (R² = 0.092), and 52.0% in HRBO (R² = 0.520). The model-fit measures revealed that it was well fit, as the SRMR was 0.068 and the NFI was 0.912. HIL, PK, and PA showed a positive relationship with HRBO in cardiac patients; PK had the greatest structural correlation with HRBO. These findings highlight the importance of strengthening health information literacy, prior knowledge, and patient activation as integral components of patient-centered cardiac care. In addition, PA mediates the effects of HIL on HRBO, whereas PK plays mediating roles in linking either HIL and HRBO or HIL and PA. The longitudinal and multicenter studies in the future need to investigate the time and contextual processes of these relationships.