Self-efficacy as a mediator between digital health literacy and self-care behaviors in older adults with cancer undergoing chemotherapy.

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Original abstract

<h4>Objective</h4>To examine the association between digital health literacy and self-care behaviors and to test whether self-efficacy statistically mediates this association, after adjusting for relevant covariates, among older adults with cancer undergoing chemotherapy.<h4>Methods</h4>A descriptive cross-sectional study was conducted with 117 older adults with cancer undergoing chemotherapy at a tertiary hospital in the Republic of Korea. Participants completed validated measures of digital health literacy (eHEALS), self-efficacy (CSSES-K), and self-care behaviors. Data were analyzed using regression-based mediation analysis (Hayes' PROCESS macro Model 4) with 5000 bootstrap samples, adjusting for sex, age, educational level, cancer diagnosis, and Eastern Cooperative Oncology Group (ECOG) performance status.<h4>Results</h4>Digital health literacy was positively associated with self-efficacy (<i>B</i> = 0.55, 95% confidence interval (CI) [0.26, 0.84], <i>P</i> < 0.001). In the total effect model, digital health literacy was positively associated with self-care behaviors (<i>B</i> = 0.36, 95% CI [0.09, 0.62], <i>P</i> = 0.009). After self-efficacy was included, self-efficacy remained positively associated with self-care behaviors (<i>B</i> = 0.51, 95% CI [0.36, 0.66], <i>P</i> < 0.001), whereas the direct association between digital health literacy and self-care behaviors was not statistically significant (<i>B</i> = 0.08, 95% CI [-0.16, 0.31], <i>P</i> = 0.530). The indirect effect was significant (<i>B</i> = 0.28, 95% bootstrap CI [0.13, 0.51]).<h4>Conclusions</h4>The findings were compatible with an indirect-only mediation pattern, suggesting that digital health literacy may be linked to self-care behaviors primarily through self-efficacy among older adults undergoing chemotherapy. Interventions to promote self-care during chemotherapy may benefit from combining digital health literacy support with strategies that strengthen self-efficacy.

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