Patient activation and self-management in patients with coronary heart disease: the mediating role of eHealth literacy.

OBJECTIVE: Although patient activation and eHealth literacy are known to influence self-management in chronic diseases, evidence on whether eHealth literacy mediates this relationship in patients with coronary heart disease (CHD) remains limited. This study explored the associations between patient activation, eHealth literacy, self-efficacy and self-management in patients with CHD and aimed to examine both the direct and indirect associations of patient activation on self-efficacy and self-management through eHealth literacy. METHODS: A cross-sectional method was adopted and a convenience sample of 433 hospitalized patients with CHD was recruited. Data were collected using the Patient Activation Measure-13, the eHealth Literacy Scale and the Heart Health Self-Efficacy and Self-Management scale (which provides a composite outcome measure) and analyzed using Pearson correlation, stepwise regression and bootstrap methods. RESULTS: The mean scores were 58.89 ± 18.87 for patient activation, 24.92 ± 8.94 for eHealth literacy and 60.70 ± 15.34 for the combined self-efficacy and self-management measure. Patient activation was moderately positively correlated with eHealth literacy (r = 0.51, p < 0.001) and the combined measure (r = 0.59, p < 0.001), and eHealth literacy showed a weak positive correlation with the combined measure (r = 0.37, p < 0.001). Patient activation was directly and positively associated with the combined measure (β = 0.533, p < 0.001), and eHealth literacy partially mediated this relationship (indirect effect = 0.043, 95% CI [0.002, 0.088], p = 0.043), accounting for 9% of the total effect. This relatively small indirect effect suggests a modest mediating role, indicating that the direct pathway from patient activation to self-efficacy and self-management is substantially more influential than the pathway through eHealth literacy in this population. CONCLUSION: Patient activation, eHealth literacy, self-efficacy and self-management in patients with CHD were at moderate or moderately low levels. Higher levels of patient activation and eHealth literacy are associated with better self-efficacy and self-management, a pattern that may underlie improved self-management.