Digital health literacy and shared decision-making in hypertension: Sequential mediation by self-efficacy and patient activation.

OBJECTIVE: This study aimed to explore the relationship between digital health literacy (DHL) and shared decision-making (SDM) among Chinese individuals with hypertension and to examine whether self-efficacy and patient activation (PA) sequentially mediated the association between DHL and SDM. METHODS: A cross-sectional questionnaire survey was conducted among individuals with hypertension in Changzhou City, Jiangsu Province. All participants completed a structured questionnaire, including demographic information, DHL, self-efficacy, PA, and SDM. Pearson correlation analysis was used to examine the relationships among DHL, self-efficacy, PA, and SDM. Multivariate linear regression analysis was performed to identify factors associated with SDM. Mediation analysis based on the Bootstrap method was applied to test the sequential mediating effects of self-efficacy and PA in the relationship between DHL and SDM. RESULTS: This cross-sectional study included 662 individuals with hypertension. DHL, self-efficacy, and PA were all significantly and positively correlated with SDM (r = 0.385-0.538, P < 0.01). Regression analysis showed that DHL was significantly associated with SDM. Mediation analysis suggested that the association between DHL and SDM may be partially explained by the sequential mediation of self-efficacy and PA. CONCLUSIONS: DHL was positively associated with SDM among individuals with hypertension, and this association may be partly explained by self-efficacy and PA. PRACTICE IMPLICATIONS: In clinical practice, interventions targeting DHL, self-efficacy, and PA may support patients' participation in SDM.