The effect of health literacy, self-efficacy, social support and fear of disease progression on the health-related quality of life of patients with cancer in China: a structural equation model

BACKGROUND: Health literacy (HL), self-efficacy (SE), social support (SS) and fear of disease progression (FOP) are all important factors affecting health-related quality of life (HRQoL) in cancer patients. However, their synergistic effects and underlying mechanisms on HRQoL in cancer patients remain unclear. Therefore, the purpose of this study was to construct a structural equation model (SEM) to explore the underlying mechanism of factors affecting HRQoL. It is hoped that this study will provide a theoretical basis for future interventions. METHODS: A cross-sectional design and convenience sampling method were used to investigate cancer inpatients in two general hospitals in Chongqing and Chengdu. Data were collected using structured scales, including HL, SE, SS, FOP and HRQoL. Finally, the SEM was constructed, and P ≤ 0.05 was considered significant. RESULTS: There were 1749 participants included in this study. Correlation analysis showed that all variables were significantly correlated with one another except for symptoms, physical health (PD) and social family (SF) (p < 0.01). The SEM of the HRQoL had a good overall fit (GFI = 0.943, AGFI = 0.917, NFI = 0.950, RFI = 0.936, CFI = 0.955, IFI = 0.955, RMSEA = 0.072). The model indicated that HL had the strongest correlation with HRQoL (β = 0.398, p < 0.01), followed by FOP (β = -0.364, p < 0.01), SE (β = 0.347, p < 0.01) and SS (β = 0.184, p < 0.01). CONCLUSIONS: The HRQoL of cancer patients is correlated with HL, SS, SE and FOP. HL can directly affect HRQoL and mediate HRQoL through SS and SE. Future programs should consider HL promotion, SE improvement and SS expansion as the breakthrough point when designing targeted intervention strategies. At the same time, the importance of the impact of FOP on the HRQoL of patients with cancer should not be ignored.