Mediating role of learned helplessness’ components in the association between health literacy/social support and self-management among maintenance haemodialysis patients in Changsha, China: a cross-sectional study

OBJECTIVES: To explore the multiple mediating roles of the learned helplessness’s core system in the relationship between health literacy/social support and self-management. DESIGN: Cross-sectional survey design. SETTING: Changsha, China. PARTICIPANTS: 239 Chinese maintenance haemodialysis (MHD) patients. METHODS: Two multiple mediator models were constructed based on the COM-B (Capacity, Opportunity, Motivation - Behaviour) model. A total of 239 Chinese MHD patients participated in a cross-sectional study, which included surveys on the Learned Helplessness Scale for MHD patients, Dialysis Knowledge Questionnaire, Social Support Scale and Self-Management Scale for Haemodialysis. The PROCESS macro in SPSS was used for mediated effects analysis. RESULTS: Helplessness and internality partially mediated the relationship between health literacy/social support and self-management ((β=−0.212, p<0.01; β=0.240, p<0.01)/(β=−0.331, p<0.001; β=0.376, p<0.001)). The mediation effect size was 0.780 (95% CI (0.373 to 1.218)) in the health literacy model, accounting for 45.29% of the total effect, and 0.286 (95% CI (0.207 to 0.377)) in the social support model, accounting for 57.88% of the total effect. The differences in effect sizes for helplessness and internality in the two models were −0.080 (95% CI (−0.374 to 0.216)) and −0.041 (95% CI (−0.127 to 0.043)), respectively. CONCLUSION: Health literacy/social support directly affects MHD patients’ self-management and indirectly affects it by changing learned helplessness, such as increasing internality while reducing helplessness.