Exploring the mediating roles of stigma and perceived social support between health literacy and health care decision-making barriers among patients with cervical cancer.

OBJECTIVE

This study aims to investigate the association between health literacy, stigma, and health care decision-making barriers in patients with cervical cancer and identifies the mediating roles of stigma and perceived social support in this relationship.

METHODS

A cross-sectional study was conducted using convenience sampling, recruiting 322 hospitalized patients with cervical cancer from three tertiary hospitals in Beijing. The participants completed self-reported questionnaires on health literacy, stigma, perceived social support, and health care decision-making barriers. Chained mediation effects were analyzed using Amos 26.0 software.

RESULTS

37.3% of patients with cervical cancer reported delays in seeking medical care. Health literacy was found to have significant negative associations with stigma ( ​< ​0.001) and health care decision-making barriers ( ​< ​0.001) and a positive correlation with perceived social support ( ​< ​0.001). Health literacy indirectly influenced health care decision-making barriers through three mediating pathways: stigma (effect ​= ​-0.073), perceived social support (effect=-0.086), and a combination of stigma and perceived social support (effect ​= ​-0.041), collectively accounting for 27.5%, 32.3%, and 15.4% of the total effect, respectively. The total indirect effect accounted for 75.1% of the total effect.

CONCLUSIONS

The health literacy levels among patients with cervical cancer in China are moderate. Stigma and perceived social support serve as partial mediators in the relationship between health literacy and health care decision-making barriers. Health care providers can reduce decision-making barriers by improving health literacy and indirectly lessen them by addressing stigma and enhancing social support.