The impact of health literacy on treatment adherence in COPD patients: chain mediation roles of self-efficacy and perceived disease threat.

Background: Treatment adherence in patients with chronic obstructive pulmonary disease (COPD) is a critical factor influencing disease prognosis and quality of life. Health literacy, defined as patients' ability to acquire and apply health information, may indirectly modulate adherence behaviors through psychological mechanisms. However, prior research has seldom examined the relationship between health literacy and treatment adherence, along with its underlying mechanisms. To bridge this gap, the present study, grounded in protection motivation theory and self-efficacy theory, investigates the mediating roles of perceived disease threat and self-efficacy in the association between health literacy and treatment adherence among COPD patients. Method: This study utilized a cross-sectional design and employed convenience sampling to recruit 456 COPD patients from four tertiary Grade A hospitals in Beijing, China. All participants completed the Health Literacy Scale, Perceived Disease Threat Scale, Self-Efficacy Scale, Treatment Adherence Scale, and provided essential demographic information. Result: Health literacy showed a significant positive correlation with treatment adherence, whereas perceived disease threat exhibited a significant negative correlation with self-efficacy. Perceived disease threat and self-efficacy demonstrated significant chain mediation in the relationship between health literacy and treatment adherence. Specifically, higher health literacy enhances patients' confidence in implementing treatment regimens by fostering an understanding of treatment efficacy, enabling accurate perceptions of disease severity and personal susceptibility. This cognition translates into motivational urgency for action, thereby driving patients to engage in long-term and proactive adherence to various treatment behaviors. Conclusion: This study confirms that health literacy promotes treatment adherence in COPD patients via a chain mediation mechanism involving enhanced self-efficacy and reduced perceived disease threat. These findings offer a foundation for clinical interventions, such as elevating literacy through health education to optimize psychological pathways and improve patient management.