ArticleBMC health services research2026
Pain-responsive to digital self-management in lumbar disc herniation: the mediating role of patient activation and the moderating effect of pain intensity.
Article in BMC health services research, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundSelf-management behaviors (SMB) are fundamental to outcomes in lumbar disc herniation (LDH), yet those remain frequently suboptimal. Electronic health literacy (eHL) may support SMB, but the mechanisms are unclear. Guided by the Information-Motivation-Behavioral Skills model, we investigated whether patient activation (PA) mediates the association between eHL and SMB among LDH patients, and whether pain intensity moderates this pathway.
methodsIn this cross-sectional study, 402 patients with LDH were recruited from a tertiary grade-A hospital in Shanghai, China. This study was conducted from November 2023 to April 2025. Data were collected using a general information questionnaire, the eHealth Literacy Scale, the Patient Activation Measure, the Self-Management Scale for Chronic Patients, and the Numerical Pain Rating Scale. Statistical analyses were performed using independent samples t-tests, one-way analysis of variance, Pearson correlation analysis, multiple linear regression, and the PROCESS macro for SPSS.
resultsThe average SMB score among LDH patients was 24.58 ± 9.67, with significantly higher scores observed in those under 40 years old, employed, holding a bachelor's degree or higher, urban residents living alone, individuals with lower monthly income, and those with fewer hospitalizations. It showed that eHL was positive correlations with PA and SMB, while pain intensity was negatively correlated with three all. PA partially mediated the relationship between eHL and exercise (indirect effect: β = 0.132, 95% CI [0.035, 0.228]) and doctor-patient communication (β = 0.053, [0.014, 0.093]) dimensions of SMB, but not cognitive symptom management. Critically, Pain intensity negatively moderated the indirect effect of eHL through PA: the mediated pathway was decreased by over 60% at high pain levels compared to low pain.
conclusionsThis study provides evidence that PA mediates the association between eHL and SMB in LDH. More importantly, his mediation pathway is progressively attenuated by increasing pain intensity, indicating that pain functions as a barrier to the translation of digital health skills into motivation and behavior. These findings support the development of pain-responsive self-management interventions that dynamically adjust support based on real-time pain levels. CLINICAL TRIAL NUMBER: Not applicable.
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