{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T14:54:46Z","timestamp":1791298486763,"version":"4.1.0"},"reference-count":48,"publisher":"Elsevier BV","license":[{"start":{"date-parts":[[2026,11,1]],"date-time":"2026-11-01T00:00:00Z","timestamp":1793491200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"},{"start":{"date-parts":[[2026,11,1]],"date-time":"2026-11-01T00:00:00Z","timestamp":1793491200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/legal\/tdmrep-license"},{"start":{"date-parts":[[2026,11,1]],"date-time":"2026-11-01T00:00:00Z","timestamp":1793491200000},"content-version":"stm-asf","delay-in-days":0,"URL":"https:\/\/doi.org\/10.15223\/policy-017"},{"start":{"date-parts":[[2026,11,1]],"date-time":"2026-11-01T00:00:00Z","timestamp":1793491200000},"content-version":"stm-asf","delay-in-days":0,"URL":"https:\/\/doi.org\/10.15223\/policy-037"},{"start":{"date-parts":[[2026,11,1]],"date-time":"2026-11-01T00:00:00Z","timestamp":1793491200000},"content-version":"stm-asf","delay-in-days":0,"URL":"https:\/\/doi.org\/10.15223\/policy-012"},{"start":{"date-parts":[[2026,11,1]],"date-time":"2026-11-01T00:00:00Z","timestamp":1793491200000},"content-version":"stm-asf","delay-in-days":0,"URL":"https:\/\/doi.org\/10.15223\/policy-029"},{"start":{"date-parts":[[2026,11,1]],"date-time":"2026-11-01T00:00:00Z","timestamp":1793491200000},"content-version":"stm-asf","delay-in-days":0,"URL":"https:\/\/doi.org\/10.15223\/policy-004"}],"content-domain":{"domain":["clinicalkey.com","clinicalkey.com.au","clinicalkey.es","clinicalkey.fr","clinicalkey.jp","elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"short-container-title":["Patient Education and Counseling"],"published-print":{"date-parts":[[2026,11]]},"DOI":"10.1016\/j.pec.2026.109831","type":"journal-article","created":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T15:21:07Z","timestamp":1787325667000},"page":"109831","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":0,"special_numbering":"C","title":["Digital health literacy and shared decision-making in hypertension: Sequential mediation by self-efficacy and patient activation"],"prefix":"10.1016","volume":"152","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9107-1565","authenticated-orcid":false,"given":"Jing","family":"Li","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qian","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qing","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yueming","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jing","family":"Sun","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"78","reference":[{"key":"10.1016\/j.pec.2026.109831_bib1","doi-asserted-by":"crossref","first-page":"1361","DOI":"10.1007\/s11606-012-2077-6","article-title":"Shared decision making: a model for clinical practice","volume":"27","author":"Elwyn","year":"2012","journal-title":"J Gen Intern Med"},{"key":"10.1016\/j.pec.2026.109831_bib2","doi-asserted-by":"crossref","DOI":"10.1016\/j.apjon.2024.100596","article-title":"Effect of shared decision-making in patients with breast cancer undergoing breast reconstruction surgery: a systematic review and meta-analysis","volume":"11","author":"Chen","year":"2024","journal-title":"Asia Pac J Oncol Nurs"},{"key":"10.1016\/j.pec.2026.109831_bib3","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1136\/heartjnl-2022-321050","article-title":"Shared decision making in cardiology: a systematic review and meta-analysis","volume":"109","author":"Mitropoulou","year":"2023","journal-title":"Heart"},{"key":"10.1016\/j.pec.2026.109831_bib4","doi-asserted-by":"crossref","first-page":"1191","DOI":"10.1111\/hex.12826","article-title":"Interventions to support shared decision making for hypertension: a systematic review of controlled studies","volume":"21","author":"Johnson","year":"2018","journal-title":"Health Expect"},{"key":"10.1016\/j.pec.2026.109831_bib5","doi-asserted-by":"crossref","DOI":"10.1161\/JAHA.124.036664","article-title":"Racial and ethnic differences in shared decision making among patients with hypertension: results from the RICH LIFE Project","volume":"14","author":"Elias","year":"2025","journal-title":"J Am Heart Assoc"},{"key":"10.1016\/j.pec.2026.109831_bib6","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1016\/j.amjsurg.2018.01.011","article-title":"Association of shared decision-making on patient-reported health outcomes and healthcare utilization","volume":"216","author":"Hughes","year":"2018","journal-title":"Am J Surg"},{"key":"10.1016\/j.pec.2026.109831_bib7","doi-asserted-by":"crossref","DOI":"10.1016\/j.heliyon.2023.e16786","article-title":"Shared decision making among hypertensive clients in public hospitals of West Shoa, central Ethiopia, 2020: institution-based cross-sectional study","volume":"9","author":"Emana","year":"2023","journal-title":"Heliyon"},{"key":"10.1016\/j.pec.2026.109831_bib8","doi-asserted-by":"crossref","first-page":"296","DOI":"10.1093\/fampra\/cmw012","article-title":"Perceived involvement and preferences in shared decision-making among patients with hypertension","volume":"33","author":"Mah","year":"2016","journal-title":"Fam Pract"},{"key":"10.1016\/j.pec.2026.109831_bib9","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pdig.0000279","article-title":"Digital literacy as a new determinant of health: a scoping review","volume":"2","author":"Arias L\u00f3pez","year":"2023","journal-title":"PLoS Digit Health"},{"key":"10.1016\/j.pec.2026.109831_bib10","doi-asserted-by":"crossref","first-page":"1505","DOI":"10.1016\/j.pec.2016.07.014","article-title":"Shared decision-making as an existential journey: aiming for restored autonomous capacity","volume":"99","author":"Gulbrandsen","year":"2016","journal-title":"Patient Educ Couns"},{"key":"10.1016\/j.pec.2026.109831_bib11","doi-asserted-by":"crossref","DOI":"10.2196\/26721","article-title":"The association between patients\u2019 eHealth literacy and satisfaction with shared decision-making and well-being: multicenter cross-sectional study","volume":"23","author":"Xu","year":"2021","journal-title":"J Med Internet Res"},{"key":"10.1016\/j.pec.2026.109831_bib12","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1007\/s13187-016-1052-z","article-title":"Health literacy and health-care engagement as predictors of shared decision-making among adult information seekers in the USA: a secondary data analysis of the Health Information National Trends Survey","volume":"33","author":"Wigfall","year":"2018","journal-title":"J Cancer Educ"},{"key":"10.1016\/j.pec.2026.109831_bib13","article-title":"Association between Korean adults\u2019 electronic health literacy and active participation in health decision-making","volume":"43","author":"Lee","year":"2025","journal-title":"Comput Inform Nurs"},{"key":"10.1016\/j.pec.2026.109831_bib14","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1186\/s12916-017-0838-0","article-title":"eHealth in the future of medications management: personalisation, monitoring and adherence","volume":"15","author":"Car","year":"2017","journal-title":"BMC Med"},{"issue":"7","key":"10.1016\/j.pec.2026.109831_bib15","doi-asserted-by":"crossref","first-page":"1490","DOI":"10.1002\/pon.5105","article-title":"Determinants of satisfactory patient communication and shared decision-making in patients with multiple myeloma","volume":"28","author":"Nejati","year":"2019","journal-title":"Psychooncology"},{"key":"10.1016\/j.pec.2026.109831_bib16","doi-asserted-by":"crossref","first-page":"158","DOI":"10.1111\/jocn.17811","article-title":"Digital health literacy in patients with hypertension: a cross-sectional study","volume":"35","author":"Totaro","year":"2026","journal-title":"J Clin Nurs"},{"key":"10.1016\/j.pec.2026.109831_bib17","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1023\/B:BREA.0000025408.46234.66","article-title":"Determinants of participation in treatment decision-making by older breast cancer patients","volume":"85","author":"Maly","year":"2004","journal-title":"Breast Cancer Res Treat"},{"key":"10.1016\/j.pec.2026.109831_bib18","series-title":"An introduction to theories of personality","article-title":"Social-cognitive theory","author":"Bandura","year":"2014"},{"key":"10.1016\/j.pec.2026.109831_bib19","doi-asserted-by":"crossref","DOI":"10.1016\/j.jpsychores.2022.111105","article-title":"Relationship between self-efficacy and adherence to self-management and medication among patients with chronic diseases in China: a multicentre cross-sectional study","volume":"164","author":"Chen","year":"2023","journal-title":"J Psychosom Res"},{"key":"10.1016\/j.pec.2026.109831_bib20","doi-asserted-by":"crossref","first-page":"44","DOI":"10.1186\/s12875-021-01391-2","article-title":"The association between self-efficacy and self-care in essential hypertension: a systematic review","volume":"22","author":"Tan","year":"2021","journal-title":"BMC Fam Pract"},{"key":"10.1016\/j.pec.2026.109831_bib21","doi-asserted-by":"crossref","first-page":"817","DOI":"10.1634\/theoncologist.2015-0517","article-title":"Treatment summaries and follow-up care instructions for cancer survivors: improving survivor self-efficacy and health care utilization","volume":"21","author":"Kenzik","year":"2016","journal-title":"Oncologist"},{"key":"10.1016\/j.pec.2026.109831_bib22","doi-asserted-by":"crossref","first-page":"207","DOI":"10.1377\/hlthaff.2012.1061","article-title":"What the evidence shows about patient activation: better health outcomes and care experiences; fewer data on costs","volume":"32","author":"Hibbard","year":"2013","journal-title":"Health Aff (Millwood)"},{"key":"10.1016\/j.pec.2026.109831_bib23","doi-asserted-by":"crossref","DOI":"10.1161\/hyp.82.suppl_1.FR453","article-title":"Abstract FR453: Digital health literacy and patient activation in adults at risk for stage 2 hypertension: insights from the LINKED-BP Program","volume":"82","author":"Owusu-Agyemang","year":"2025","journal-title":"Hypertension"},{"key":"10.1016\/j.pec.2026.109831_bib24","doi-asserted-by":"crossref","first-page":"335","DOI":"10.1097\/00005650-200003000-00010","article-title":"Patient preferences for medical decision making: who really wants to participate?","volume":"38","author":"Arora","year":"2000","journal-title":"Med Care"},{"key":"10.1016\/j.pec.2026.109831_bib25","doi-asserted-by":"crossref","first-page":"1276","DOI":"10.1016\/j.pec.2017.03.019","article-title":"Does patient activation level affect the cancer patient journey?","volume":"100","author":"Hibbard","year":"2017","journal-title":"Patient Educ Couns"},{"key":"10.1016\/j.pec.2026.109831_bib26","doi-asserted-by":"crossref","first-page":"2791","DOI":"10.1016\/j.pec.2021.03.039","article-title":"Factors associated with patient activation in a socially deprived population: evidence from Germany","volume":"104","author":"Golubinski","year":"2021","journal-title":"Patient Educ Couns"},{"key":"10.1016\/j.pec.2026.109831_bib27","doi-asserted-by":"crossref","first-page":"732","DOI":"10.1007\/s11606-019-05351-6","article-title":"Patient activation as a pathway to shared decision-making for adults with diabetes or cardiovascular disease","volume":"35","author":"Poon","year":"2020","journal-title":"J Gen Intern Med"},{"key":"10.1016\/j.pec.2026.109831_bib28","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1016\/j.apnr.2017.11.002","article-title":"Self-care among Filipinos in the United States who have hypertension","volume":"39","author":"Ea","year":"2018","journal-title":"Appl Nurs Res"},{"key":"10.1016\/j.pec.2026.109831_bib29","doi-asserted-by":"crossref","DOI":"10.1161\/JAHA.123.032568","article-title":"Multiethnic perspectives of shared decision-making in hypertension: a mixed-methods study","volume":"13","author":"Elias","year":"2024","journal-title":"J Am Heart Assoc"},{"key":"10.1016\/j.pec.2026.109831_bib30","doi-asserted-by":"crossref","first-page":"e127","DOI":"10.1016\/j.jacc.2017.11.006","article-title":"2017 ACC\/AHA\/AAPA\/ABC\/ACPM\/AGS\/APhA\/ASH\/ASPC\/NMA\/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults","volume":"71","author":"Whelton","year":"2018","journal-title":"J Am Coll Cardiol"},{"key":"10.1016\/j.pec.2026.109831_bib31","doi-asserted-by":"crossref","DOI":"10.2196\/jmir.8.4.e27","article-title":"eHEALS: the eHealth literacy scale","volume":"8","author":"Norman","year":"2006","journal-title":"J Med Internet Res"},{"key":"10.1016\/j.pec.2026.109831_bib32","article-title":"Thousand Oaks: Sage Publications","author":"Lorig","year":"1996","journal-title":"Outcome Meas Health Educ Other Health care Interv"},{"key":"10.1016\/j.pec.2026.109831_bib33","doi-asserted-by":"crossref","first-page":"1005","DOI":"10.1111\/j.1475-6773.2004.00269.x","article-title":"Development of the Patient Activation Measure (PAM): conceptualizing and measuring activation in patients and consumers","volume":"39","author":"Hibbard","year":"2004","journal-title":"Health Serv Res"},{"key":"10.1016\/j.pec.2026.109831_bib34","doi-asserted-by":"crossref","first-page":"94","DOI":"10.1016\/j.pec.2009.09.034","article-title":"M. The 9-item Shared Decision Making Questionnaire (SDM-Q-9): development and psychometric properties in a primary care sample","volume":"80","author":"Kriston","year":"2010","journal-title":"Patient Educ Couns"},{"key":"10.1016\/j.pec.2026.109831_bib35","doi-asserted-by":"crossref","first-page":"539","DOI":"10.1146\/annurev-psych-120710-100452","article-title":"Sources of method bias in social science research and recommendations on how to control it","volume":"63","author":"Podsakoff","year":"2012","journal-title":"Annu Rev Psychol"},{"key":"10.1016\/j.pec.2026.109831_bib36","series-title":"Introduction to mediation, moderation, and conditional process analysis: a regression-based approach","author":"Hayes","year":"2017"},{"key":"10.1016\/j.pec.2026.109831_bib37","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1186\/1471-2296-14-135","article-title":"Shared decision-making in antihypertensive therapy: a cluster randomised controlled trial","volume":"14","author":"Tinsel","year":"2013","journal-title":"BMC Fam Pract"},{"key":"10.1016\/j.pec.2026.109831_bib38","doi-asserted-by":"crossref","first-page":"2226","DOI":"10.1186\/s12889-022-14695-4","article-title":"Associations between e-health literacy and chronic disease self-management in older Chinese patients with chronic non-communicable diseases: a mediation analysis","volume":"22","author":"Wu","year":"2022","journal-title":"BMC Public Health"},{"key":"10.1016\/j.pec.2026.109831_bib39","doi-asserted-by":"crossref","DOI":"10.1016\/j.ijmedinf.2023.105124","article-title":"Sociodemographic determinants of digital health literacy: a systematic review and meta-analysis","volume":"177","author":"Estrela","year":"2023","journal-title":"Int J Med Inform"},{"key":"10.1016\/j.pec.2026.109831_bib40","doi-asserted-by":"crossref","first-page":"198","DOI":"10.1038\/jhh.2014.58","article-title":"The association of family social support, depression, anxiety and self-efficacy with specific hypertension self-care behaviours in Chinese local community","volume":"29","author":"Hu","year":"2015","journal-title":"J Hum Hypertens"},{"key":"10.1016\/j.pec.2026.109831_bib41","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1007\/s11606-020-06125-1","article-title":"Decisional conflict during major medical treatment decision-making: a survey study","volume":"36","author":"Pecanac","year":"2021","journal-title":"J Gen Intern Med"},{"key":"10.1016\/j.pec.2026.109831_bib42","doi-asserted-by":"crossref","first-page":"550","DOI":"10.1177\/0272989X16632197","article-title":"Effect of health literacy on decision-making preferences among medically underserved patients","volume":"36","author":"Seo","year":"2016","journal-title":"Med Decis Mak"},{"key":"10.1016\/j.pec.2026.109831_bib43","first-page":"1","article-title":"Electronic health literacy as a source of self-efficacy among community-dwelling older adults","author":"Park","year":"2024","journal-title":"Clin Gerontol"},{"key":"10.1016\/j.pec.2026.109831_bib44","article-title":"Understanding how digital health literacy affects health self-management behaviors: the mediating role of self-efficacy in college students","volume":"15","author":"Zhou","year":"2025","journal-title":"Sci Rep"},{"key":"10.1016\/j.pec.2026.109831_bib45","doi-asserted-by":"crossref","first-page":"451","DOI":"10.1016\/j.pec.2019.09.018","article-title":"The potency of education programs for management of blood pressure through increasing self-efficacy of hypertensive patients: a systematic review and meta-analysis","volume":"103","author":"Foroumandi","year":"2020","journal-title":"Patient Educ Couns"},{"key":"10.1016\/j.pec.2026.109831_bib46","doi-asserted-by":"crossref","DOI":"10.1093\/eurpub\/ckae144.1715","article-title":"Impact of digital health literacy on public health: An umbrella review","volume":"34","author":"Corvo","year":"2024","journal-title":"Eur J Public Health"},{"key":"10.1016\/j.pec.2026.109831_bib47","doi-asserted-by":"crossref","DOI":"10.1016\/j.pec.2024.108274","article-title":"The influence of health literacy, anxiety and education on shared decision making and decisional conflict in older adults, and the mediating role of patient participation: a video observational study","volume":"124","author":"Pel-Littel","year":"2024","journal-title":"Patient Educ Couns"},{"key":"10.1016\/j.pec.2026.109831_bib48","article-title":"Impact of behavioral interventions on patient activation in adults with hypertension: a systematic review and meta-analysis","volume":"59","author":"Innab","year":"2022","journal-title":"Inquiry"}],"container-title":["Patient Education and Counseling"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S0738399126003642?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S0738399126003642?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"}],"deposited":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T14:38:03Z","timestamp":1791297483000},"score":1,"resource":{"primary":{"URL":"https:\/\/linkinghub.elsevier.com\/retrieve\/pii\/S0738399126003642"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,11]]},"references-count":48,"alternative-id":["S0738399126003642"],"URL":"https:\/\/doi.org\/10.1016\/j.pec.2026.109831","relation":{},"ISSN":["0738-3991"],"issn-type":[{"value":"0738-3991","type":"print"}],"subject":[],"published":{"date-parts":[[2026,11]]},"assertion":[{"value":"Elsevier","name":"publisher","label":"This article is maintained by"},{"value":"Digital health literacy and shared decision-making in hypertension: Sequential mediation by self-efficacy and patient activation","name":"articletitle","label":"Article Title"},{"value":"Patient Education and Counseling","name":"journaltitle","label":"Journal Title"},{"value":"https:\/\/doi.org\/10.1016\/j.pec.2026.109831","name":"articlelink","label":"CrossRef DOI link to publisher maintained version"},{"value":"article","name":"content_type","label":"Content Type"},{"value":"\u00a9 2026 Elsevier B.V. All rights are reserved, including those for text and data mining, AI training, and similar technologies.","name":"copyright","label":"Copyright"}],"article-number":"109831"}}