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A cross-sectional study was conducted with 287 Chinese COPD patients. Mediation analysis was performed using structural equation modeling with Amos 24.0. The findings indicated that self-efficacy and self-management behaviors independently mediated the relationship between breathlessness beliefs and HRQoL, accounting for 28.91% and 33.01% of the overall effect, respectively. Additionally, a serial mediating effect of self-efficacy and self-management behaviors was found in the link between breathlessness beliefs and HRQoL, accounting for 6.33% of the total effect. This finding demonstrated that self-efficacy and self-management behaviors served as sequential mediators in the relationship between breathlessness beliefs and HRQoL. Targeted interventions should be developed to address breathlessness beliefs, enhance self-efficacy, and promote self-management behaviors, ultimately improving HRQoL.<\/jats:p>","DOI":"10.1177\/13591053251331940","type":"journal-article","created":{"date-parts":[[2025,4,17]],"date-time":"2025-04-17T06:47:32Z","timestamp":1744872452000},"page":"3397-3416","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":2,"title":["Effect of breathlessness beliefs on quality of life in chronic obstructive pulmonary disease: Chain-mediating role of self-efficacy and self-management behaviors"],"prefix":"10.1177","volume":"30","author":[{"given":"Lin","family":"Wang","sequence":"first","affiliation":[{"name":"Department of Pharmacy, The First Hospital of China Medical University, People\u2019s Republic of China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qiuli","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Pain Medicine, The First Hospital of China Medical University, People\u2019s Republic of China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-5104-199X","authenticated-orcid":false,"given":"Naiwen","family":"Jiang","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, The First Hospital of China Medical University, People\u2019s Republic of China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2025,4,17]]},"reference":[{"key":"e_1_3_3_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.sjbs.2021.05.076"},{"key":"e_1_3_3_3_1","doi-asserted-by":"publisher","DOI":"10.2147\/JMDH.S62476"},{"key":"e_1_3_3_4_1","doi-asserted-by":"publisher","DOI":"10.12688\/f1000research.121783.1"},{"key":"e_1_3_3_5_1","doi-asserted-by":"publisher","DOI":"10.1080\/08964289.2021.1983755"},{"key":"e_1_3_3_6_1","doi-asserted-by":"publisher","DOI":"10.1037\/0033-295X.84.2.191"},{"key":"e_1_3_3_7_1","doi-asserted-by":"publisher","DOI":"10.1177\/1090198104263660"},{"key":"e_1_3_3_8_1","doi-asserted-by":"publisher","DOI":"10.5152\/ThoracResPract.2023.22184"},{"key":"e_1_3_3_9_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11136-019-02231-8"},{"key":"e_1_3_3_10_1","doi-asserted-by":"publisher","DOI":"10.2147\/COPD.S58478"},{"key":"e_1_3_3_11_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12890-019-0796-8"},{"key":"e_1_3_3_12_1","doi-asserted-by":"publisher","DOI":"10.1093\/geront\/gnaa045"},{"key":"e_1_3_3_13_1","doi-asserted-by":"publisher","DOI":"10.2147\/COPD.S377857"},{"key":"e_1_3_3_14_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40271-017-0218-z"},{"key":"e_1_3_3_15_1","doi-asserted-by":"publisher","DOI":"10.2147\/COPD.S343108"},{"key":"e_1_3_3_16_1","doi-asserted-by":"publisher","DOI":"10.1177\/1479972310383592"},{"key":"e_1_3_3_17_1","doi-asserted-by":"publisher","DOI":"10.12688\/f1000research.6557.1"},{"key":"e_1_3_3_18_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12931-020-01395-z"},{"key":"e_1_3_3_19_1","doi-asserted-by":"publisher","DOI":"10.2147\/COPD.S31209"},{"key":"e_1_3_3_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.rmed.2009.09.007"},{"key":"e_1_3_3_21_1","doi-asserted-by":"publisher","DOI":"10.1080\/02813432.2022.2073961"},{"key":"e_1_3_3_22_1","doi-asserted-by":"publisher","DOI":"10.1177\/1479972309102810"},{"key":"e_1_3_3_23_1","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.202009-3533SO"},{"key":"e_1_3_3_24_1","doi-asserted-by":"publisher","DOI":"10.1080\/10705519909540118"},{"key":"e_1_3_3_25_1","doi-asserted-by":"publisher","DOI":"10.2147\/COPD.S90812"},{"key":"e_1_3_3_26_1","doi-asserted-by":"publisher","DOI":"10.1183\/09031936.00102509"},{"key":"e_1_3_3_27_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12144-023-05104-z"},{"key":"e_1_3_3_28_1","doi-asserted-by":"publisher","DOI":"10.2147\/PI.S12624"},{"key":"e_1_3_3_29_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.pec.2014.07.026"},{"issue":"3","key":"e_1_3_3_30_1","article-title":"Chronic obstructive pulmonary disease","volume":"173","author":"Labaki WW","year":"2020","unstructured":"Labaki WW, Rosenberg SR (2020) Chronic obstructive pulmonary disease. 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