{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,7]],"date-time":"2026-05-07T06:56:15Z","timestamp":1778136975301,"version":"3.51.4"},"reference-count":97,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,3,16]],"date-time":"2026-03-16T00:00:00Z","timestamp":1773619200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Psychol."],"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To investigate the serial mediating roles of self-esteem and health literacy in the relationship between self-efficacy and benefit finding among patients with systemic lupus erythematosus (SLE), and to provide empirical evidence for developing targeted clinical interventions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A cross-sectional study was conducted using convenience sampling. A total of 207 patients with SLE were recruited from the rheumatology outpatient department of a tertiary Grade-A hospital in Zhejiang Province. Data were collected using the General Information Questionnaire, the Rosenberg Self-Esteem Scale (RSES), the Self-Efficacy for Managing Chronic Disease Scale, the Health Literacy Scale, and the Benefit Finding Scale (BFS). Pearson correlation analysis and Hayes' Process macro, were used to analyze the data.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The mean scores for self-efficacy, self-esteem, health literacy, and benefit finding were 21.47 \u00b1 5.37, 27.42 \u00b1 2.68, 94.29 \u00b1 10.71, and 65.20 \u00b1 10.92, respectively. Correlation analysis revealed significant positive associations among self-efficacy, self-esteem, health literacy, and benefit finding (\n                      <jats:italic>r<\/jats:italic>\n                      = 0.833, 0.885,\n                      <jats:italic>P<\/jats:italic>\n                      &amp;lt; 0.001). Path analysis indicated that self-efficacy had a significant direct effect on benefit finding (\u03b2 = 0.339, 95% CI: 0.041\u20130.636). The mediating effects of self-esteem (effect = 0.636, 95% CI: 0.234\u20131.067) and health literacy (effect = 0.506, 95% CI: 0.200\u20130.819) were also significant. Furthermore, the serial mediating pathway of \u201cself-efficacy \u2192 self-esteem \u2192 health literacy \u2192 benefit finding\u201d was significant (effect = 0.212, 95% CI: 0.042\u20130.577). The moderation analysis indicated that the indirect effect of self-efficacy on benefit finding via the chain mediation of self-esteem and health literacy was stronger in younger patients (\u03b2 = \u22120.080, 95% CI: \u22120.120 to \u22120.039).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Self-efficacy is positively associated with benefit finding in patients with SLE directly and indirectly through self-esteem and health literacy. Age moderates the relationship between self-efficacy and self-esteem. Clinical nursing staff should adopt age-specific interventions to improve patients' self-esteem and health literacy, which may help promote their benefit finding.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpsyg.2026.1784999","type":"journal-article","created":{"date-parts":[[2026,3,16]],"date-time":"2026-03-16T05:23:06Z","timestamp":1773638586000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["The serial mediating role of self-esteem and health literacy in the relationship between self-efficacy and benefit finding among Chinese systemic lupus erythematosus patients"],"prefix":"10.3389","volume":"17","author":[{"given":"Xu","family":"Tong","sequence":"first","affiliation":[{"name":"Department of Nursing, Bozhou College of Traditional Chinese Medicine, Bozhou","place":["Anhui, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mingling","family":"Zhu","sequence":"additional","affiliation":[{"name":"Department of Nursing, Zhejiang Shuren University, Hangzhou","place":["Zhejiang, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yinsong","family":"Xu","sequence":"additional","affiliation":[{"name":"Department of Nursing, Bozhou College of Traditional Chinese Medicine, Bozhou","place":["Anhui, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cancan","family":"Sun","sequence":"additional","affiliation":[{"name":"Department of Nursing, Bozhou College of Traditional Chinese Medicine, Bozhou","place":["Anhui, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xuan","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Nursing, Bozhou College of Traditional Chinese Medicine, Bozhou","place":["Anhui, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,3,16]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"e30330","DOI":"10.7759\/cureus.30330","article-title":"An overview of systemic lupus erythematosus (SLE) pathogenesis, classification, and management","volume":"14","author":"Ameer","year":"2022","journal-title":"Cureus"},{"key":"B2","doi-asserted-by":"publisher","first-page":"20","DOI":"10.1037\/0278-6133.20.1.20","article-title":"Cognitive-behavioral stress management intervention decreases the prevalence of depression and enhances benefit finding among women under treatment for early-stage breast cancer","volume":"20","author":"Antoni","year":"2001","journal-title":"Health Psychol."},{"key":"B3","doi-asserted-by":"publisher","first-page":"1278","DOI":"10.2105\/AJPH.92.8.1278","article-title":"Functional health literacy and the risk of hospital admission among Medicare managed care enrollees","volume":"92","author":"Baker","year":"2002","journal-title":"Am. 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