{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T06:07:32Z","timestamp":1789106852379,"version":"build-2803163510"},"reference-count":56,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T00:00:00Z","timestamp":1789084800000},"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. Public Health"],"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Although patient activation and eHealth literacy are known to influence self-management in chronic diseases, evidence on whether eHealth literacy mediates this relationship in patients with coronary heart disease (CHD) remains limited. This study explored the associations between patient activation, eHealth literacy, self-efficacy and self-management in patients with CHD and aimed to examine both the direct and indirect associations of patient activation on self-efficacy and self-management through eHealth literacy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A cross-sectional method was adopted and a convenience sample of 433 hospitalized patients with CHD was recruited. Data were collected using the Patient Activation Measure-13, the eHealth Literacy Scale and the Heart Health Self-Efficacy and Self-Management scale (which provides a composite outcome measure) and analyzed using Pearson correlation, stepwise regression and bootstrap methods.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The mean scores were 58.89\u202f\u00b1\u202f18.87 for patient activation, 24.92\u202f\u00b1\u202f8.94 for eHealth literacy and 60.70\u202f\u00b1\u202f15.34 for the combined self-efficacy and self-management measure. Patient activation was moderately positively correlated with eHealth literacy (\n                      <jats:italic>r<\/jats:italic>\n                      \u202f=\u202f0.51,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.001) and the combined measure (\n                      <jats:italic>r<\/jats:italic>\n                      \u202f=\u202f0.59,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.001), and eHealth literacy showed a weak positive correlation with the combined measure (\n                      <jats:italic>r<\/jats:italic>\n                      \u202f=\u202f0.37,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.001). Patient activation was directly and positively associated with the combined measure (\n                      <jats:italic>\u03b2<\/jats:italic>\n                      \u202f=\u202f0.533,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.001), and eHealth literacy partially mediated this relationship (indirect effect\u202f=\u202f0.043, 95% CI [0.002, 0.088],\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.043), accounting for 9% of the total effect. This relatively small indirect effect suggests a modest mediating role, indicating that the direct pathway from patient activation to self-efficacy and self-management is substantially more influential than the pathway through eHealth literacy in this population.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Patient activation, eHealth literacy, self-efficacy and self-management in patients with CHD were at moderate or moderately low levels. Higher levels of patient activation and eHealth literacy are associated with better self-efficacy and self-management, a pattern that may underlie improved self-management.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2026.1799712","type":"journal-article","created":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T05:30:15Z","timestamp":1789104615000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Patient activation and self-management in patients with coronary heart disease: the mediating role of eHealth literacy"],"prefix":"10.3389","volume":"14","author":[{"given":"Juan","family":"Tan","sequence":"first","affiliation":[{"name":"Operating Room, Hunan Provincial People\u2019s Hospital (the First Affiliated Hospital of Hunan Normal University)","place":["Changsha, Hunan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yiyun","family":"Huang","sequence":"additional","affiliation":[{"name":"School of Nursing, Hunan Normal University","place":["Changsha, Hunan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Han","family":"Fu","sequence":"additional","affiliation":[{"name":"Department of Emergency 2, Hunan Provincial People\u2019s Hospital (the First Affiliated Hospital of Hunan Normal University)","place":["Changsha, Hunan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miyao","family":"Wu","sequence":"additional","affiliation":[{"name":"Respiratory ICU, Hunan Provincial People\u2019s Hospital (the First Affiliated Hospital of Hunan Normal University)","place":["Changsha, Hunan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yin","family":"Hu","sequence":"additional","affiliation":[{"name":"School of Nursing, Hunan Normal University","place":["Changsha, Hunan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Feilan","family":"Jiang","sequence":"additional","affiliation":[{"name":"ICU of Emergency Department 3, Hunan Provincial People\u2019s Hospital (the First Affiliated Hospital of Hunan Normal University)","place":["Changsha, Hunan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pengpeng","family":"Gao","sequence":"additional","affiliation":[{"name":"School of Nursing, Hunan Normal University","place":["Changsha, Hunan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhoumin","family":"Shen","sequence":"additional","affiliation":[{"name":"Price Office, Hunan Provincial People\u2019s Hospital (the First Affiliated Hospital of Hunan Normal University)","place":["Changsha, Hunan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,11]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"116305","DOI":"10.1016\/j.biopha.2024.116305","article-title":"The interactions and biological pathways among metabolomics products of patients with coronary heart disease","volume":"173","author":"Chu","year":"2024","journal-title":"Biomed Pharmacother"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"37","DOI":"10.1016\/j.actbio.2023.09.011","article-title":"Nanotechnology in coronary heart disease","volume":"171","author":"Guo","year":"2023","journal-title":"Acta Biomater"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"140","DOI":"10.1016\/j.puhe.2023.08.034","article-title":"The economic burden of coronary heart disease in mainland China","volume":"224","author":"Mi","year":"2023","journal-title":"Public Health (Lond)"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"521","DOI":"10.1211\/ccj.184","article-title":"Report on cardiovascular health and diseases in China 2024:an updated summary","volume":"40","year":"2025","journal-title":"Chin Circ J"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"E61","DOI":"10.1097\/JCN.0000000000000830","article-title":"Patterns of adherence to secondary prevention measures among Chinese patients with coronary artery disease: a longitudinal study","volume":"37","author":"Lu","year":"2022","journal-title":"J Cardiovasc Nurs"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"104040","DOI":"10.1016\/j.ijnurstu.2021.104040","article-title":"Effects of a nurse-led eHealth cardiac rehabilitation programme on health outcomes of patients with coronary heart disease: a randomised controlled trial","volume":"122","author":"Su","year":"2021","journal-title":"Int J Nurs Stud"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"431","DOI":"10.1016\/j.ihj.2022.11.011","article-title":"Revisiting secondary prevention in coronary heart disease","volume":"74","author":"Sigamani","year":"2022","journal-title":"Indian Heart J"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"719","DOI":"10.2147\/VHRM.S435288","article-title":"A scoping review of predictors associated with self-efficacy among patients with coronary heart disease","volume":"19","author":"Sugiharto","year":"2023","journal-title":"Vasc Health Risk Manag"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"1918","DOI":"10.1111\/j.1475-6773.2005.00438.x","article-title":"Development and testing of a short form of the patient activation measure","volume":"40","author":"Hibbard","year":"2005","journal-title":"Health Serv Res"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"144","DOI":"10.1186\/s12875-023-02102-9","article-title":"Patient activation in adults attending appointments in general practice: a cross-sectional study","volume":"24","author":"Hernar","year":"2023","journal-title":"BMC Prim Care"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"5202","DOI":"10.1002\/nop2.1756","article-title":"The role of patient activation in self-care behaviours of Korean older adults with heart failure","volume":"10","author":"Son","year":"2023","journal-title":"Nurs Open"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"105","DOI":"10.1053\/j.ajkd.2021.07.015","article-title":"Integrating patient activation into dialysis care","volume":"79","author":"Hussein","year":"2022","journal-title":"Am J Kidney Dis"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"238","DOI":"10.1111\/wvn.12634","article-title":"The effectiveness of patient activation interventions in adults with chronic kidney disease: a systematic review and meta-analysis","volume":"20","author":"Lunardi","year":"2023","journal-title":"Worldviews Evid-Based Nurs"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"59","DOI":"10.33546\/bnj.3638","article-title":"Mediating role of self-efficacy in the relationship between family functioning and self-management behaviors in patients with coronary heart disease: a cross-sectional study in Jiangsu, China","volume":"11","author":"Wang","year":"2025","journal-title":"Belitung Nurs J"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"3181","DOI":"10.1002\/nop2.1031","article-title":"Influence of chronic illness resources on self-management and the mediating effect of patient activation among patients with coronary heart disease","volume":"8","author":"Zhang","year":"2021","journal-title":"Nurs Open"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"139","DOI":"10.1016\/j.gerinurse.2022.09.008","article-title":"Relationships among social support, self-efficacy, and patient activation in community-dwelling older adults living with coronary heart disease: a cross-sectional study","volume":"48","author":"Zhu","year":"2022","journal-title":"Geriatr Nurs"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"e70112","DOI":"10.2196\/70112","article-title":"eHealth literacy 3.0: updating the Norman and Skinner 2006 model","volume":"27","author":"Milanti","year":"2025","journal-title":"J Med Internet Res"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"e23473","DOI":"10.2196\/23473","article-title":"Application of the eHealth literacy model in digital health interventions: scoping review","volume":"23","author":"El Benny","year":"2021","journal-title":"J Med Internet Res"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"e50313","DOI":"10.2196\/50313","article-title":"Factors influencing eHealth literacy worldwide: systematic review and Meta-analysis","volume":"27","author":"Hua","year":"2025","journal-title":"J Med Internet Res"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"205","DOI":"10.1186\/s13643-022-02076-2","article-title":"eHealth literacy measurement tools: a systematic review protocol","volume":"11","author":"D\u00e9l\u00e9troz","year":"2022","journal-title":"Syst Rev"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"e21","DOI":"10.1016\/j.jacc.2021.09.006","article-title":"2021 ACC\/AHA\/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology\/American Heart Association Joint Committee on Clinical Practice Guidelines","volume":"79","author":"Lawton","year":"2021","journal-title":"J Am Coll Cardiol"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"378","DOI":"10.1307\/CJN.0000000000001930","article-title":"The sample size estimation in quantitative nursing research","volume":"45","author":"Ping","year":"2010","journal-title":"Chin J Nurs"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"e74786","DOI":"10.1371\/journal.pone.0074786","article-title":"Validation of the German version of the patient activation measure 13 (PAM13-D) in an international multicentre study of primary care patients","volume":"8","author":"Brenk-Franz","year":"2013","journal-title":"PLoS One"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"1079","DOI":"10.3390\/healthcare12111079","article-title":"A systematic review of the reliability and validity of the patient activation measure tool","volume":"12","author":"Ng","year":"2024","journal-title":"Healthcare (Basel)"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"1","DOI":"10.3390\/ejihpe16010001","article-title":"Reliability and validity of the Japanese version of the eHealth literacy scale in community-dwelling older adults: a cross-sectional study","volume":"16","author":"Tsujimoto","year":"2025","journal-title":"Eur J Investig Health Psychol Educ"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"E81","DOI":"10.1097\/JCN.0000000000000777","article-title":"Development and validation of a scale to measure self-efficacy and self-management in people with coronary heart disease","volume":"37","author":"Mares","year":"2022","journal-title":"J Cardiovasc Nurs"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"378","DOI":"10.1307\/CJN.0000000000001356","article-title":"Reliability and validity of the Chinese version of the heart health self-efficacy and self-management scale in patients with coronary heart disease","volume":"56","author":"Mi","year":"2021","journal-title":"Chin J Nurs"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"1210","DOI":"10.1186\/s40359-025-03539-6","article-title":"Validity and reliability of the Turkish translation of the heart health self-efficacy and self-management scale in patients with chronic heart disease","volume":"13","author":"Tunc Suygun","year":"2025","journal-title":"BMC Psychol"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"1173","DOI":"10.1037\/\/0022-3514.51.6.1173","article-title":"The moderator-mediator variable distinction in social psychological research: conceptual, strategic, and statistical considerations","volume":"51","author":"Baron","year":"1986","journal-title":"J Pers Soc Psychol"},{"key":"ref30","volume-title":"Introduction to Mediation, Moderation, and Conditional Process Analysis: A Regression-Based Approach","author":"Hayes","year":"2022"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"1107","DOI":"10.1111\/hex.13725","article-title":"The patient activation measure (PAM) and the pandemic: predictors of patient activation among Australian health consumers during the COVID-19 pandemic","volume":"26","author":"Dammery","year":"2023","journal-title":"Health Expect"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"336","DOI":"10.1016\/j.gerinurse.2021.01.006","article-title":"Patient activation and its predictors in hospitalized older adults in Singapore","volume":"42","author":"Chan","year":"2021","journal-title":"Geriatr Nurs"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"e067862","DOI":"10.1136\/bmjopen-2022-067862","article-title":"Patient activation, adherence to hypertension treatment plans and blood pressure control in Saudi Arabia: a cross-sectional study","volume":"13","author":"Innab","year":"2023","journal-title":"BMJ Open"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"20552076231194915","DOI":"10.1177\/20552076231194915","article-title":"Psychometric properties of the German revised version of the eHealth literacy scale in individuals with cardiac diseases: validation and test of measurement invariance","volume":"9","author":"B\u00e4uerle","year":"2023","journal-title":"Digit Health"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"996","DOI":"10.1186\/s12889-022-13378-4","article-title":"Current status and influencing factors of digital health literacy among community-dwelling older adults in Southwest China: a cross-sectional study","volume":"22","author":"Liu","year":"2022","journal-title":"BMC Public Health"},{"key":"ref36","doi-asserted-by":"publisher","first-page":"105","DOI":"10.1002\/nop2.1283","article-title":"Kinesiophobia and self-management behaviour related to physical activity in Chinese patients with coronary heart disease: the mediating role of self-efficacy","volume":"10","author":"Zhang","year":"2023","journal-title":"Nurs Open"},{"key":"ref37","doi-asserted-by":"publisher","first-page":"e13165","DOI":"10.1111\/nhs.13165","article-title":"Current status and factors influencing mental health literacy in patients with coronary heart disease: a cross-sectional study","volume":"26","author":"Sun","year":"2024","journal-title":"Nurs Health Sci"},{"key":"ref38","doi-asserted-by":"publisher","first-page":"8080561","DOI":"10.1155\/jare\/8080561","article-title":"Thai older persons' digital capacity and application of Technology for Healthy Aging: a mixed-method study","volume":"2025","author":"Pan","year":"2025","journal-title":"J Aging Res"},{"key":"ref39","doi-asserted-by":"publisher","first-page":"e22051","DOI":"10.2196\/22051","article-title":"Relationship between internet use and change in health status: panel study of young adults","volume":"23","author":"Hunsaker","year":"2021","journal-title":"J Med Internet Res"},{"key":"ref40","doi-asserted-by":"publisher","first-page":"e78430","DOI":"10.2196\/78430","article-title":"Identifying skill and usability barriers to digital health tool use among older adult patients in US safety net clinics: mixed methods study","volume":"13","author":"Rapson","year":"2026","journal-title":"JMIR Hum Factors"},{"key":"ref41","doi-asserted-by":"publisher","first-page":"893","DOI":"10.1036\/NWS-2021-067786","article-title":"Internet skills and the digital divide","volume":"13","author":"Van Deursen","year":"2021","journal-title":"New Media Soc"},{"key":"ref42","doi-asserted-by":"publisher","first-page":"e1","DOI":"10.1093\/geront\/gny037","article-title":"Exploring privilege in the digital divide: implications for theory, policy, and practice","volume":"59","author":"Fang","year":"2019","journal-title":"The Gerontologist"},{"key":"ref43","doi-asserted-by":"publisher","first-page":"e076768","DOI":"10.1136\/bmj-2023-076768","article-title":"Bridging the digital divide to promote prevention and control of non-communicable diseases for all in China and beyond","volume":"387","author":"Gong","year":"2024","journal-title":"BMJ"},{"key":"ref44","first-page":"e70052","article-title":"Effect of health literacy and patient activation on health-seeking behaviour: a cross-sectional study in Turkey","volume-title":"Health Expect","author":"Eri\u015fen","year":"2024"},{"key":"ref45","doi-asserted-by":"publisher","first-page":"e028554","DOI":"10.1136\/bmjopen-2018-028554","article-title":"Optimising patient active role with a user-centred eHealth platform (CONCERTO+) in chronic diseases management: a study protocol for a pilot cluster randomised controlled trial","volume":"9","author":"Gagnon","year":"2019","journal-title":"BMJ Open"},{"key":"ref46","doi-asserted-by":"publisher","first-page":"20552076241313160","DOI":"10.1177\/20552076241313160","article-title":"How does mHealth benefit older Chinese adults' quality of life? Examining the roles of eHealth literacy, health motivation, and patient activation","volume":"11","author":"Qiu","year":"2025","journal-title":"Digit Health"},{"key":"ref47","doi-asserted-by":"publisher","first-page":"136","DOI":"10.1016\/j.gerinurse.2023.02.017","article-title":"The mediating effect of self-efficacy on the relationship between diabetes self-management ability and patient activation in older adults with type 2 diabetes","volume":"51","author":"Zhang","year":"2023","journal-title":"Geriatr Nurs"},{"key":"ref48","doi-asserted-by":"publisher","first-page":"111105","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":"ref49","doi-asserted-by":"publisher","first-page":"e315","DOI":"10.1097\/jnr.0000000000000588","article-title":"Relationship between electronic health literacy and self-management in people with type 2 diabetes using a structural equation modeling approach","volume":"32","author":"Lee","year":"2024","journal-title":"J Nurs Res"},{"key":"ref50","doi-asserted-by":"publisher","first-page":"358","DOI":"10.46497\/ArchRheumatol.2024.10397","article-title":"Assessment of electronic health literacy and its association with self-management among gout patients: a cross-sectional study","volume":"39","author":"Qian","year":"2024","journal-title":"Arch Rheumatol"},{"key":"ref51","doi-asserted-by":"publisher","first-page":"8043","DOI":"10.1111\/jocn.16876","article-title":"What are the roles of eHealth literacy and empowerment in self-management in an eHealth care context? A cross-sectional study","volume":"32","author":"Shiu","year":"2023","journal-title":"J Clin Nurs"},{"key":"ref52","doi-asserted-by":"publisher","first-page":"281","DOI":"10.1002\/nur.22447","article-title":"Validity and reliability of patient activation measure (PAM13-I) Italian version among patient undergoing elective surgery","volume":"48","author":"Provenzano","year":"2025","journal-title":"Res Nurs Health"},{"key":"ref53","doi-asserted-by":"publisher","first-page":"2616","DOI":"10.1007\/s40593-025-00466-w","article-title":"Towards an AI-literate future: a systematic literature review exploring education, ethics, and applications","volume":"35","author":"Biagini","year":"2025","journal-title":"Int J Artif Intell Educ"},{"key":"ref54","doi-asserted-by":"publisher","DOI":"10.46787\/ijaipil.v2i1.7287","article-title":"From digital literacy to AI literacy: a systematic review and integrative framework for education","volume":"2","author":"Memarian","year":"2026","journal-title":"Int J AI Pedagog Innov Learn Fut"},{"key":"ref55","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1080\/15710882.2025.2608872","article-title":"Cocreating support: toward a digital inclusion intervention for parents in poverty","volume":"26","author":"Boerkamp","year":"2026","journal-title":"CoDesign"},{"key":"ref56","doi-asserted-by":"publisher","first-page":"259","DOI":"10.1002\/hcs2.70033","article-title":"A smartphone is not enough: telehealth attendance and the digital divide","volume":"4","author":"Labadorf","year":"2025","journal-title":"Health Care Sci"}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2026.1799712\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T05:30:17Z","timestamp":1789104617000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2026.1799712\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,11]]},"references-count":56,"alternative-id":["10.3389\/fpubh.2026.1799712"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2026.1799712","relation":{},"ISSN":["2296-2565"],"issn-type":[{"value":"2296-2565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,11]]},"article-number":"1799712"}}