{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T06:18:17Z","timestamp":1783491497590,"version":"3.55.0"},"reference-count":44,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T00:00:00Z","timestamp":1783468800000},"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>Background<\/jats:title>\n                    <jats:p>Kidney transplant recipients face complex self-management challenges that require a high level of health literacy, particularly in digital health contexts. However, the mechanisms underlying eHealth literacy in this population remain underexplored. This study aimed to examine the association between social support and eHealth literacy and to investigate the mediating role of self-efficacy in this relationship among kidney transplant recipients in China.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A cross-sectional survey was conducted in June 2025 among 236 kidney transplant recipients at a tertiary hospital in northeastern China. Eligible participants had undergone kidney transplantation at the study hospital between January 2022 and May 2025. Standardized self-report questionnaires were used to measure social support, self-efficacy, and eHealth literacy. Mediation analysis was performed using the PROCESS macro for SPSS, adjusting for relevant covariates.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      After adjustment for covariates, social support was significantly associated with self-efficacy (B\u202f=\u202f0.351,\n                      <jats:italic>p<\/jats:italic>\n                      &amp;lt;\u202f0.001) and eHealth literacy (total effect: B\u202f=\u202f0.213,\n                      <jats:italic>p<\/jats:italic>\n                      &amp;lt;\u202f0.001). When self-efficacy was included in the model, the direct association between social support and eHealth literacy remained significant (direct effect: B\u202f=\u202f0.143,\n                      <jats:italic>p<\/jats:italic>\n                      &amp;lt;\u202f0.001). The indirect effect through self-efficacy was also significant (B\u202f=\u202f0.070,\n                      <jats:italic>p<\/jats:italic>\n                      &amp;lt;\u202f0.001), indicating findings consistent with a partial mediation pattern.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Among kidney transplant recipients, social support and self-efficacy were positively associated with eHealth literacy, and self-efficacy partly accounted for the association between social support and eHealth literacy. These findings suggest that perceived social support and self-efficacy may represent promising targets for interventions aimed at enhancing eHealth literacy and digital health engagement in this population.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2026.1864417","type":"journal-article","created":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T05:54:22Z","timestamp":1783490062000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["The mediating role of self-efficacy in the association between social support and eHealth literacy among kidney transplant recipients"],"prefix":"10.3389","volume":"14","author":[{"given":"Xu","family":"Liu","sequence":"first","affiliation":[{"name":"Transplantation and Hepatobiliary Department, The First Hospital of China Medical University","place":["Shenyang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xuange","family":"Sun","sequence":"additional","affiliation":[{"name":"School of Nursing, China Medical University","place":["Shenyang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaofei","family":"Li","sequence":"additional","affiliation":[{"name":"Transplantation and Hepatobiliary Department, The First Hospital of China Medical University","place":["Shenyang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,8]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"2271","DOI":"10.2147\/IDR.S356543","article-title":"Retrospective analysis of the risk factors of perioperative bacterial infection and correlation with clinical prognosis in kidney transplant recipients","volume":"15","author":"Cheng","year":"2022","journal-title":"Infect Drug Resist"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"175","DOI":"10.1186\/s12882-019-1368-0","article-title":"Life and expectations post-kidney transplant: a qualitative analysis of patient responses","volume":"20","author":"Tucker","year":"2019","journal-title":"BMC Nephrol"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"6310","DOI":"10.1038\/s41598-026-37536-5","article-title":"Life expectancy after kidney transplantation in a population-based retrospective cohort","volume":"16","author":"Babich","year":"2026","journal-title":"Sci Rep"},{"key":"ref4","doi-asserted-by":"publisher","DOI":"10.1097\/TP.0000000000001651","article-title":"Practical recommendations for long-term management of modifiable risks in kidney and liver transplant recipients: a guidance report and clinical checklist by the consensus on managing modifiable risk in transplantation (COMMIT) group","volume":"101","author":"Neuberger","year":"2017","journal-title":"Transplant"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"e27","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":"ref6","doi-asserted-by":"publisher","first-page":"2375","DOI":"10.1001\/jama.2020.7943","article-title":"Implications for telehealth in a Post-pandemic future: regulatory and privacy issues","volume":"323","author":"Shachar","year":"2020","journal-title":"JAMA"},{"key":"ref7","volume-title":"The 55th Statistical Report on China\u2019s Internet Development","year":"2025"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"e73520","DOI":"10.2196\/73520","article-title":"Effectiveness of eHealth for medication adherence in renal transplant recipients: systematic review and Meta-analysis","volume":"27","author":"Zhou","year":"2025","journal-title":"J Med Internet Res"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"356","DOI":"10.1177\/01939459241238683","article-title":"Early post-transplant adaptation experience in young and middle-aged people with kidney transplant in China: a qualitative study","volume":"46","author":"Hu","year":"2024","journal-title":"West J Nurs Res"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"2626","DOI":"10.1016\/j.transproceed.2020.05.031","article-title":"Transplant patients' isolation and social distancing because of COVID-19: analysis of the resilient capacities of the transplant in the Management of the Coronavirus Emergency","volume":"52","author":"Lupi","year":"2020","journal-title":"Transplant Proc"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"193","DOI":"10.1007\/s00345-025-05582-9","article-title":"The effectiveness of remote interventions based on digital health technology in kidney transplant recipients: a systematic review","volume":"43","author":"Kuang","year":"2025","journal-title":"World J Urol"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"e14184","DOI":"10.1111\/ctr.14184","article-title":"eHealth literacy and web-based patient portal usage among kidney and liver transplant recipients","volume":"35","author":"Maroney","year":"2021","journal-title":"Clin Transpl"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"589","DOI":"10.1007\/s10865-022-00306-5","article-title":"Perceived social support predicts self-reported and objective health and health behaviors among pregnant women","volume":"45","author":"Mitchell","year":"2022","journal-title":"J Behav Med"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"341","DOI":"10.2147\/VHRM.S417401","article-title":"The mediating effect of self-efficacy on health literacy and social support in young and middle-aged patients with coronary heart disease after PCI","volume":"19","author":"Liu","year":"2023","journal-title":"Vasc Health Risk Manag"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"143","DOI":"10.1177\/1090198104263660","article-title":"Health promotion by social cognitive means","volume":"31","author":"Bandura","year":"2004","journal-title":"Health Educ Behav"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"2141","DOI":"10.2147\/NDT.S137233","article-title":"Moderating role of self-efficacy on the associations of social support with depressive and anxiety symptoms in Chinese patients with rheumatoid arthritis","volume":"13","author":"Liu","year":"2017","journal-title":"Neuropsychiatr Dis Treat"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"868","DOI":"10.1186\/s12912-024-02546-z","article-title":"The mediating effects of self-efficacy, family health, and perceived stress on the relationship between perceived social support and eHealth literacy in nursing students: a structural equation model","volume":"23","author":"Shi","year":"2024","journal-title":"BMC Nurs"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"275","DOI":"10.1177\/031289628801300210","article-title":"Organisational applications of social cognitive theory","volume":"13","author":"Bandura","year":"1988","journal-title":"Aust J Manag"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"e48838","DOI":"10.2196\/48838","article-title":"Structural validation and measurement invariance testing of the Chinese version of the eHealth literacy scale among undergraduates: cross-sectional study","volume":"25","author":"Long","year":"2023","journal-title":"J Med Internet Res"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"298986","DOI":"10.1155\/2013\/298986","article-title":"Validation of a Chinese version of the self-efficacy for managing chronic disease 6-item scale in patients with hypertension in primary care","volume":"2013","author":"Hu","year":"2013","journal-title":"Int Sch Res Not"},{"key":"ref21","first-page":"256","article-title":"Effect of a self-management program on patients with chronic disease","volume":"4","author":"Lorig","year":"2001","journal-title":"Eff Clin Pract"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"30","DOI":"10.1207\/s15327752jpa5201","article-title":"The multidimensional scale of perceived social support","volume":"52","author":"Zimet","year":"1988","journal-title":"J Pers Assess"},{"key":"ref23","first-page":"41","article-title":"Perceived social support scale (PSSS)","volume":"10","author":"Qianjin","year":"2001","journal-title":"Chin Ment Health J"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"e9935996","DOI":"10.1155\/jonm\/9935996","article-title":"Technophobia and its associated factors among registered nurses in China: a cross-sectional multicenter study","volume":"2026","author":"Sun","year":"2026","journal-title":"J Nurs Manag"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"233","DOI":"10.1111\/j.1467-9280.2007.01882.x","article-title":"Required sample size to detect the mediated effect","volume":"18","author":"Fritz","year":"2007","journal-title":"Psychol Sci"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"379","DOI":"10.1177\/1948550617715068","article-title":"Determining power and sample size for simple and complex mediation models","volume":"8","author":"Schoemann","year":"2017","journal-title":"Soc Psychol Personal Sci"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"1361","DOI":"10.1093\/geronb\/gbac007","article-title":"Childhood stressors, relationship quality, and cognitive health in later life","volume":"77","author":"Thomas","year":"2022","journal-title":"J Gerontol B Psychol Sci Soc Sci"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"96","DOI":"10.34172\/jcs.2021.018","article-title":"Association between perceived social support and health-promoting lifestyle in pregnant women: a cross-sectional study","volume":"10","author":"Fathnezhad-Kazemi","year":"2021","journal-title":"J Caring Sci"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"16","DOI":"10.1016\/j.trre.2017.04.001","article-title":"Is social support associated with post-transplant medication adherence and outcomes? A systematic review and meta-analysis","volume":"32","author":"Ladin","year":"2018","journal-title":"Transplant Rev (Orlando)"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"648","DOI":"10.1111\/hex.13412","article-title":"Journey to transplant: developing a social support network counselling intervention to improve kidney transplantation","volume":"25","author":"D'Cunha","year":"2022","journal-title":"Health Expect"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"106","DOI":"10.3389\/fpsyt.2020.00106","article-title":"Psychological and psychopathological aspects of kidney transplantation: a systematic review","volume":"11","author":"De Pasquale","year":"2020","journal-title":"Front Psych"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"705783","DOI":"10.3389\/fcvm.2021.705783","article-title":"Association between social support and medication literacy in Chinese patients with coronary heart disease","volume":"8","author":"Qiao","year":"2021","journal-title":"Front Cardiovasc Med"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"304","DOI":"10.3389\/fpubh.2020.00304","article-title":"Physical comorbidity and health literacy mediate the relationship between social support and depression among patients with hypertension","volume":"8","author":"Zhang","year":"2020","journal-title":"Front Public Health"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"987526","DOI":"10.3389\/fpubh.2022.987526","article-title":"Association between social support and medication literacy in older adults with hypertension","volume":"10","author":"Shen","year":"2022","journal-title":"Front Public Health"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"56","DOI":"10.1007\/s11892-016-0756-0","article-title":"Social support for diabetes self-management via eHealth interventions","volume":"16","author":"Vorderstrasse","year":"2016","journal-title":"Curr Diab Rep"},{"key":"ref36","doi-asserted-by":"publisher","first-page":"e12179","DOI":"10.2196\/12179","article-title":"Associations of health app use and perceived effectiveness in people with cardiovascular diseases and diabetes: population-based survey","volume":"7","author":"Ernsting","year":"2019","journal-title":"JMIR Mhealth Uhealth"},{"key":"ref37","volume-title":"Social Foundations of Thought and Action","author":"Bandura","year":"1986"},{"key":"ref38","doi-asserted-by":"publisher","first-page":"352","DOI":"10.1016\/j.ijnss.2018.09.009","article-title":"Correlation of long-term medication behaviour self-efficacy with social support and medication knowledge of kidney transplant recipients","volume":"5","author":"Du","year":"2018","journal-title":"Int J Nurs Sci"},{"key":"ref39","doi-asserted-by":"publisher","first-page":"1445","DOI":"10.1111\/jonm.12828","article-title":"Work stress, perceived social support, self-efficacy and burnout among Chinese registered nurses","volume":"27","author":"Liu","year":"2019","journal-title":"J Nurs Manag"},{"key":"ref40","doi-asserted-by":"publisher","first-page":"e19452","DOI":"10.2196\/19452","article-title":"Mobile health app with social media to support self-management for patients with chronic kidney disease: prospective randomized controlled study","volume":"22","author":"Li","year":"2020","journal-title":"J Med Internet Res"},{"key":"ref41","doi-asserted-by":"publisher","first-page":"265","DOI":"10.1111\/jnu.12377","article-title":"The roles of social support and health literacy in self-management among patients with chronic kidney disease","volume":"50","author":"Chen","year":"2018","journal-title":"J Nurs Scholarsh"},{"key":"ref42","doi-asserted-by":"publisher","first-page":"445","DOI":"10.1111\/jorc.12507","article-title":"Challenges in post-transplantation care for kidney transplant recipients: a qualitative study highlighting gaps in psychological, social and exercise support","volume":"50","author":"De Beir","year":"2024","journal-title":"J Ren Care"},{"key":"ref43","doi-asserted-by":"publisher","first-page":"4366","DOI":"10.1111\/jocn.17697","article-title":"Associations between social support, health literacy and psychological resilience to self-management behaviours in liver transplant recipients-a structural equation model","volume":"34","author":"Gong","year":"2025","journal-title":"J Clin Nurs"},{"key":"ref44","doi-asserted-by":"publisher","first-page":"9","DOI":"10.7182\/pit2015957","article-title":"Determinants of frequent internet use in an urban kidney transplant population in the United States: characterizing the digital divide","volume":"25","author":"Lockwood","year":"2015","journal-title":"Prog Transplant"}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2026.1864417\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T05:54:24Z","timestamp":1783490064000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2026.1864417\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,8]]},"references-count":44,"alternative-id":["10.3389\/fpubh.2026.1864417"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2026.1864417","relation":{},"ISSN":["2296-2565"],"issn-type":[{"value":"2296-2565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,8]]},"article-number":"1864417"}}