{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T01:24:00Z","timestamp":1789608240037,"version":"build-2803163510"},"reference-count":52,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,6]],"date-time":"2026-08-06T00:00:00Z","timestamp":1785974400000},"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>Patient activation is essential for effective self-management among breast cancer patients, yet the mechanisms through which eHealth literacy contributes to it remain incompletely understood.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>This investigation sought to delineate the chain mediating roles of self-efficacy and social support linking eHealth literacy to patient activation among breast cancer populations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>316 breast cancer patients were recruited into a cross-sectional survey framework. Each participant underwent an evaluation of their levels of patient activation, perceived social support, self-efficacy, and eHealth literacy. After controlling relevant factors, model 6 in PROCESS 4.1 was applied to construct a chain mediation model; the bootstrapping procedure was subsequently applied to verify the mediating pathways.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      eHealth literacy showed a significant association with patient activation (\n                      <jats:italic>p<\/jats:italic>\n                      &amp;lt; 0.001) and demonstrated meaningful positive associations with self-efficacy and social support (\n                      <jats:italic>p<\/jats:italic>\n                      &amp;lt; 0.01). Chain mediation analysis revealed that social support and self-efficacy acted as sequential intermediaries transmitting the influence of eHealth literacy onto patient activation. The aggregate indirect effect accounted for 35.7%, with all pathway confidence intervals excluding zero.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Among breast cancer patients, eHealth literacy was associated with patient activation through sequential mediation by social support and self-efficacy. These findings suggest that strategies to strengthen patients' eHealth literacy, mobilize social support, and build self-efficacy may hold promise for promoting active participation in health self-management, although the effectiveness of such interventions warrants confirmation in future longitudinal or intervention studies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2026.1904185","type":"journal-article","created":{"date-parts":[[2026,8,6]],"date-time":"2026-08-06T05:32:10Z","timestamp":1785994330000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Understanding the relationship between eHealth literacy, self-efficacy, social support, and patient activation in breast cancer patients: a chain mediation analysis"],"prefix":"10.3389","volume":"14","author":[{"given":"Lijia","family":"Hou","sequence":"first","affiliation":[{"name":"Department of Nursing, Deyang People's Hospital, 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