Title : Social support, health literacy, perceived control, and health-promoting behaviors in young and middle-aged lung cancer surgical patients: A structural equation model analysis
Abstract:
Background: Lung cancer has become a major challenge in the global public health field. Young and middle-aged lung cancer surgery patients face multiple pressures at the physiological, psychological, and social levels. Health promotion behaviors, as a low-cost and high-efficiency intervention approach, can directly affect the health outcomes of lung cancer surgery patients. However, there is still a lack of systematic research based on scientific theories and models on the influencing factors and internal mechanisms of health promotion behaviors in young and middle-aged lung cancer surgery patients.
Objective: Based on a health promotion model, a structural equation model was established to quantitatively analyze the relationship between perceived social support, health literacy, perceived control, and health promotion behavior in lung cancer surgery patients.
Methods: This study employed a cross-sectional design to investigate 450 young and middle-aged lung cancer surgery patients recruited from three public hospitals between December 2024 and August 2025. The assessment instruments comprised the General Sociodemographic Characteristics Questionnaire, the Perceived Social Support Scale (PSSS), the Chinese version of Health Literacy Management Scale (HeLMS), the Cancer Experience and Efficacy Scale (CEES) (including the cancer experience and control efficacy subscales), and the Chinese version of the Health-Promoting Lifestyle Profile II (HPLP II). In total, 436 valid questionnaires were collected; the effective recovery rate was 96.9%, Descriptive data analysis was performed using SPSS 27.0 software, while AMOS 28.0 was used for model validation and mediation path analysis.
Results: Structural equation modeling results showed that the perceived social support was positively correlated with health-promoting lifestyle (β=0.200, P<0.001); health literacy was positively correlated with health-promoting lifestyle (β=0.354, P<0.001); cancer experience was negatively correlated with health-promoting lifestyle (β=-0.188, P<0.001); and control efficacy was positively correlated with health-promoting lifestyl (β=0.138, P<0.05). Mediation analyses further confirmed that health literacy (β=0.148, SE=0.029, 95% CI [0.100, 0.215]), cancer experience (β=0.070, SE=0.023, 95% CI [0.030, 0.121]), and control efficacy (β=0.073, SE=0.032, 95% CI [0.016, 0.141]) each served as significant mediators in the relationship between perceived social support and health-promoting lifestyles. A significant chain mediation pathway was identified through health literacy and cancer experience (β=0.033, SE=0.012, 95% CI [0.015, 0.063]), and another through health literacy and control efficacy (β=0.013, SE=0.006, 95% CI [0.003, 0.028]), linking perceived social support to health-promoting lifestyles.
Conclusions: The relationship between perceived social support and health-promoting lifestyles is embedded in the mediating roles of health literacy, cancer experience, and control efficacy. Early identification and intervention of perceived social support, health literacy, cancer experience, and control efficacy can help lung cancer surgery patients adopt health-promoting lifestyles.
