# 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

## TL;DR

This study shows how self-efficacy helps Chinese lupus patients find benefits in their illness, both directly and through improved self-esteem and health literacy.

## Contribution

The study identifies a serial mediation pathway involving self-esteem and health literacy in the self-efficacy-benefit finding relationship among SLE patients.

## Key findings

- Self-efficacy directly and significantly predicts benefit finding in SLE patients.
- Self-esteem and health literacy serially mediate the relationship between self-efficacy and benefit finding.
- Younger patients show a stronger indirect effect of self-efficacy on benefit finding through self-esteem and health literacy.

## Abstract

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.

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.

The mean scores for self-efficacy, self-esteem, health literacy, and benefit finding were 21.47 ± 5.37, 27.42 ± 2.68, 94.29 ± 10.71, and 65.20 ± 10.92, respectively. Correlation analysis revealed significant positive associations among self-efficacy, self-esteem, health literacy, and benefit finding (r = 0.833, 0.885, P < 0.001). Path analysis indicated that self-efficacy had a significant direct effect on benefit finding (β = 0.339, 95% CI: 0.041–0.636). The mediating effects of self-esteem (effect = 0.636, 95% CI: 0.234–1.067) and health literacy (effect = 0.506, 95% CI: 0.200–0.819) were also significant. Furthermore, the serial mediating pathway of “self-efficacy → self-esteem → health literacy → benefit finding” was significant (effect = 0.212, 95% CI: 0.042–0.577). 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 (β = −0.080, 95% CI: −0.120 to −0.039).

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.