Mediating effect of disease uncertainty on the relationship between health literacy and anxiety in uremic dialysis patients

doi:10.3969/j.issn.1004-583X.2026.04.005

Abstract

Abstract:

Objective To investigate the mediating effect of disease uncertainty on the relationship between health literacy and anxiety in uremic dialysis patients. Methods Using convenience sampling, 127 uremic dialysis patients admitted to Nanyang Third People's Hospital from April 2021 to April 2025 were selected. Disease uncertainty, health literacy, and anxiety were assessed using the Mishel Uncertainty in Illness Scale (MUIS), the Health Literacy Scale for Chronic Patients (HLSCP), and the Self-Rating Anxiety Scale (SAS), respectively. Pearson correlation analysis was used to examine associations among the variables. Hierarchical regression analysis and Bootstrap resampling were applied to test the mediating effect of disease uncertainty between health literacy and anxiety. Results A total of 127 questionnaires were distributed, and 116 valid questionnaires were returned, yielding an effective response rate of 91.34%. Among the 116 uremic dialysis patients, the total scores were 75.13±18.76 for MUIS, 64.28±10.97 for HLSCP, and 56.82±6.44 for SAS. Pearson correlation analysis showed that the total MUIS score was positively correlated with the total SAS score (P<0.05) and negatively correlated with the total HLSCP score (P<0.05); the total HLSCP score was negatively correlated with the total SAS score (P<0.05). Mediation analysis indicated that disease uncertainty had a partial mediating effect on the relationship between health literacy and anxiety in uremic dialysis patients, accounting for 53.4% of the total effect. Conclusion Disease uncertainty is an important mediating mechanism through which health literacy influences anxiety in uremic dialysis patients. In clinical practice, anxiety symptoms may be alleviated by improving health literacy and reducing disease uncertainty.

Key words: uremia, dialysis, disease uncertainty, health literacy, anxiety, mediating effect

CLC Number:

R692.5

Wang Yan, Yang Heng. Mediating effect of disease uncertainty on the relationship between health literacy and anxiety in uremic dialysis patients[J]. Clinical Focus, 2026, 41(4): 318-322.

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URL: https://www.lchc.cn/EN/10.3969/j.issn.1004-583X.2026.04.005

https://www.lchc.cn/EN/Y2026/V41/I4/318

Figures/Tables 4

Tab.1 MUIS, HLSCP, and SAS scores in uremic dialysis patients

项目	总分(分)	分数(分)	条目均分(分)
MUIS总分	25~125	75.13±18.76	3.01±0.75
不明确性	11~55	32.19±8.85	2.93±0.80
缺乏澄清	7~35	21.96±6.71	3.14±0.96
信息缺乏	4~20	11.48±3.58	2.87±0.90
不可预测性	3~15	9.27±3.06	3.09±1.02
HLSCP总分	24~120	64.28±10.97	2.68±0.46
信息获取能力	9~45	21.73±4.68	2.41±0.52
交流互动能力	9~45	28.63±6.45	3.18±0.72
改善健康意愿	4~20	10.16±2.71	2.54±0.68
经济支持意愿	2~10	5.04±1.22	2.52±0.61
SAS总分	25~100	56.82±6.44	-

Tab.2 Correlation analysis of uncertainty, health literacy, and anxiety in uremic dialysis patients

变量	SAS总分	MUIS总分	HLSCP总分
SAS总分	1.000	-	-
MUIS总分	0.517^*	1.000	-
HLSCP总分	-0.618^*	-0.592^*	1.000

Tab.3 Regression analysis of the mediating effect of disease uncertainty

步骤	因变量	预测变量	β值	标准误	$t$ 值	$P$ 值	调整 $R 2$
步骤1	焦虑	健康素养	-0.601	0.072	-8.352	<0.01	0.374
步骤2	疾病不确定感	健康素养	-0.584	0.065	-8.985	<0.01	0.336
步骤3	焦虑	健康素养	-0.280	0.069	-4.058	<0.01	0.526
		疾病不确定感	0.548	0.062	8.839	<0.01

Tab.3 Regression analysis of the mediating effect of disease uncertainty

步骤	因变量	预测变量	β值	标准误	$t$ 值	$P$ 值	调整 $R 2$
步骤1	焦虑	健康素养	-0.601	0.072	-8.352	<0.01	0.374
步骤2	疾病不确定感	健康素养	-0.584	0.065	-8.985	<0.01	0.336
步骤3	焦虑	健康素养	-0.280	0.069	-4.058	<0.01	0.526
		疾病不确定感	0.548	0.062	8.839	<0.01

Tab.4 Bootstrap test of the mediating effect of disease uncertainty

效应路径	效应值	标准误	$P$ 值	95% $C I$		效应占比
效应路径	效应值	标准误	$P$ 值	下限	上限	效应占比
总效应(c)	-0.601	0.072	<0.01	-0.743	-0.459	100%
直接效应(c')	-0.280	0.069	<0.01	-0.416	-0.144	46.6%
间接效应(a×b)	-0.321	0.051	<0.01	-0.425	-0.227	53.4%

Tab.4 Bootstrap test of the mediating effect of disease uncertainty

效应路径	效应值	标准误	$P$ 值	95% $C I$		效应占比
效应路径	效应值	标准误	$P$ 值	下限	上限	效应占比
总效应(c)	-0.601	0.072	<0.01	-0.743	-0.459	100%
直接效应(c')	-0.280	0.069	<0.01	-0.416	-0.144	46.6%
间接效应(a×b)	-0.321	0.051	<0.01	-0.425	-0.227	53.4%

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