Objective  To explore the mediating effect of social support and health literacy on self-efficacy and self-advocacy in patients with postoperative chemotherapy for breast cancer.

Methods  By convenient sampling method, patients with postoperative chemotherapy in the breast surgery department of Xi 'an tertiary hospitals were selected as the research objects. The general data questionnaire, General Self-Efficacy Scale, Social Support Rating Scale, Health Literacy Management Scale and Female Self-Advocacy in Cancer Survivorship were used to collect information. Pearson correlation analysis was performed to explore the correlation between variables. The model 6 of the PROCESS component of the SPSS macro program was used to construct the structural equation model.

Results  A total of 295 patients with postoperative chemotherapy for breast cancer were included. The total score of self-advocacy was (76.16±5.59), and self-efficacy, social support, and health literacy were positively correlated with self-advocacy (all P<0.05). The results of path analysis showed that self-efficacy had a significant direct effect on self-advocacy (β=0.130, P<0.05), and it also had indirect effects on self-advocacy through social support (β=0.057, P<0.05) and health literacy (β=0.096, P<0.05). Social support and health literacy played a mediation role between self-efficacy and self-advocacy (β=0.162, P<0.05), with a total indirect effect accounting for 55.48% of the total effect.

Conclusion  The self-advocacy in patients with postoperative chemotherapy for breast cancer was at a medium level, and self-efficacy can directly affect the self-advocacy of patients, but also indirectly affect the self-advocacy through social support and health literacy. Medical staff can improve patients' self-efficacy, broaden social support channels, strengthen health literacy and improve patients' self-advocacy through various  ways.

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