The Impact of Health Beliefs on Treatment Decision Conflict through Treatment Expectations Mediation in Lumbar Disc Herniation Patients

Background: Low back pain (LBP) is a leading cause of disability worldwide, with lumbar disc herniation (LDH) being a prevalent contributor. Treatment strategies for LDH range from conservative management to surgical decompression for persistent or neurocompressive cases, making effective treatment decision-making critical. This study investigates the impact of the Health Belief Scale (HBS) on decisional conflict scale (DCS) regarding treatment choices in patients with LDH. Methods: A cross-sectional survey was administered to 707 consecutively recruited patients with LDH. Three key constructs were assessed using validated instruments: health beliefs (Health Belief Model scale), DCS, and treatment expectations (Illness Perception Questionnaire-Revised). First, the goodness-of-fit of the hypothesized theoretical framework was evaluated through structural equation modeling (SEM). Subsequently, descriptive statistics and Pearson correlation analyses were conducted to examine intervariable relationships. Finally, the mediation effect of treatment expectations was tested using bias-corrected bootstrap procedures. Results: Health beliefs demonstrated a significant negative association with DCS (r = -0.66, p < 0.001), indicating that stronger health beliefs correlated with reduced decision-making difficulties. Similarly, treatment expectations exhibited a moderate inverse relationship with DCS (r = -0.32, p < 0.001). Mediation analysis identified that treatment expectations were associated with a partial mediating pattern in the relationship between health beliefs and DCS (B = -0.013, SE = 0.005, 95% CI: -0.024 to -0.006), reflecting an observed correlational pathway that accounts for 19.7% of the total association. Conclusion: This study provides novel insights into the psychosocial determinants of treatment decision-making in patients with LDH, highlighting the critical role of health beliefs and treatment expectations. These findings have significant clinical implications, suggesting that enhancing patients’ health literacy and calibrating realistic treatment expectations may be associated with more informed decision-making, with potential to improve therapeutic outcomes; however, causal inferences cannot be drawn from cross-sectional data. Future interventions should integrate belief-cognitive components into shared decision-making frameworks to optimize patient-centered care.