Oral Health Literacy and Oral Health-Related Quality of Life in Maintenance Hemodialysis Patients: The Serial Mediation of Social Support and Self-Efficacy

Objective To examine the relationship between oral health literacy (OHL) and oral health-related quality of life (OHRQoL) in patients undergoing maintenance hemodialysis (MHD), and to analyze the mediating roles of social support and self-efficacy for self-care of oral health (SESS) in this relationship. Methods A cross-sectional study was conducted using convenience sampling to recruit 402 MHD patients from three tertiary hospitals in Guangzhou between June 2023 and January 2024. Data were collected using the Health Literacy in Dentistry scale (HeLD-14), the Perceived Social Support Scale (PSSS), the Self-Efficacy for Self-Care of Oral Health Scale (SESS), and the Oral Health Impact Profile-14 (OHIP-14). Data analysis was performed using SPSS 27.0 for descriptive statistics, correlation analysis, and linear regression analysis. The mediation effects were tested using Model 6 from Hayes' PROCESS macro. Results (1) OHL was positively correlated with both social support (r = 0.649, p < 0.001) and SESS (r = 0.731, p < 0.001), and negatively correlated with OHRQoL (r=-0.523, p < 0.001) in MHD patients. (2) Mediation analysis revealed a significant direct effect of OHL on OHRQoL (effect size: -0.199). Both social support and SESS served as independent mediators in the relationship between OHL and OHRQoL, with indirect effect sizes of -0.135 and − 0.148, respectively. Furthermore, they played a serial mediating role, with an indirect effect size of -0.041. Conclusion Oral health literacy in MHD patients not only directly influences their OHRQoL but also exerts indirect effects through the independent mediating roles of social support and self-efficacy for oral health self-care, as well as their serial mediation. Clinical interventions should focus on synergistically enhancing patients' perceived social support and self-efficacy levels.