Health Literacy and Negative Emotions in Hospitalised COPD Patients:The Serial Mediating Roles of Social Support and Illness Perception

Background Negative emotions such as anxiety and depression are common among hospitalized patients with chronic obstructive pulmonary disease and are important predictors of poor clinical outcomes and prolonged hospitalization. As a key patient-related capacity, health literacy influences patients’ ability to understand health information, engage in self-management, and cope with illness-related stress. However, the heterogeneity of health literacy among hospitalized COPD patients and the mechanisms through which it affects negative emotions remain unclear. Analysis of the associations and pathways linking health literacy and negative emotions may provide essential evidence for targeted nursing interventions. This study aimed to investigate the association between health literacy and negative emotions among hospitalized COPD patients, identify potential subgroup characteristics, and explore the mediating roles of social support and illness perception. Methods This study employed a cross-sectional design. From November 2024 to August 2025, COPD patients meeting the inclusion and exclusion criteria were recruited via convenience sampling from the respiratory medicine and geriatrics departments of a Grade A tertiary hospital in Shenzhen. Data were collected using questionnaires covering general information, health literacy, perceived social support, illness perception, and anxiety and depression. Descriptive statistics, latent class analysis, correlation analysis, and mediation analysis were conducted using Mplus 8.3, R 4.4.2, and the PROCESS macro 4.3. Results Health literacy among hospitalized COPD patients is heterogeneous in relation to negative emotions, with higher health literacy generally associated with lower levels of negative affect. Moreover, the protective effect of health literacy on negative emotions is partially mediated by improvements in social support and illness perception. Conclusions When addressing negative emotions in hospitalized COPD patients, healthcare professionals should prioritize social support and illness perception while enhancing health literacy. Strengthening patients’ understanding and coping skills, along with emotional and informational support, may reduce anxiety and depression, improve outcomes, expedite discharge, and enhance quality of life. Clinical trial number Not applicable.