The roles of health literacy and social support in self-management among older adults with chronic obstructive pulmonary disease in China

Background Chronic obstructive pulmonary disease (COPD) is a major chronic condition among older adults in China, associated with high morbidity and healthcare burden. Effective self-management is crucial for disease control and improved outcomes, yet many older patients struggle to maintain it due to socioeconomic, cognitive, and physical challenges. Social support and health literacy—the ability to access, understand, and use health information—are recognized as key factors influencing health behaviors, but their interplay in self-management remains unclear in this population. Objective This study aimed to examine the prevalence and associated factors of self-management among older adults with COPD in China. Furthermore, it sought to investigate the mediating role of health literacy in the relationship between social support and self-management, providing insights into the psychological mechanisms through which social resources influence health behaviors in this population. Methods and results In this cross-sectional study, a total of 219 older adults with COPD were recruited from a tertiary hospital in China. The results of the survey showed that the current state of self-management among patients with COPD generally indicates a moderate level, with a mean score of (130.62 ± 20.70). After adjusting for potential confounders, participants residing in rural areas had significantly lower self-management scores compared to those in urban areas ( β = -6.531, p  < 0.05). In contrast, patients receiving home oxygen therapy demonstrated a higher self-management score ( β  = 7.748, p  < 0.05). Additionally, each one-unit increase in health literacy was associated with a 4.473 point increase in self-management ( β  = 4.473, p  < 0.001), and a one-unit increase in social support corresponded to a 1.052 point increase ( β  = 1.052, p  < 0.001). Pearson correlation analysis revealed that both health literacy ( r  = 0.501, p  < 0.01) and social support ( r  = 0.500, p  < 0.01) were significantly positively correlated with self-management. Furthermore, mediation analysis showed that health literacy partially mediated the association between social support and self-management, accounting for 61.08% of the total effect. Conclusion Self-management was suboptimal among older adults with COPD in China. Factors such as residence, home oxygen therapy, health literacy, and social support were significantly associated with self-management. Notably, health literacy partially mediated the association between social support and self-management, highlighting its role as both a direct contributor and a psychological mechanism linking social resources to health behaviors.