Social determinants and health literacy in cancer coping: sequential mediation through illness perceptions within the...

Social disadvantage may affect how people with cancer access, interpret, and use health information, but pathways linking social determinants to coping remain unclear. We examined whether health literacy and illness perceptions sequentially mediated associations between social determinants and coping.

Adults receiving oncology care at a national cancer center completed measures of health literacy, illness perceptions, and coping, including confrontation, avoidance, and acceptance-resignation. Mediation analyses and structural equation modelling tested potential pathways.

Older age, Chinese-dominant primary language, lower education, and non-employment/retirement were consistently associated with lower health literacy. Health literacy mediated associations of language, education, and employment with illness perceptions and partially mediated the age association. In the full path model, higher health literacy was associated with greater confrontation (standardized β = .31, p < .001) and less threatening illness perceptions (β =  - .33, p < .001). More threatening illness perceptions were associated with lower confrontation (β =  - .50, p < .001) and higher maladaptive coping (β = .37, p < .001). Serial mediation pathways from each social determinant to coping through health literacy and illness perceptions were significant. Sensitivity analyses supported the overall pattern, although Cancer Health Literacy Test-6 effects were weaker and partly divergent for avoidance.

Health literacy and illness perceptions may be linked psychosocial mechanisms connecting social determinants with cancer coping. The cross-sectional design precludes causal inference.

Routine assessment of health literacy and illness perceptions may help identify survivors who need linguistically accessible, age-sensitive, and digitally inclusive coping support.