Self-efficacy as a mediator between health technology readiness and health-related quality of life: A survey study with mediation analysis

Background: Digital health supports self-management of preference-sensitive conditions and improves health-related quality of life (HR-QoL). Additionally, digital health literacy (DHL) is positively associated with HR-QoL, although not always directly, with self-efficacy as a mediator. Health technology readiness, as a broader concept, encompasses DHL and may further enhance understanding of these relationships. Objective: This study aimed to examine the relationship between health technology readiness and HR-QoL and the potential mediating role of self-efficacy in this association among people with preference-sensitive neurological conditions. Methods: The cross-sectional study used Finnish versions of the Readiness and Enablement Index for Health Technology (READHY-FIN), Self-Efficacy for Managing Chronic Disease (SEMCD-FIN), and EuroQol five-dimensional questionnaire (EQ-5D-5L) to assess health technology readiness, self-efficacy, and HR-QoL. A linear regression model was used to investigate associations between the constructs, and the PROCESS Macro for SPSS was used to test self-efficacy as a possible mediator. Results: The domains of health technology readiness: DHL (B=.156, p<.001), self-management (B=.296, p<.001), and social support (B=.118, p<.001), were positively associated with HR-QoL. However, the associations were indirect between DHL and HR-QoL (B=.163; p<.001), and between social support and HR-QoL (B=.122; p<.001), consistent with mediation through self-efficacy. Self-management had significant direct (B=.105, p=.003) and indirect (B=.191, p< .001) associations, consistent with partial mediation. Conclusions: Self-efficacy mediates the associations of DHL and social support with HR-QoL, whereas self-management had both direct and indirect associations. These findings emphasize a holistic approach of health technology readiness in the development of digital health.