Health literacy and self-efficacy as predictors of self-care behaviors in patients with hematological malignancies: A multicenter cross-sectional study in northeastern Thailand

Ueamporn Summart (Faculty of Nursing, Roi et Rajabhat University , Roi Et, Thailand)
Monthida Sangruangake (Faculty of Nursing, Udon Thani Rajabhat University , Udon Thani, Thailand)
Chanathip Halak (Ubon Ratchathani Cancer Hospital, Ubon Ratchathani, Thailand)
Phawadee Thongnopkhun Toyn (Faculty of Nursing, Udon Thani Rajabhat University , Udon Thani, Thailand)

Belitung Nursing Journal
Vol. 12 No. 5 (2026): September - October

Background: Self-care is vital for patients with hematological malignancies (HMs) to manage the severe side effects of chemotherapy. While social support is a traditional focus of care, internal psychological resources may be more critical for sustaining treatment adherence in isolated therapeutic settings. Objective: To determine the prevalence of self-care behaviors and evaluate the extent to which health literacy and self-efficacy predict these behaviors among patients with HMs in northeastern Thailand. Methods: This multicenter, cross-sectional study, conducted from August to December 2025, utilized convenience sampling to recruit 350 patients with HMs from three tertiary hospitals in northeastern Thailand. Data were collected via self-administered questionnaires and analyzed using descriptive statistics and binary logistic regression. The predictive model’s performance was evaluated using the Area Under the Curve (AUC), with significance set at p < 0.05. Results: The prevalence of high self-care behaviors was 61.2% (95% CI = 55.8-66.3). Bivariable analysis showed that social support was initially associated with higher self-care. However, binary logistic regression identified only health literacy (AOR = 18.05, 95% CI = 14.40-20.10) and self-efficacy (AOR = 10.79, 95%CI = 5.70-11.40) as significant independent predictors. Social support did not remain a significant predictor in the final model. The model exhibited excellent discriminant ability with an AUC of 0.86 (95% CI = 0.78-0.91, p < 0.001). Conclusion: High self-care behaviors are common among patients with HMs in northeastern Thailand. Our results show that internal factors, specifically health literacy and self-efficacy, are stronger predictors of self-care than external social support in this treatment-intensive context. These findings underscore the need for oncology nurses to screen for both health literacy and self-efficacy during clinical assessments, enabling early identification of at-risk patients and delivery of targeted interventions to promote effective self-management.