Health Literacy and Self-Care Maintenance in Posttransplantation Diabetes Mellitus Among Kidney Transplant Recipients: The Mediating Role of Self-Care Confidence.

Background and Purpose: Given the unique therapeutic challenges that kidney transplant recipients with posttransplantation diabetes mellitus face, understanding how self-care confidence influences self-care maintenance is paramount. This study aimed to examine the mediating role of self-care confidence in the association between health literacy and self-care maintenance among kidney transplant recipients with posttransplantation diabetes mellitus. Methods: This study used a cross-sectional, descriptive, and correlational design. A convenience sample of 109 participants was recruited from a single tertiary hospital, and participants completed a web-based questionnaire. The mediation analysis was conducted using the percentile bootstrap method, controlling for participants' general characteristics. Results: Health literacy was significantly associated with self-care maintenance (β = 0.46, p < .001, 95% confidence interval [CI] [0.44, 1.29]). Including self-care confidence reduced the direct effect (β = 0.37, p = .001, 95% CI [0.31, 1.08]), indicating partial mediation. The completely standardized indirect effect was significant (β = 0.18, 95% CI [0.07, 0.32]), and the model explained 45% of the variance in self-care maintenance (R² = .45). Implications for Practice: Strengthening self-care confidence may enhance self-care maintenance, while ongoing strategies to support health literacy remain important.