Abstract
BACKGROUND: Chronic hepatitis B (CHB) is a global health challenge with low rates of diagnosis and treatment worldwide. Since social factors and individual cognition significantly influence antiviral therapy adherence in CHB patients, both of which are shaped by patients' understanding of hepatitis B, this study aimed to investigate the effects of social influences on antiviral therapy behavior among CHB patients with different levels of disease knowledge. METHODS: From March to October 2023, a survey was conducted among CHB patients in Fuqing City, Fujian Province. A self-designed scale was developed based on the attitude-social influence-efficacy (ASE) model, prototype willingness model (PWM), and theory of planned behavior (TPB). Using the mean score as the cutoff point, CHB patients were divided into high and low knowledge levels. Multi-group structural equation modeling (SEM) was used to validate the hypotheses and determine the mechanism of antiviral therapy behavior. RESULTS: A total of 611 individuals were ultimately included. Multi-group structural equation modeling (SEM) analyses revealed significant differences between patients with high and low disease knowledge levels across three pathways: social support towards self-efficacy (CR = -2.839, P < 0.05), social support towards attitude (CR = 2.142, P < 0.05), and self-efficacy towards behavior (CR = 3.720, P < 0.001). Social support had a stronger influence on self-efficacy in CHB patients with low disease knowledge compared to those with high disease knowledge. Among patients with higher disease knowledge, social support exerted a greater impact on treatment attitudes, while self-efficacy demonstrated a stronger influence on treatment behaviors. CONCLUSION: To enhance the motivation and adherence of CHB patients to antiviral therapy, healthcare providers could implement tailored health education strategies based on patients' varying levels of knowledge. Additionally, dynamic health goal-setting should be integrated to drive continuous health management. Furthermore, establishing a multi-tiered social support network that incorporates family involvement, community support groups, and healthcare institution collaboration is essential.