Abstract
OBJECTIVE: This study aimed to examine the chain mediating roles of eHealth literacy and pelvic floor muscle training (PFMT) adherence in the association between urinary incontinence (UI) severity and anxiety. METHODS: A cross-sectional study was conducted using convenience sampling to recruit 240 patients with prostate cancer one month after surgery. Validated instruments were used to assess PFMT adherence (PFMT Adherence Scale), eHealth literacy (eHEALS), UI severity (International Consultation on Incontinence Questionnaire-Short Form), and anxiety (Generalized Anxiety Disorder-7). Structural equation modeling (SEM) was performed using AMOS 24.0 to evaluate direct and indirect effects. Mediation effects were tested using bias-corrected bootstrap analyses with 5000 resamples and 95% CI. RESULTS: At one month postoperatively, 45.05% of patients experienced anxiety, 60.40% reported moderate-to-severe urinary incontinence, and 71.78% demonstrated low eHealth literacy. High adherence to PFMT was observed in only 36.63% of participants. UI severity was indirectly associated with anxiety through three pathways: eHealth literacy (β = 0.154, P < 0.01), PFMT adherence (β = -0.047, P < 0.05), and a sequential pathway involving both eHealth literacy and PFMT adherence (β = 0.038, P < 0.01). eHealth literacy accounted for 22.3% of the total effect, PFMT adherence for 6.8%, and their combined chain mediation effect for 5.5%. CONCLUSIONS: Urinary incontinence severity one month after prostate cancer surgery is a significant predictor of anxiety, exerting both direct and indirect effects. eHealth literacy and PFMT adherence function as important psychological and behavioral mediators, together explaining 34.6% of the total effect. Interventions aimed at enhancing eHealth literacy and promoting structured pelvic floor muscle training may help reduce postoperative anxiety and support recovery in this population.