Social support, health literacy, perceived control, and health-promoting behaviors in young and middle-aged lung cancer surgical patients: a structural equation model analysis

Background Lung cancer is a significant public health challenge worldwide. For young and middle-aged patients undergoing lung cancer surgery, health-promoting behaviors offer a low-cost, high-impact approach for improving postoperative recovery and long-term health outcomes. Objective This study explored the associations between perceived social support, health literacy, perceived control, and health-promoting behaviors in young and middle-aged patients undergoing lung cancer surgery. Methods We employed a cross-sectional design to investigate 436 young and middle-aged patients undergoing lung cancer surgery who were recruited from three public hospitals between December 2024 and August 2025. Data were collected using the Sociodemographic Questionnaire, Perceived Social Support Scale, Chinese Health Literacy Management Scale, Cancer Experience and Efficacy Scale (cancer experience and control efficacy subscales), and Chinese Health-Promoting Lifestyle Profile-II. Descriptive analyses were conducted using SPSS 27.0, and AMOS 28.0 was used for structural equation modeling and mediation analysis. Results Perceived social support, health literacy, and control efficacy were positively associated with health-promoting lifestyles, whereas cancer experience was negatively associated with health-promoting lifestyles. The structural equation modeling results indicated that the model fit was good (root mean square error of approximation = 0.063, P 0.05). The mediation analyses indicated that health literacy, cancer experience, and control efficacy significantly mediated the relationship between perceived social support and health-promoting lifestyles. Conclusion Perceived social support was significantly associated with healthy lifestyles among young and middle-aged patients undergoing lung cancer surgery. Health literacy, cancer experience, and control efficacy played mediating roles in this association. Early identification and interventions targeting these factors may enhance patients' adoption of health-promoting behaviors.