Masumeh Saeidi Health Providers 2820-9192 6 1 2026 06 01 Association between Health Literacy and Quality of Life in Patients with Cardiac Disease: The Mediating Role of Social Support and the Moderating Role of Spiritual Well-Being 77 86 248261 10.22034/hp.2026.594379.1094 EN Afrasyab Altaf School of Leadership, Faculty of Management Sciences, Riphah International University, Islamabad Pakistan. 0000-0002-4292-5541 Ashiq Ali School of Leadership, Faculty of Management Sciences, Riphah International University, Islamabad, Pakistan. Ayman Javaid School of Leadership, Faculty of Management Sciences, Riphah International University, Islamabad, Pakistan. Nazar Ul Islam National University of Medical Sciences, Islamabad, Pakistan Journal Article 2026 07 29 Background: Cardiac disease substantially impairs quality of life (QoL). Although psychosocial factors influence health outcomes, the mechanisms through which health literacy (HL) affects QoL in patients with cardiac disease remain unclear. This study examined the association between HL and QoL, with social support (SS) as a mediator and spiritual well-being (SWB) as a moderator. Materials and Methods: This cross-sectional study enrolled adults aged ≥30 years with stable coronary artery disease receiving optimal medical therapy at two tertiary-care hospitals in Islamabad, Pakistan, between April and September 2024. Patients with acute coronary syndromes, severe cognitive or psychiatric impairment, or major comorbidities were excluded. Validated instruments assessed health literacy (BHLS), social support (LSNS-6), subjective well-being (ISWBI), and quality of life (QOLS). Moderated mediation was tested using Hayes’ PROCESS Model 14 with 1,000 bias-corrected bootstrap resamples (p≤0.05). Results: Of 400 distributed questionnaires, 322 were completed (response rate: 80.5%). Participants reported moderate levels of HL (3.54 ± 1.11), SS (3.32 ± 1.08), SWB (3.46 ± 1.07), and QoL (4.27 ± 1.18). QoL did not differ significantly across demographic groups (all ANOVA p>0.05). All variables were positively correlated (r=0.314–0.462, p<0.05). HL was directly associated with QoL (B=0.2016, SE=0.0291, 95% CI: 0.1456–0.2607, p<0.001) and indirectly associated with QoL through SS (B-indirect=0.1187, SE=0.0578, 95% bootstrap CI: 0.0051–0.2324), supporting partial mediation. SWB significantly moderated the association between SS and QoL (B=1.6727, SE=0.1308, t=12.7837, p<0.001). Conclusion: Health literacy was positively associated with QoL among patients with cardiac disease, both directly and indirectly through social support. Spiritual well-being strengthened the positive association between social support and QoL, supporting integrated cardiac rehabilitation approaches that incorporate health communication, social support, and spiritual care.

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