The relationship between two-way social support, psychological flexibility, intolerance of uncertainty, and patient activation in patients with chronic obstructive pulmonary disease: A chain mediation model

This research aimed to investigate whether psychological flexibility and intolerance of uncertainty serve as intermediaries connecting two-way social support to patient activation in patients with chronic obstructive pulmonary disease (COPD). A cross-sectional study was conducted with 442 Chinese COPD patients. Data analysis was performed using IBM SPSS v26.0 software and the PROCESS macro. The results showed that the COPD patient activation score was 60.62 ± 14.84. Correlation analysis showed that patient activation scores were positively correlated with two-way social support scores, but negatively correlated with psychological flexibility scores and intolerance of uncertainty scores. Mediation analyses confirmed that both psychological flexibility and intolerance of uncertainty significantly mediated the relationship between two-way social support and patient activation. Developing targeted interventions against these mediators is essential to activate patient health behaviors.