Job effort moderates associations between knowledge sharing by chronic disease physicians and patient health literacy: Cross-sectional study guided by TPB

Abstract

Introduction: Effective knowledge sharing by physicians is integral to patient education and health literacy, particularly in the management of chronic diseases. Drawing on the theory of planned behavior (TPB), this study examines how physicians’ attitudes, perceived norms, and perceived behavioral control shape their knowledge-sharing intentions and behaviors, and how these behaviors are associated with patient health literacy within public hospital settings in China. Methods: A cross-sectional survey of 607 physicians from 39 public hospitals across 6 provinces in China was conducted between March and April 2024. Measures included attitudes, subjective norms, perceived behavioral control, behavioral intention, knowledge-sharing behavior, perceived patient health literacy, and job effort. Structural equation modeling was used to test hypothesized relationships. Results: Attitudes, subjective norms, and perceived behavioral control were positively associated with physicians’ intentions to share knowledge. Behavioral intention mediated the relationship between perceived behavioral control and actual knowledge-sharing behavior. Actual knowledge-sharing behavior was positively associated with perceived patient health literacy. Importantly, job effort moderated this relationship: high levels of job effort attenuated the positive association between knowledge-sharing behavior and patient health literacy. Conclusions: Findings underscore the organizational relevance of fostering supportive practice environments that strengthen physicians’ motivation and capacity to share knowledge. Reducing excessive job effort may enhance the impact of knowledge-sharing behaviors on patient health literacy, with implications for hospital management, workforce policy, and chronic disease care delivery.