From health literacy to organ donation and transplantation awareness: The path through self-control

Abstract

BACKGROUND

Organ donation and transplantation are vital for saving lives, yet awareness remains limited. Health literacy, the ability to understand and use health information, and self-control, which influences decision-making, are crucial factors in promoting awareness. Understanding their relationship can guide efforts to increase participation in organ donation.

AIM

To investigate the effect of health literacy on organ donation and transplantation awareness, with self-control acting as a mediator, and to emphasize its importance.

METHODS

The study comprised 345 adults recruited from five different cities in Türkiye. The sample included 208 women (60.29%) and 137 men (39.71%). The age range of the sample group varies between 18 and 49 (median age = 24.13; SD = 8.81). Self-report data were collected including psychometric measures assessing organ donation and transplantation awareness, health literacy, and self-control. Reliability analysis, descriptive statistics, correlational analysis, and mediational analysis of the data were carried.

RESULTS

The analysis showed that health literacy was positively correlated with organ donation and transplantation awareness (r = 0.340) and self-control (r = 0.376). Self-control was positively related to organ donation and transplantation awareness (r = 0.531). Mediating analysis supported a mediation model where health literacy was found to influence organ donation and transplantation awareness via self-control (bootstrap = 0.158, 95% confidence interval = 0.105-0.215).

CONCLUSION

The results indicate that self-control mediates the positive relationship between health literacy and organ donation and transplantation awareness. Enhancing individuals’ health literacy may therefore increase awareness of organ donation and transplantation through improvements in self-control.

Key Words: Health literacy; Organ donation; Organ transplantation; Self-assessments; Mediation

Core Tip: This study explores the relationship between health literacy, self-control, and organ donation and transplantation awareness. Findings reveal that self-control mediates the positive impact of health literacy on awareness. By enhancing health literacy, individuals can develop better self-control, leading to increased awareness of organ donation and transplantation. These insights highlight the importance of targeting health literacy and self-regulation in public health initiatives to promote organ donation.

INTRODUCTION

Organ donation and transplantation awareness (ODTA) refers to the public’s level of knowledge and understanding about organ donation and transplantation processes, the benefits of these procedures, and their ethical dimensions[1]. This awareness is considered a crucial component in addressing the global shortage of donor organs. ODTA encompasses not only knowledge of the fundamental processes of organ donation but also awareness of the legal regulations, cultural attitudes, and personal values that influence this decision[2]. Research has shown that individuals with higher levels of awareness are more likely to support organ donation and to register as potential donors, thereby playing a significant role in reducing mortality rates among patients awaiting transplants[3].

ODTA is closely related to individuals’ levels of health literacy. Health literacy refers to the ability of individuals to understand and evaluate health-related information and to make appropriate health decisions based on this information[4]. High health literacy allows individuals to engage more consciously with the healthcare system and to discern accurate information, which increases awareness—especially in complex and sensitive issues like organ donation[5]. Specifically, regarding organ donation and transplantation, individuals with higher levels of health literacy can better comprehend information about organ donation and more effectively evaluate its potential risks and benefits. In societies where health literacy is high, the public tends to develop more positive attitudes toward healthcare system processes, and misinformation on these topics is less prevalent[6]. Research indicates that health literacy affects not only individuals’ personal health but also influences societal health behaviors[7]. In this context, enhancing the level of health literacy is considered an important strategy for increasing awareness of organ donation and transplantation.

The mediating role of self-control

Self-control is defined as the ability of individuals to regulate their behaviors and emotions in alignment with long-term goals[8]. This capability enables one to overcome immediate impulses and desires, facilitating the attainment of more beneficial outcomes that require greater effort[9]. Self-control can be seen as an important psychological skill that eases the adoption and maintenance of healthy behaviors among individuals. When applied to the context of organ donation awareness, self-control may assist individuals in managing resistance stemming from existing fears, anxieties, or misinformation when making complex and future-oriented decisions like organ donation[10].

The mediating role of self-control between organ donation awareness and health literacy is associated with an individual’s capacity to effectively utilize the knowledge they possess. While individuals with high health literacy can access more information about organ donation, it is believed that self-control comes into play when transforming this knowledge into behavioral intention[11]. Self-control supports the process of making a conscious donation decision by allowing individuals to evaluate the information they have acquired. Those with low levels of self-control may more readily succumb to immediate fears or prevalent misconceptions about organ donation, whereas high self-control reduces the impact of these negative emotional reactions, enabling more rational and information-based decision-making[12]. Research indicates that considering future benefits and managing short-term emotional reactions play a critical role in adopting altruistic behaviors like donation[13]. In this context, self-control acts as a bridge between health literacy levels and organ donation awareness, helping to better understand the relationship between these two variables. Studies have shown that individuals with high self-control are better at processing health-related information, accurately evaluating this information, and making healthier decisions[14].

The present study

The aim of this study is to examine the effect of health literacy on ODTA and to investigate the mediating role of self-control in this relationship. In the literature, both health literacy and self-control have been identified as critical variables that influence individuals’ health-related decision-making processes[4,10,14]. However, studies exploring how the effect of health literacy on ODTA is shaped through self-control are limited.

It is anticipated that individuals with high health literacy possess more knowledge about organ donation and transplantation and can make more informed decisions by effectively utilizing this knowledge. Additionally, self-control is thought to be an important mechanism that mediates the processing of health literacy information and the shaping of attitudes related to organ donation. This suggests that individuals with high levels of self-control may exhibit more positive and informed attitudes toward organ donation by using health information more effectively. Based on all these explanations, the following hypotheses (H) have been developed: (1) H1: Health literacy positively predicts ODTA; (2) H2: Self-control positively predicts ODTA; and (3) H3: Self-control mediates the relationship between health literacy and organ donation awareness.

MATERIALS AND METHODS

Participants and procedure

The study comprised 345 adults recruited online from five different cities in Türkiye. Participants ranged in age from 18 to 49 years, with a mean age of 24.13 years (SD = 8.81). The sample included 208 women (60.29%) and 137 men (39.71%). Socioeconomic status (SES) was self-reported and categorized into three levels: Low, middle, and high. Twenty-seven participants (7.83%) identified as low SES, 296 (85.80%) as middle SES, and 22 (6.38%) as high SES. In terms of healthcare utilization, participants reported the number of hospital visits in the past six months. Eighty-one participants (23.48%) had visited a hospital once, 83 (24.06%) had visited twice, 84 (24.35%) had visited three times, and 77 (22.32%) had visited four times or more. Twenty participants (5.80%) had not visited a hospital during this period. Prior to participation, individuals were informed that their involvement was voluntary and that they could discontinue completing the survey at any time without any penalty. No rewards or incentives were offered for participation. Informed consent was obtained from all participants before they began the measures.

Data collection tools

Organ tissue donation and transplantation knowledge scale: Organ tissue donation and transplantation knowledge scale was developed by Ozturk Emiral et al[15]. It includes a 2-choice rating consisting of 17 items and two subscales. The organ tissue donation and transplantation knowledge scale demonstrated good internal consistency, with a Cronbach’s alpha reliability coefficient calculated as 0.88[15].

The health literacy scale-short: From a 4-point Likert-type scale consisting of 12 items. The scale developed by Duong et al[16] and adapted into Turkish by Karahan-Yılmaz and Eskici[17]. Cronbach’s alpha reliability coefficient was found as 0.86[17].

The brief self-control scale: The brief self-control scale is a 5-point Likert-type scale consisting of 13 items. The scale developed by Tangney et al[9] and adapted into Turkish by Nebioglu et al[18]. Cronbach’s alpha reliability coefficient was found as 0.83[18].

Statistical analyses

Firstly, we computed descriptive statistics including means and standard deviations for all study variables, and examined their bivariate correlations. Next, to evaluate the proposed mediation model, we utilized the PROCESS macro for statistical product and service solutions (model 4) as outlined by Hayes[19]. In this model, health literacy served as the predictor variable (X), self-control as the mediator (M), and ODTA as the outcome variable (Y). To determine the significance of indirect effects, we employed bootstrapping with 5000 resamples to generate 95% confidence intervals; effects were deemed significant if these intervals did not include zero. All analyses controlled for potential confounding variables, specifically age and gender.

Ethical issues

All study procedures adhered to the ethical standards set forth in the Declaration of Helsinki and received approval from the Yıldız Technical University Scientific Research and Ethical Review Board.

RESULTS

The analysis revealed a positive association between health literacy and ODTA (r = 0.340, P < 0.01), as well as positive correlations between health literacy and self-control (r = 0.376, P < 0.01). Additionally, ODTA was found to be positively related to self-control (r = 0.531, P < 0.01) (Table 1).

Table 1 Descriptive statistics and correlations among study variables.

Variable	Health literacy	ODTA	Self-control	Mean	SD	Cronbach α
Health literacy				33.98	4.63	0.791
ODTA	0.340b			31.10	2.38	0.719
Self-control	0.376b	0.531b		28.49	4.89	0.750

^bP < 0.01.

ODTA: Organ donation and transplantation awareness.

Statistical assumption tests

The results of the statistical assumption tests indicated that skewness values ranged from -3.03 to -0.15, and kurtosis values varied between -0.39 and 1.12, confirming that the normality assumption was met. Furthermore, all reliability coefficients were above the acceptable threshold of 0.70. The Mahalanobis distance values were below 10, suggesting no issues related to multivariate outliers. The variance inflation factor was recorded as 1.64, with a tolerance value of 0.86. Additionally, the Durbin-Watson statistic was calculated as 2.04, indicating no multicollinearity or residual-related concerns. In conclusion, all statistical assumptions were adequately satisfied.

The mediation analysis

It was hypothesized that the influence of health literacy on ODTA would diminish or completely vanish when self-control was included as a mediator. To account for potential confounding effects, age and gender were included in the model as control variables, based on previous literature indicating their significant influence on both health literacy and organ donation behaviors[20,21]. The results of the unstandardized regression pathways and direct effects examined in the mediation analysis are illustrated in Figure 1.

Figure 1 The mediating role of self-control in the relationship between health literacy and organ donation and transplantation awareness.

The coefficient of the direct relationship between health literacy and ODTA was found to be 0.17 (P < 0.01). When self-control was introduced as a mediating variable, this coefficient dropped to 0.08. The reduction of 0.09 in the coefficient, while retaining statistical significance, indicates that self-control partially mediates this relationship (c’ = 0.08; P < 0.01). This finding confirmed the partial mediating role of self-control in the effect of health literacy on ODTA, thus supporting the final hypothesis of the study.

To further quantify the mediation effect, effect size estimates were calculated. The completely standardized indirect effect was found to be 0.1582 (BootSE = 0.0283, 95% confidence interval: 0.1050-0.2139), indicating a small-to-moderate mediation effect based on commonly used benchmarks. Additionally, the proportion mediated was calculated as 48.7%, suggesting that self-control accounts for nearly half of the total effect of health literacy on ODTA. These results confirm the significant yet partial mediating role of self-control in the relationship between health literacy and ODTA. The direct and indirect effects from the bootstrapping analysis are presented in Table 2.

Table 2 Bootstrapping results of direct and indirect effects in the mediation model.

Path	Coefficient	95% Confidence interval
		Lower level	Upper level
Direct effect
Health literacy ODTA	0.166	0.115	0.218
Health literacy self-control	0.352	0.251	0.453
Self-control ODTA	0.230	0.181	0.279
Indirect effect
Health literacy self-control ODTA	0.158	0.105	0.215

ODTA: Organ donation and transplantation awareness.

DISCUSSION

This study examined the relationship between health literacy and ODTA, considering the mediating role of self-control. The findings indicate that health literacy significantly enhances awareness of organ donation. Additionally, self-control was found to play a crucial mediating role in this relationship. These results highlight that both health literacy and self-control are critical factors in increasing individuals’ awareness regarding organ donation.

The initial findings of the study support H1, which proposes that health literacy has a positive effect on ODTA. This result is consistent with previous studies in the literature that confirm the relationship between health literacy and individuals’ health-related behaviors. Individuals with high health literacy understand health information better and use this information more effectively to make correct decisions[4,7]. In the context of organ donation, it is thought that these individuals can more easily overcome negative thoughts and anxieties about donation by gaining more information about the donation process, legal regulations, and potential risks. Indeed, it has been shown that individuals with low levels of health literacy hesitate in health processes based on misinformation and fears, but their awareness increases when this information gap is closed[2]. Therefore, increasing health literacy holds strategic importance for promoting positive attitudes toward organ donation in society and raising donation rates.

The study’s results also support H2, which predicts that self-control has a direct effect on ODTA. It is known that individuals with high self-control behave more consciously in their health-related decisions and make more rational choices by considering long-term outcomes[14]. When it comes to complex and emotional decisions like organ donation, individuals who tend to succumb to immediate fears or misinformation are observed to be less affected by these influences when they have high levels of self-control[12]. High self-control enables individuals to develop positive and informed attitudes toward organ donation, helping them set aside short-term concerns and gain more information about donation processes. This finding aligns with previous research demonstrating that self-control is effective not only in personal health behaviors but also in behaviors that increase societal benefit[10].

The findings of this study also support H3, which proposes that self-control mediates the relationship between health literacy and organ donation awareness. Research indicates that self-control plays a critical role in the process by which individuals transform their health knowledge into behavioral intentions and awareness[11]. Although individuals with high health literacy possess more extensive information on health matters, they require self-control capacities to meaningfully and consistently reflect this knowledge in their behaviors. Those with high self-control can process health information and use it to make more rational decisions, whereas individuals with low self-control may struggle to use this information effectively[9]. The capacity for self-control can help individuals manage their emotional responses when making long-term and complex decisions based on health information, such as organ donation.

Limitations

This study has several methodological and content-related limitations that should be acknowledged. First, the cross-sectional design limits our ability to draw definitive causal inferences. Although significant relationships among health literacy, self-control, and organ donation awareness were identified, future longitudinal studies are necessary to explore the dynamic interplay between these variables over time. Second, the reliance on self-reported data may introduce biases such as social desirability bias and subjective reporting errors. To address this limitation, future research should incorporate objective measurements of self-control, such as behavioral assessments or performance-based tasks (e.g., delay discounting tasks), alongside self-report questionnaires. Employing multiple research methods, including experimental designs and observational studies, could further enhance the validity and reliability of findings. The mediating role of self-control, while confirmed in this study, requires further exploration to better understand its underlying mechanisms. Future research should consider qualitative approaches, such as in-depth interviews, to provide richer insights into the psychological and contextual factors influencing self-control in the context of organ donation awareness. Additionally, other potential influencing factors, such as cultural attitudes, social support, and health-related behaviors, should be explored to provide a more comprehensive understanding of the topic. Moreover, despite the study’s efforts to recruit participants from multiple locations, the sample characteristics may still limit the generalizability of the findings. Future research should aim to include more diverse samples in terms of age, SESs, and geographical distribution to enhance external validity. Addressing these limitations through methodological diversification and deeper content exploration will contribute to a more comprehensive understanding of the relationships examined in this study.

CONCLUSION

This study examined the relationship between health literacy and ODTA, as well as the mediating role of self-control in this relationship. The findings demonstrate that health literacy has a significant effect on increasing organ donation awareness and that this effect is strengthened by self-control. Individuals with high self-control can use health information more effectively to make informed decisions about organ donation. These results suggest that educational programs aimed at enhancing health literacy levels and self-control may be an important strategy for increasing organ donation awareness. The findings of this study provide important practical implications for public health initiatives and policy development. Educational programs and interventions should focus not only on improving health literacy but also on enhancing individuals’ self-control skills to foster informed decision-making regarding organ donation. Healthcare professionals and policymakers can develop targeted awareness campaigns that incorporate strategies to boost self-regulation, thereby maximizing the impact of health literacy initiatives. Furthermore, integrating self-control training into existing health education curricula may contribute to long-term behavioral changes, encouraging individuals to take a more proactive role in organ donation decisions. These efforts can ultimately contribute to increasing organ donation rates and addressing the global shortage of donor organs.