The health communication ability of nurses significantly impacts patients' health positively. A strong knowledge base is essential for nurses to deliver high-quality health communication. This study aims to explore the mechanisms linking nurse health knowledge acquisition and health communication ability. A cross-sectional study. This cross-sectional study utilised convenience sampling of 667 nurses from nine county-level hospitals. Questionnaires were used to assess health knowledge acquisition, health literacy, health education competence and health literacy communication ability in nurses. Structural equation modelling was employed to investigate the mechanisms linking nurse health knowledge acquisition and health literacy communication ability. The correlation analysis revealed significant positive relationships among nurses' health knowledge acquisition, health literacy, health education competence and health communication ability. The chain-mediating model indicated that health knowledge acquisition significantly influences health communication ability, with a total effect, comprising a direct effect and an indirect effect. The indirect effects were mediated either independently by health education competence or through a combination of health literacy and health education competence. A structural equation model was developed to provide a comprehensive framework for understanding the complex interplay among nurses' health knowledge acquisition, health literacy, health education competence and health communication ability. The model demonstrates that health knowledge acquisition has a significant overall effect and indirect effect on the improvement of health communication ability. Assisting nurses in translating health knowledge into health literacy may be a crucial step in enhancing their competence in health education. These findings enhance our understanding of the predictive effects of health knowledge acquisition on health communication ability and offer practical implications for the promoting and intervening in the health communication ability of nurses. STROBE statement. No patient or public contribution.
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