Self-care behaviors among Iranian adults with non-alcoholic fatty liver disease based on the health belief model and structural equation modeling

Non-alcoholic fatty liver disease (NAFLD) is increasingly recognized as a widespread chronic liver condition globally, with a prevalence of 33% in Iran (35% in males and 37% in females). Understanding health-related behaviors in NAFLD patients is crucial for designing effective interventions. This study is novel in applying the Health Belief Model (HBM) and Structural Equation Modeling (SEM) to examine psychological determinants correlated with self-care behaviors among Iranian adults with NAFLD. A cross-sectional study was conducted with 513 NAFLD patients at the Internal Medicine Clinic of Shahid Motahari Clinic in Shiraz (Persian years 2024-2025) using a questionnaire capturing demographic information and HBM constructs. SEM analysis demonstrated good model fit (CFI = 0.95, TLI = 0.94, RMSEA = 0.038, SRMR = 0.032), indicating that self-care behaviors were primarily correlated with HBM constructs. Perceived susceptibility (β = 0.32, p < 0.001) and self-efficacy (β = 0.31, p < 0.001) showed the strongest positive associations, whereas perceived barriers (β = -0.26, p < 0.001) were negatively correlated with self-care behaviors. Demographic factors, including younger age, higher education, family history, and income, demonstrated smaller but notable associations. These findings highlight that psychological constructs such as self-efficacy, perceived barriers, perceived benefits, and awareness are closely correlated with self-care behaviors, suggesting potential targets for theory-driven interventions to support individuals at risk of NAFLD.