Predictors of self-management in older adults with chronic disease: a structural equation model

To examine whether digital health literacy, chronic disease self-efficacy, and psychological distress mediate the relationship between social support and self-management behavior in older adult patients with chronic diseases. Using convenience sampling, we surveyed 536 older adult patients with chronic illnesses from three tertiary hospitals in Anhui Province between October 2023 and May 2024. Instruments included a demographic questionnaire, Digital Health Literacy Scale, Social Support Rating Scale, Brief Symptom Rating Scale, Chronic Disease Self-Efficacy Scale, Chronic Disease Self-Management Study Scale, and the age-adjusted Charlson Comorbidity Index. The average self-management score was 20.87 ± 10.37. Self-management behavior was positively correlated with social support, digital health literacy, and self-efficacy (r = 0.391, 0.536, 0.423; all P < 0.01), and negatively correlated with psychological distress (r = − 0.265, P < 0.01). Social support had a significant total effect on self-management (P < 0.001; 95% CI: 0.488–0.920), including both direct (P = 0.008; 95% CI: 0.033–0.278) and indirect effects (P < 0.001; 95% CI: 0.376–0.726). Mediators accounted for 72.26% of the total effect, with chain mediation explaining 18.25%. Older adult patients with chronic diseases exhibit low levels of self-management. Digital health literacy and self-efficacy are sequential mediators linking social support to improved self-management. Interventions targeting these mediators may enhance chronic disease management in this population.