Abstract
BACKGROUND: Elevating levels of self-management (sm) is conducive to the timely detection, control, and prevention of diseases, thereby enhancing overall quality of life. A substantial body of literature has elucidated a robust association between self-management and factors such as social support (ss), self-efficacy (se), and health literacy (hl). However, current research has not been able to comprehensively and deeply explore the mechanism that influences self-management by integrating the above three factors due to limitations in research content and methods. Additionally, there exists a necessity to comprehend the modulatory influence of the external environment and individual behavioral motivation on self-management. Therefore, this study proposes, constructs, and validates a model elucidating the mechanisms impacting self-management levels, furnishing a framework for researching and intervening in self-management behavior. METHODS: Following the application of precise inclusion criteria, multiple databases were systematically searched to identify research literature related to social support, self-efficacy, health literacy, and self-management, encompassing their interrelationships. The extracted data included correlation coefficients and sample sizes from the identified research relationships. Employing the meta-analytic structural equation method, the study constructed a rational model elucidating the optimization's role in self-management across diverse demographics, inclusive of both elderly and middle-aged populations. Additionally, the random effects model was employed to estimate pooled effect sizes between different variables. RESULTS: A total of 162 valid literature were included for analysis. The findings indicate that improving health literacy is associated with enhanced self-management, particularly among the elderly population compared to the middle-aged population (ES(Elderly) = 0.358, p = 0.011; ES(Middle-aged) = 0.272, p = 0.012). Furthermore, increasing social support and health literacy can jointly improve self-management behavior by positively influencing self-efficacy, and health literacy has a stronger effect on self-efficacy than social support (ES(Sample population(hl-se)) = 0.403 > ES(Sample population(ss-se)) = 0.222, p11 = p12 = 0.008; ES(Elderly(hl-se)) = 0.336 > ES(Elderly(ss-se)) = 0.237, p21 = p22 = 0.012; ES(Middle-aged(hl-se)) = 0.362 > ES(Middle-aged(ss-se)) = 0.206, p31 = p32 = 0.013). This mechanism model has good fit and stability in the sample population/elderly/middle-aged population (CFI = 0.986/0.992/0.973; TLI = 0.929/0.960/0.864;SRMR = 0.029/0.020/0.039; RSMEA = 0.106/0.078/0.140). CONCLUSION: Irrespective of the age group, be it the elderly or middle-aged, health literacy significantly and positively influences self-management. Both health literacy and social support contribute positively to self-management by bolstering self-efficacy, with health literacy assuming a primary role in this relationship.