Abstract
OBJECTIVE: 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. METHODS: 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. RESULTS: 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%. CONCLUSION: 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. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12877-026-07335-8.