Correlation between family function and self-management abilities in patients with metabolic dysfunction-associated steatotic liver disease

Abstract

Objective

This study aims to evaluate the current state of family function and self-management abilities in patients with metabolic dysfunction-associated steatotic liver disease (MASLD) and analyze the correlation between the two.

Methods

Baseline data were collected from 243 patients with MASLD, utilizing the Family Care Index and Self-Management Scale. Multiple linear regression analysis was employed to assess factors influencing self-management in these patients.

Results

The mean score on the Self-Management Scale for the 243 MASLD patients was (92.74 ± 17.22), while the Family Function Scale score was (5.99 ± 1.61). Spearman correlation analysis indicated a positive correlation between family function and scores in disease prevention and control, daily living, disease knowledge, psychological awareness, and unhealthy lifestyle (rs = 0.220, 0.198, 0.227, 0.149, 0.257, 0.266; P < 0.05). Multiple linear regression analysis identified several factors affecting self-management abilities in MASLD patients: smoking history (β’=-0.317), marital status (β’=0.292), family function (β’=0.279), educational level (β’=0.157), severity of fatty liver (β’=0.144), and gender (β’=-0.126) (P < 0.05).

Conclusion

A significant proportion of MASLD patients exhibit family function impairment, which severely affects their self-management abilities. Interventions aimed at improving family function in MASLD patients are necessary to enhance self-management behaviors and improve disease prognosis.

Introduction

Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) is a common chronic liver disease characterized by steatosis and fat accumulation in liver parenchymal cells, closely linked to genetic, environmental, and metabolic stress factors, and occurs in individuals with no history of excessive alcohol consumption [1]. In recent years, the incidence of MASLD has significantly increased, with prevalence rates as high as 15–30% [2], posing a serious global health burden. Current treatments for non-alcoholic fatty liver disease primarily involving pharmacotherapy have shown limited effectiveness and remain controversial [3, 4]. The European Association for the Study of the Liver 2024 guidelines for the diagnosis and treatment of MASLD indicate that successful lifestyle interventions can effectively improve MASLD-related physiological indicators [5], highlighting the critical role of patients’ self-management abilities in the treatment of MASLD. Self-management abilities refer to the capacity developed in response to chronic diseases for managing symptoms, treatments, physiological and psychosocial changes, and making lifestyle adjustments [6]. Family function reflects the ability of family members to care for each other, communicate emotionally, and jointly cope with life events and stressors, serving as a measure of how well a family meets its members’ diverse needs [7]. The family is fundamental for patients, providing care, emotional support, and financial assistance, which directly influences their self-management behaviors. Understanding the relationship between family function and self-management behaviors in patients with non-alcoholic fatty liver disease is critical to disease control. This study explores this relationship and aims to establish a foundation for promoting effective self-management behaviors in patients with non-alcoholic fatty liver disease, ultimately providing a theoretical basis for more scientifically sound and effective interventions in clinical nursing.

Subjects and methods

Study participants

Due to time and resource constraints, and considering that MASLD is a specific disease, this retrospective study employed a convenience sampling method. A total of 243 patients were included in the study. The flowchart is shown in Fig. 1.Participants included MASLD patients admitted to the Infectious Disease Department of Wenzhou Medical University First Affiliated Hospital from July 2021 to June 2022. Inclusion criteria were: (1) diagnosed as NAFLD according to the guidelines for the prevention and treatment of non-alcoholic fatty liver disease and re-diagnosed as MASLD according to the 2024 EASL MASLD guideline [5, 8, 9]; (2) aged 18 to 65 years; (3) no history of long-term excessive alcohol consumption, defined as men consuming less than 30 g of ethanol (less than 210 g per week) and women consuming less than 20 g (less than 140 g per week) [calculated as: ethanol intake (g) = volume (ml) × alcohol content (%) × 0.8]; (4) voluntary participation and signed informed consent. Exclusion criteria included: (1) patients unable to cooperate due to mental disorders; (2) patients with liver cirrhosis; (3) patients with other liver diseases; (4) patients with infectious disease. Withdrawal criteria included: (1) loss of contact; (2) voluntary withdrawal. This study was approved by the Ethics Committee of Wenzhou Medical University First Affiliated Hospital (Approval No: 2016246). The study adhered to principles of voluntary participation, confidentiality, and non-harm, ensuring that patients were informed of their right to withdraw from the study at any time.

Fig. 1

Flowchart of study patients and reasons of exclusion

Baseline survey for MASLD patients

A general baseline survey was designed to collect information on patients’ gender, age, marital status, educational level, per capita family income, living conditions, medical payment status, mployment status, smoking history, severity of fatty liver, and family history of non-alcoholic fatty liver disease. Fibroscan were used to assess fatty liver severity. A Controlled Attenuation Parameter (CAP) value greater than 238 dB/m is considered mild, greater than 259 dB/m is moderate, and greater than 292 dB/m is severe.

Self-management scale

The self-management scale for MASLD patients, constructed based on Dana Ivancovsky Wajcman and et al.’s research, encompasses five dimensions reflecting patients’ self-management abilities: disease prevention and control (11 items), daily living (10 items), disease knowledge (4 items), psychological awareness (3 items), and unhealthy lifestyle (3 items) [10]. The scale consists of 31 items scored on a 5-point Likert scale, with total scores ranging from 31 to 155, where higher scores indicate better self-management abilities. The scale’s Cronbach’s α coefficient is 0.8990.

Family function scale

The Family Care Index (Adaptation, Partnership, Growth, Affection, and Resolve, APGAR) is primarily used to assess patients’ satisfaction with family function. Developed by Smilkstein et al. in 1978, this scale evaluates five aspects: adaptability, partnership, growth, affection, and resolve, comprising five questions [11]. Each question has three answer options, scored as “often,” “sometimes,” and “rarely” with respective points of 2, 1, and 0. Total scores range from 0 to 10, with higher scores indicating better family function. Scores of 0–6 suggest family dysfunction, while 7–10 indicate good family function. The scale’s Cronbach’s α coefficient is 0.94 [12].

Data collection

Baseline data were obtained through patient medical records and interviews. A research team comprised of three nurses and two head nurses conducted the assessments. Following patient enrollment, family function evaluations were performed. Approximately one month after discharge, during follow-up consultations, self-management assessments were conducted at nearby treatment facilities. Researchers clarified how to complete the scales and assisted patients in accurately filling out the questionnaires if needed. After completion, the researchers verified and collected the questionnaires.

Statistical methods

Data management was conducted using Excel software, while statistical analysis was performed using SPSS 24.0. Baseline data and scale scores were presented using frequency and percentage for categorical data and mean ± standard deviation for continuous data. Non-normally distributed quantitative data were described using median (interquartile range) [M (P25, P75)], and differences between groups were compared using the Kruskal-Wallis H test or the Mann-Whitney U test. The relationships between variables such as gender, marital status, and educational level with self-management abilities in MASLD patients were analyzed using multiple linear regression analysis. Spearman correlation analysis was employed to assess the potential correlation between family function and self-management abilities in MASLD patients. All tests were two-sided, with P < 0.05 considered statistically significant.

Results

Characteristics of baseline data and self-management scores in patients with non-alcoholic fatty liver disease

Out of 260 distributed questionnaires, 243 valid responses were received, yielding a response rate of 93.5%. Table 1 provides the general demographic characteristics of the patients. The average score on the Self-Management Scale for the 243 MASLD patients was 92.74 ± 17.22, while the average score on the Family Function Scale was 5.99 ± 1.61. These results indicate a moderate level of self-management ability among patients and suggest that family function falls below the optimal level, highlighting a potential area for intervention.

Table 1 Baseline characteristics of patients with non-alcoholic fatty liver disease (n = 243)

Self-management scores in patients with non-alcoholic fatty liver disease

Self-management scores among the 243 patients ranged from 60 to 138, with an average of 92.74 ± 17.22, reflecting a moderate self-management capacity. The highest mean score was observed in the disease prevention and control dimension, indicating patient awareness of preventive measures’ importance. Conversely, the lowest mean score was in the unhealthy lifestyle dimension, suggesting difficulties in adopting healthier lifestyle changes. This underscores the need for targeted interventions to promote lifestyle modifications.

Family function scores in patients with non-alcoholic fatty liver disease

Family function scores ranged from 3 to 10, with an average of 5.99 ± 1.61(Table 2). The highest mean score was found in the affection dimension, reflecting a moderate perception of emotional support from families. The lowest mean score was in the adaptability dimension, indicating challenges families face in adjusting to the patient’s illness. This could affect patients’ ability to effectively manage their condition, as family adaptability is crucial for providing a supportive environment.

Table 2 Self-management behaviors and family function scores in patients with non-alcoholic fatty liver disease (n = 243)

Correlation between family function and self-management behaviors in patients with non-alcoholic fatty liver disease

Spearman correlation analysis revealed a positive correlation between family function and scores in disease prevention and control, daily living, disease knowledge, psychological awareness, and unhealthy lifestyle (rs = 0.220, 0.198, 0.227, 0.149, 0.257, 0.266; P < 0.05;Table 3). This indicates that better family function is associated with improved self-management behaviors across various dimensions, emphasizing the importance of family support in enhancing patient self-care behaviors.

Table 3 Correlation between family function and self-management behaviors (n = 243)

Comparison of family function status and self-management behavior scores in patients with non-alcoholic fatty liver disease

Among the patients, 163 (67.1%) exhibited family dysfunction, while 80 (32.9%) reported good family function. Table 4 compares self-management behavior scores between patients with different family function statuses. Patients with good family function demonstrated significantly higher self-management behavior scores compared to those with family dysfunction, underscoring the significant role family function plays in self-management abilities.

Table 4 Comparison of self-management behavior scores in patients with non-alcoholic fatty liver Disease based on family function

Multiple linear regression analysis of self-management behavior in patients with non-alcoholic fatty liver disease

Using self-management scale scores as the dependent variable, a multiple linear regression analysis was conducted, including 12 independent variables (Table 5). The analysis revealed that marital status, educational level, smoking history, severity of non-alcoholic fatty liver disease (MASLD), and family function significantly influenced self-management abilities (P < 0.05; Table 6). Smoking history was negatively correlated with self-management abilities, while marital status, educational level, severity of MASLD, and family function were positively correlated. According to the standardized regression coefficients, smoking history (β=-0.287) was the most significant factor, followed by family function (β = 0.291), marital status (β = 0.300), severity of MASLD (β=-0.188 for mild, β=-0.047 for medium), and educational level (β=-0.164 for primary school). These findings suggest that interventions targeting improvements in family function and cessation of smoking habits could significantly enhance self-management abilities in MASLD patients. Additionally, educational interventions, particularly for those with primary school education, may also contribute to better self-management.

Table 5 Variable value assignment explanation

Table 6 Multiple Linear regression analysis of self-management ability in patients with non-alcoholic fatty liver disease

Discussion

The structure and organization of a family play a decisive role in the behavior of its members and are essential for the healthy physical, psychological, and social development of individuals, directly influencing their health and emotional well-being [13]. This study found that patients with non-alcoholic fatty liver disease exhibited moderate to low levels of family function, with relatively low scores in cooperation and intimacy, indicating a tendency for family members to inadequately express their emotions and communicate effectively. This lack of communication can exacerbate psychological stress for patients due to both the disease and personal factors. Families not only provide material support for the patients’ recovery but also offer crucial psychological and emotional support. A harmonious family environment with fewer conflicts and better family function positively impacts patients’ self-management abilities. The finding that 67.1% of patients experienced family dysfunction underscores the urgent need to improve family function among patients with non-alcoholic fatty liver disease.

Current research both domestically and internationally suggests that MASLD is a reversible lifestyle disease, with lifestyle changes—particularly dietary modifications and exercise—being the most effective means of improving the condition [14, 15]. This study indicated that the self-management abilities of patients with non-alcoholic fatty liver disease fell between “sometimes” and “often,” suggesting a moderate level of self-management behavior. Therefore, healthcare providers should focus on enhancing patients’ self-management capabilities, particularly by providing more information and resources regarding disease prevention, disease knowledge, psychological awareness, and addressing unhealthy lifestyles.

The family unit serves as the most substantial support system for patients following illness and significantly influences their behavior. This study demonstrated a statistically significant difference in self-management behavior scores between patients with good family function and those with family dysfunction (P < 0.05); family function was positively correlated with all five dimensions of self-management abilities (P < 0.05, P < 0.001). Specifically, adaptability and cooperation within family function were positively correlated with self-management abilities (P < 0.001). Further multiple linear regression analysis indicated that family function is a primary factor influencing self-management behavior. Research by Dunbar et al. [16] found that family function affects patients’ emotional and physical states, ultimately influencing their dietary behaviors and self-care practices. Good family function facilitates emotional support from family members, enabling patients to cope positively with their illness, navigate challenges, and promote overall health, thus adhering to healthy self-management behaviors. When patients are unwell, family members with high family function levels tend to proactively inquire about the patients’ conditions and allocate appropriate time and energy to provide care. Family communication allows discussing disease progression, managing challenges, and encouraging adherence to treatments in areas such as medication, diet, and exercise, thereby enhancing family intimacy and cooperation [17]. This suggests that nursing interventions should emphasize the positive impact of family function on patients’ self-management behaviors and guide patients in adopting appropriate communication strategies. Encouraging family members to engage more with patients can increase emotional and material support within the family, while mutual encouragement among family members can improve the psychological health of stroke patients and enhance their self-management behaviors.

Limitations

While our study provides valuable insights into the correlation between family function and self-management abilities in patients with MASLD, it is not without limitations. This study is limited by its convenience sampling, which may introduce selection bias and restrict the generalizability of the findings. The cross-sectional design precludes the establishment of causality, only allowing for the observation of correlations at a single point in time. Future research should employ more robust sampling methods and consider longitudinal designs to address these limitations.