Associations of social support and disease-specific quality of life with self-management among patients with chronic hepatitis B: a multicenter cross-sectional study

Abstract

Self-management behaviors are central to long-term care for chronic hepatitis B (CHB), but the independent associations of social support and disease-specific quality-of-life domains with self-management remain unclear. This study assessed self-management and its associated factors among patients with CHB. This multicenter cross-sectional study included 583 patients with CHB recruited by convenience sampling at three tertiary hospitals in Hengyang, China, from March to October 2025. Participants completed the Chronic Hepatitis B Self-Management Scale (CHBSMS), Social Support Rating Scale (SSRS), and Chronic Hepatitis B Quality of Life Instrument (CHBQOL). Hierarchical multiple linear regression, HC3 robust standard errors, and sensitivity analyses were used. The mean total CHBSMS score was 85.03 ± 19.38. The sociodemographic model yielded an R 2 of 0.194. Adding clinical and healthcare utilization factors increased the explained variance (Δ R 2  = 0.083), and adding social support and the four CHBQOL domain scores further increased the explained variance (Δ R 2  = 0.102), yielding a final R 2 of 0.379. In the fully adjusted model, social support ( B  = 0.577, 95% CI: 0.416–0.739, p  < 0.001), the emotional symptoms domain ( B  = 0.170, 95% CI: 0.039–0.301, p  = 0.011), and the social stigma domain ( B  = 0.235, 95% CI: 0.082–0.388, p  = 0.003) were positively associated with self-management scores. Higher scores in the latter two domains indicated fewer emotional symptoms and less social stigma, respectively. For a 1-SD higher value of each predictor, the corresponding CHBSMS differences were 4.79, 1.90, and 2.15 points for social support, emotional symptoms, and social stigma, respectively, equivalent to 4.79, 1.90, and 2.15% of the score range. The somatic symptoms and belief domains were not significantly associated with self-management. Robustness and sensitivity analyses did not materially alter the main findings. Among patients with CHB recruited from three tertiary hospitals, social support, the emotional symptoms domain, and the social stigma domain were associated with self-management after adjustment for sociodemographic, clinical, and healthcare utilization factors. Further longitudinal research is needed to clarify the temporal direction and clinical relevance of these associations.