Factors influencing self-management behaviours among patients with chronic disease multimorbidity in China: A nationwide cross-sectional study

Background The intensification of population aging has placed China under a heavy disease burden caused by multiple comorbidities. Self-management behaviors are at the core of chronic disease management, significantly impacting patients' health and quality of life. Existing research remains predominantly limited to single-factor analyses, with insufficient exploration of multidimensional factors influencing self-management behaviors in patients with multiple comorbidities and their theoretical integration. Methods Based on the data from the Psychological and Behavioral Survey of Chinese Residents (PBICR) in 2021, 626 patients with chronic disease co-morbidities were selected as the study subjects, and their relationship with self-management behaviors was systematically analyzed in terms of the five dimensions of the ecological model of health, i.e., personal traits, behavioral traits, interpersonal networks, living and working conditions, and the policy environment, using univariate analysis, multivariate linear regression, quantile regression, and pathway analysis methods. behavior. Results The self-management ability of chronic disease co-morbid patients was generally at a moderately high level. Multifactorial analysis showed that self-assessed good health status (β = 8.465, P < 0.001), non-rural hukou (β = 2.336, P = 0.009), working (β = 3.808, P < 0.001) and retired status (β = 4.414, P = 0.003), and participation in the residents' medical insurance (β = 2.826, P = 0.008) were the facilitators of the self-management behaviors; while female (β=-1.798, P = 0.029), married (β=-3.965, P < 0.001) and divorced/widowed (β=-4.778, P = 0.007) were risk factors. Tertile regression suggested stratified heterogeneity in the effects of the above factors, e.g., those with good self-assessed health had a significant positive effect in all tertiles, which was enhanced with higher tertiles. Path analysis showed that the total effect of self-assessed health was the strongest (β = 0.237), and occupational status and gender had indirect effects through mediating variables. Conclusions Self-management behaviors of chronic disease co-morbid patients in China are influenced by multidimensional factors and group heterogeneity exists. Precise interventions should be implemented according to patients' ability level, focusing on strengthening health awareness, optimizing social support and health insurance policies, and paying special attention to the health management needs of women, rural and unmarried populations.