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. 2025 Feb 8;15(1):4758.
doi: 10.1038/s41598-024-81943-5.

The mediating role of social support in self-management and quality of life in patients with liver cirrhosis

Ying Zhang #  1   2   3 , LeYao Xiao #  1   3   4 , Qian Liu  1   2   3 , XinYi Zhang  1   2   3 , MingDan Li  1   2   3 , YaLi Xu  1   2   3 , Mei Dai  1   3 , Fei Zhao  1   3 , YouShu Shen  1   3 , Jordan Tovera Salvador  5 , Ping Yang  6   7   8   9
Affiliations

The mediating role of social support in self-management and quality of life in patients with liver cirrhosis

Ying Zhang et al. Sci Rep. .

Abstract

Patients with liver cirrhosis often experience factors such as malnutrition and lack of exercise, leading to reduced quality of life. Insufficient social support is related to self-management in patients with chronic diseases. Therefore, this study explores the mediating role of social support in the relationship between self-management and quality of life, analyzing the impact of exercise frequency and malnutrition risk assessment on social support, self-management, and quality of life. Using a convenience sampling method, cross-sectional data were collected from 257 patients with liver cirrhosis at the infectious disease department of a tertiary hospital in Zunyi, China, from 2021 to 2022. The patients were evaluated using a demographic questionnaire, the Self-Management Behavior Scale for Liver Cirrhosis Patients, the Social Support Rating Scale (SSRS), the Chronic Liver Disease Questionnaire (CLDQ), and the Royal Free Hospital Nutritional Prioritizing Tool (RFH-NPT). Data were analyzed using SPSS and PROCESS software. (1) Patients in the decompensated stage of liver cirrhosis and those classified in Child-Pugh class B/C had lower scores in self-management, quality of life, and social support compared to patients in the compensated stage of liver cirrhosis and those classified in Child-Pugh Class A. (2) Quality of life was positively correlated with both social support and self-management (r = 0.668, r = 0.665, both P < 0.001). (3) Mediation analysis showed that self-management had a direct predictive effect on quality of life. Social support had a mediating effect between self-management and quality of life, with an indirect effect of 0.489 (95% CI: 0.362, 0.629), accounting for 40.58% of the total effect. (4) Exercise frequency and malnutrition risk assessment were independent influencing factors for social support, self-management, and quality of life. (5) In the regression model, after excluding confounding factors, Model I explained 14% of the variance in quality of life due to control variables, Model II explained 49.5%, and when social support was added, Model III explained 56.9% of the variance in quality of life. Under the mediating role of social support, self-management can improve quality of life. Exercise frequency and malnutrition risk assessment, as independent influencing factors, also modulate social support and self-management. These findings underscore the importance of strengthening social support and developing self-management programs targeting exercise and nutrition to enhance the quality of life in patients with liver cirrhosis.

Keywords: Exercise; Liver cirrhosis; Mediation effect; Nutrition; Quality of life; Self-management; Social support.

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Conflict of interest statement

Declaration. Competing interests: The authors declare no competing interests. Institutional review board statement: This study protocol was approved by the Ethics Committee of the Affiliated Hospital of Zunyi Medical University on December 31, 2021, with the approval number: (KLLY-2021–149). Informed consent: Informed consent was obtained from all subjects involved in the study.

Figures

Fig. 1
Fig. 1
Flowchart of participant selection.
Fig. 2
Fig. 2
Mediating Effect Model of Social Support between Self-Management and Quality of Life in Patients with Liver Cirrhosis (**P < 0.001).
See this image and copyright information in PMC

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