The impact of self-efficacy on health-related quality of life among community-dwelling older adults with chronic diseases: the mediating role of self-management behaviour.

OBJECTIVE: To examine the relationships among self-efficacy, self-management behaviour and quality of life in community-dwelling older adults with chronic conditions, to test the mediating effect of self-management behaviour on the relationship between self-efficacy and quality of life, and to provide a theoretical basis for the development of a community-based chronic disease management nursing model led by specialist nurses. METHODS: A convenience sampling method was used to recruit 189 older patients with chronic diseases from a community health service centre in Jiange County, Guangyuan City, Sichuan Province, between November 2025 and February 2026. Participants completed a general information questionnaire, the Chinese version of the Self-Efficacy for Managing Chronic Disease Scale, the Self-Management Behaviour Scale for Chronic Patients, and the Short Form 12 Health Survey. Data were analysed using SPSS 26.0, employing descriptive statistics, independent-samples t-tests, one-way analysis of variance, and Pearson correlation analysis. The mediating effect was examined using the PROCESS macro and verified with the bias-corrected bootstrap method. RESULTS: Among community-dwelling older adults with chronic diseases, the mean score for the physical component summary (PCS) of HRQOL was 45.87 ± 8.92, and that for the mental component summary (MCS) was 48.23 ± 9.14. The mean score on the Chronic Disease Management Self-Efficacy Scale was 47.63 ± 12.84, and the mean self-management behaviour score was 72.41 ± 9.86. Pearson correlation analysis showed that SF-12 scores were positively correlated with C-SEMCD scores (r = 0.523, p < 0.01) and with self-management behaviour scores (r = 0.481, p < 0.01), and that C-SEMCD scores were positively correlated with self-management behaviour scores (r = 0.562, p < 0.01). Mediation analysis verified the partial mediating role of self-management behaviour. The indirect effect was 0.187 (38.6% of the total effect) for the PCS model, and the indirect effect was 0.203 (41.2% of the total effect) for the MCS model. CONCLUSION: Among community-dwelling older adults with chronic diseases, self-efficacy has a direct correlation with health-related HRQoL, and also correlates with HRQoL indirectly via self-management behaviour. Self-management behaviour acts as a partial mediator between the two variables. In clinical nursing practice, targeted efforts to improve patients' self-efficacy may help foster positive self-management behaviours and may ultimately contribute to better HRQoL.