# Prospective Association Between Illness Uncertainty and Self-Management Self-Efficacy in Patients With Early-Stage Chronic Liver Disease Over a Six-Month Follow-Up

## TL;DR

This study found that uncertainty about their illness lowers patients' confidence in managing early-stage chronic liver disease, but confidence improves slightly over six months.

## Contribution

The study prospectively examines the relationship between illness uncertainty and self-management self-efficacy in early-stage chronic liver disease patients over six months.

## Key findings

- Higher baseline illness uncertainty predicted lower self-efficacy at six months.
- Baseline self-efficacy was the strongest predictor of future self-management confidence.
- Female patients showed greater illness uncertainty and lower self-efficacy than males.

## Abstract

Background: Chronic liver disease (CLD) is a long-term, frequently progressive disease with few indicators of the disease during the initial phases. Many patients face uncertainty regarding their illness, and it might have adverse impacts on their confidence in dealing with being ill. This study aimed to examine the prospective association between illness uncertainty and self-management self-efficacy over six months in patients with early-stage CLD. We hypothesized that higher baseline illness uncertainty would predict lower self-efficacy over time, whereas higher baseline self-efficacy would predict better future self-management confidence.

Methods: The study involved a prospective observational study of 384 patients with early-stage CLD who were recruited across outpatient hepatology clinics in Islamabad, Pakistan. Illness uncertainty was assessed at baseline using the Mishel Uncertainty in Illness Scale - Community Form (MUIS-C), and self-management self-efficacy was evaluated at baseline, three months, and six months using the Self-Efficacy for Managing Chronic Disease 6-Item Scale (SEMCD-6), which measures patients' confidence in performing self-management tasks rather than actual behaviors. Descriptive statistics, Pearson correlations, independent t-tests, repeated measures ANOVA, and multiple linear regression were used to analyze the data, with mean differences between groups indicating statistical significance at p < 0.05. Data collection took place from July 2024 to December 2024, spanning a six-month period.

Results: Illness uncertainty was significantly related to lower self-efficacy in three time points (T1, T2, and T3; p < 0.001). The results showed that female participants had greater illness uncertainty and lower self-efficacy compared to male participants (p < 0.001). There was a small but significant improvement in self-efficacy scores after six months (p < 0.001). Baseline illness uncertainty was found to be an important negative predictor of self-efficacy at six months (B = -0.06, p = 0.001), while baseline self-efficacy emerged as the most potent positive predictor (B = 0.55, p < 0.001) according to regression analysis. The kind of liver disease had a small, significant impact, and comorbidities were not influential predictors.

Conclusion: Illness uncertainty negatively influences self-management self-efficacy in patients with early-stage CLD, although self-efficacy slightly improves over time. Reducing illness uncertainty early can play a crucial role in enhancing self-efficacy and promoting positive long-term health outcomes. Educational and psychological support strategies, as part of preventive efforts, must be highlighted when planning a hepatology patient intervention.