Factors influencing self-management behaviors in patients with metabolic dysfunction-associated steatotic liver disease: a systematic review and meta-analysis.

OBJECTIVE

To evaluate self-management levels and influencing factors in patients with metabolic dysfunction-associated steatotic liver disease (MASLD) to inform targeted interventions.

METHODS

A mixed-methods systematic review was conducted following the Joanna Briggs Institute methodology and reported according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Nine English and Chinese databases were searched from inception to October 28, 2025.

RESULTS

Ten studies (8 quantitative, 2 qualitative) were included, all conducted in China (n = 8) and South Korea (n = 2). Meta-analysis of seven studies (n = 3281) showed a moderate-to-low level of self-management. Factors significantly associated with better self-management included higher education, lower body mass index, being female, married, having a higher income, and a non-smoking history. Qualitative data reinforced these findings and revealed additional barriers, such as limited health literacy, low self-efficacy, and inadequate follow-up support. Convergent synthesis underscored the need for multifaceted interventions across capability, opportunity, and motivation dimensions.

CONCLUSIONS

The self-management of patients with MASLD is a public health priority shaped by the interaction between individual capabilities and broader social determinants. Our findings support integrated public health strategies that enhance individual capabilities, strengthen external support, and bolster motivation to prevent progression of MASLD.