Research on the impact of empowerment on disability in older patients with chronic disease: based on chain mediating effect analysis

Objective: This study investigates the mediating effect of self-efficacy and self-management on the relationship between empowerment and disability in older adults with chronic diseases. Methods: Using convenience sampling, this study enrolled 436 elderly patients with chronic diseases from eight tertiary hospitals across Sichuan Province. Patient characteristics were captured via a demographic questionnaire, and validated instruments were applied to assess disability, empowerment, self-efficacy, and self-management behaviors. All statistical analyses were performed using SPSS 26.0, and the PROCESS macro was utilized to test whether self-efficacy and self-management mediated the observed relationships. Results: The mean score for disability was 156.08 ± 28.41, for empowerment was 23.95 ± 7.49, for self-efficacy was 23.61 ± 5.10, and for self-management was 47.75 ± 9.88. Empowerment was positively correlated with self-efficacy (r = 0.75, p < 0.001) and self-management (r = 0.69, p < 0.001), while negatively correlated with disability (r = -0.81, p < 0.001). Self-management was positively correlated with self-efficacy (r = 0.74, p < 0.001), and negatively correlated with disability (r = -0.78, p < 0.001). Self-efficacy was negatively correlated with disability (r = -0.87, p < 0.001). Empowerment was found to significantly positively predict self-efficacy ( β = 0.279, P < 0.001), both empowerment and self-efficacy significantly positively predicted self-management ( β = 0.158 to 0.204, P < 0.05), and empowerment, self-efficacy, and self-management significantly negatively predicted disability ( β = -0.314 to -0.123, P < 0.05). The direct impact of empowerment on disability is -0.123, accounting for 49.6% of the total effect. The total indirect effect of self-efficacy and self-management between empowerment and disability in elderly patients with chronic diseases is -0.125, accounting for 50.4% of the total effect. The mediating effect value of self-efficacy in the relationship between the concept of empowerment and disability in elderly patients with chronic diseases is -0.057, accounting for 45.6% of the total indirect effect. The mediating effect value of self-management between empowerment and disability in elderly patients with chronic diseases is -0.050, accounting for 40.0% of the total indirect effect. The relationship between empowerment and disability is mediated by self-efficacy and self-management, which act as a chain mediator, with an indirect effect. The mediating effect value was found to be -0.018, accounting for 14.4% of the total indirect effect. Conclusion: Empowerment can directly affect the disability of elderly patients with chronic diseases, and it can also influence it indirectly through the self-efficacy and self-management. Self-efficacy and self-management play a mediating role between empowerment and disability. It is recommended that healthcare professionals implement strategies to enhance the empowerment of elderly patients suffering from chronic diseases, whilst concurrently strengthening their self-efficacy and self-management abilities. This approach is intended to improve the disability status of patients.