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<article xsi:noNamespaceSchemaLocation="http://jats.nlm.nih.gov/publishing/1.1/xsd/JATS-journalpublishing1-mathml3.xsd" dtd-version="1.1" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance"><front><journal-meta><journal-id journal-id-type="publisher-id">JCNR</journal-id><journal-title-group><journal-title>Journal of Clinical and Nursing Research</journal-title></journal-title-group><issn>2208-3685</issn><eissn>2208-3693</eissn><publisher><publisher-name>Bio-Byword Scientific Publishing Pty. Ltd.</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="doi">10.26689/jcnr.v10i3.13748</article-id><article-categories><subj-group subj-group-type="heading"><subject>Article</subject></subj-group></article-categories><title>Self-Management Experiences and Challenges in Patients with Metabolic Dysfunction-associated Steatotic Liver Disease: A Qualitative Study Guided by Pender’s Health Promotion Model</title><url>https://artdesignp.com/journal/JCNR/10/3/10.26689/jcnr.v10i3.13748</url><author>HaoHaojie,GuoDanyang,QuanYidan,FeiHan,XuJiayin,ZhangWei</author><pub-date pub-type="publication-year"><year>2026</year></pub-date><volume>10</volume><issue>3</issue><history><date date-type="pub"><published-time>2026-04-10</published-time></date></history><abstract>Objective: The study aims to explore experiences of patients with metabolic dysfunction–associated steatotic liver disease (MASLD) in self-management, identify the challenges they encountered and their needs during the self-management process. Methods: This qualitative study was conducted at an integrated tertiary hospital between March and May 2025. Semi-structured interviews with 15 participants were analyzed using Colaizzi’s seven-step method, and the resulting themes were mapped onto the constructs of the Pender health promotion model (HPM). Result: Three themes and nine sub-themes were mapped onto the HPM as challenges and obstacles in the self-management process of patients with MASLD. The themes encompass individual characteristics and negative experiences (personal factors and previous experiences with weight loss and rebound), cognitive and emotional deficits in self-management behaviors (insufficient recognition of the benefits of self-management, lack of interpersonal and situational support, negative emotional impact related to behavior, and low self-efficacy), and temporary needs and compromises with hobbies (unhealthy dietary preferences and long-term dietary habits, behavioral compromises in social situations, and temporary needs conflicting with healthy behaviors). Conclusion: Healthcare professionals should comprehensively assess the individual characteristics of patients with MASLD and provide personalized dietary and exercise management tailored to their lifestyle and behavioral preferences, while also paying close attention to their psychological and emotional well-being. Addressing patients’ behavioral, psychological, and social needs enhance the feasibility and sustainability of lifestyle changes, thereby promoting more effective and long-term self-management.</abstract><keywords/></article-meta></front><body/><back><ref-list><ref id="B1" content-type="article"><label>1</label><element-citation publication-type="journal"><p>Owrangi S, Paik J, Golabi P, et al., 2025, Global Prevalence and Mortality of Cirrhosis in Metabolic Dysfunction-Associated Steatotic Liver Disease: A Meta-Analysis. Alimentary Pharmacology and Therapeutics, 61(3): 433–443.</p><pub-id pub-id-type="doi"/></element-citation></ref><ref id="B2" content-type="article"><label>2</label><element-citation publication-type="journal"><p>Bajo F, Shipman K, 2023, Reclassification of Nonalcoholic Fatty Liver Disease: A Multi-Society Delphi Consensus Statement. Clinical and Experimental Dermatology, 48(12): 1418–1421.</p><pub-id pub-id-type="doi"/></element-citation></ref><ref id="B3" content-type="article"><label>3</label><element-citation publication-type="journal"><p>Miao L, Targher G, Byrne C, et al., 2024, Current Status and Future Trends of Global Burden of MASLD. Trends in Endocrinology and Metabolism, 35(8): 697–707.</p><pub-id pub-id-type="doi"/></element-citation></ref><ref id="B4" content-type="article"><label>4</label><element-citation publication-type="journal"><p>Lou T, Yang R, Fan J, 2024, Global Burden of Fatty Liver Disease: Major Impact of China. Hepatobiliary Surgery and Nutrition, 13(1): 119–123.</p><pub-id pub-id-type="doi"/></element-citation></ref><ref id="B5" content-type="article"><label>5</label><element-citation publication-type="journal"><p>Eslam M, Fan J, Yu M, et al., 2025, Asian Pacific Clinical Practice Guidelines for Diagnosis and Management of MASLD. Hepatology International, 19(2): 261–301.</p><pub-id pub-id-type="doi"/></element-citation></ref><ref id="B6" content-type="article"><label>6</label><element-citation publication-type="journal"><p>EASL-EASD-EASO, 2024, Clinical Practice Guidelines on Management of MASLD. Journal of Hepatology, 81(3): 492–542.</p><pub-id pub-id-type="doi"/></element-citation></ref><ref id="B7" content-type="article"><label>7</label><element-citation publication-type="journal"><p>Chinese Society of Hepatology, 2024, Guidelines for Prevention and Treatment of MASLD (Version 2024). Zhonghua Gan Zang Bing Za Zhi, 32(5): 418–434.</p><pub-id pub-id-type="doi"/></element-citation></ref><ref id="B8" content-type="article"><label>8</label><element-citation publication-type="journal"><p>Younossi Z, Zelber-Sagi S, Henry L, et al., 2023, Lifestyle Interventions in Nonalcoholic Fatty Liver Disease. Nature Reviews Gastroenterology and Hepatology, 20(11): 708–722.</p><pub-id pub-id-type="doi"/></element-citation></ref><ref id="B9" content-type="article"><label>9</label><element-citation publication-type="journal"><p>Perez-Diaz-Del-Campo N, Riezu-Boj J, Marin-Alejandre B, et al., 2022, Nutrigenetic Tool for Precision Dietary Management of NAFLD. Panminerva Medica, 64(4): 485–496.</p><pub-id pub-id-type="doi"/></element-citation></ref><ref id="B10" content-type="article"><label>10</label><element-citation publication-type="journal"><p>Zhou R, Zhang B, Zhang W, et al., 2024, Self-Management Behaviours in Adults with NAFLD: A Cross-Sectional Survey. BMJ Open, 14(2): e078333.</p><pub-id pub-id-type="doi"/></element-citation></ref><ref id="B11" content-type="article"><label>11</label><element-citation publication-type="journal"><p>Kwon O, Kim S, Ahn S, et al., 2022, Self-Management and Associated Factors among NAFLD Patients. International Journal of Environmental Research and Public Health, 20(1): 667.</p><pub-id pub-id-type="doi"/></element-citation></ref><ref id="B12" content-type="article"><label>12</label><element-citation publication-type="journal"><p>Xiao C, Zhang L, Li Z, et al., 2025, Periodontal Health Intervention in Older Type 2 Diabetes Patients: A Randomized Controlled Trial. Scientific Reports, 15(1): 28014.</p><pub-id pub-id-type="doi"/></element-citation></ref><ref id="B13" content-type="article"><label>13</label><element-citation publication-type="journal"><p>Santos M, Pleutim N, Queiroz-Cardoso A, et al., 2025, Use of Health Promotion Model by Nursing in Primary Care: An Integrative Review. Revista Brasileira de Enfermagem, 78(2): e20240096.</p><pub-id pub-id-type="doi"/></element-citation></ref><ref id="B14" content-type="article"><label>14</label><element-citation publication-type="journal"><p>Ozcelik H, Gozum S, 2025, Breast Cancer Risk Reduction Program Based on Health Belief Model: A Randomized Controlled Trial. Cancer Nursing, 48(5): 360–369.</p><pub-id pub-id-type="doi"/></element-citation></ref><ref id="B15" content-type="article"><label>15</label><element-citation publication-type="journal"><p>Mohanty J, 2008, Philosophy of Edmund Husserl: A Historical Development.</p><pub-id pub-id-type="doi"/></element-citation></ref><ref id="B16" content-type="article"><label>16</label><element-citation publication-type="journal"><p>Hennink M, Kaiser B, Marconi V, 2017, Code Saturation versus Meaning Saturation: How Many Interviews Are Enough. Qualitative Health Research, 27(4): 591–608.</p><pub-id pub-id-type="doi"/></element-citation></ref><ref id="B17" content-type="article"><label>17</label><element-citation publication-type="journal"><p>Colaizzi P, Valle R, King M, 1978, Existential Phenomenological Alternatives for Psychology. Oxford U Press.</p><pub-id pub-id-type="doi"/></element-citation></ref><ref id="B18" content-type="article"><label>18</label><element-citation publication-type="journal"><p>Tong A, Sainsbury P, Craig J, 2007, COREQ: A 32-Item Checklist for Interviews and Focus Groups. International Journal of Quality in Health Care, 19(6): 349–357.</p><pub-id pub-id-type="doi"/></element-citation></ref><ref id="B19" content-type="article"><label>19</label><element-citation publication-type="journal"><p>Karataş T, Polat Ü, 2021, Nurse-Led Program on Exercise Behaviour Based on Pender’s Health Promotion Model in Coronary Patients. Patient Education and Counseling, 104(5): 1183–1192.</p><pub-id pub-id-type="doi"/></element-citation></ref><ref id="B20" content-type="article"><label>20</label><element-citation publication-type="journal"><p>Zhu Y, Chen R, Han H, et al., 2025, Correlation between Family Function and Self-Management Abilities in MASLD Patients. Journal of Health Population and Nutrition, 44(1): 6.</p><pub-id pub-id-type="doi"/></element-citation></ref><ref id="B21" content-type="article"><label>21</label><element-citation publication-type="journal"><p>Cardoso R, Caldas C, Brandão M, et al., 2021, Healthy Aging Promotion Model Referenced in Nola Pender’s Theory. Revista Brasileira de Enfermagem, 75(1): e20200373.</p><pub-id pub-id-type="doi"/></element-citation></ref><ref id="B22" content-type="article"><label>22</label><element-citation publication-type="journal"><p>Bijani M, Niknam M, Karimi S, et al., 2022, Peer Education Based on Pender’s Health Promotion Model in Multiple Sclerosis: A Randomized Controlled Trial. BMC Neurology, 22(1): 144.</p><pub-id pub-id-type="doi"/></element-citation></ref><ref id="B23" content-type="article"><label>23</label><element-citation publication-type="journal"><p>Lin X, Bao S, Yu Y, et al., 2024, Self-Management in MASLD: Influencing Factors and Impact on Readmission. Journal of Health Population and Nutrition, 43(1): 134.</p><pub-id pub-id-type="doi"/></element-citation></ref><ref id="B24" content-type="article"><label>24</label><element-citation publication-type="journal"><p>Cook N, Nagar S, Jain A, et al., 2019, Patient Preferences and Unmet Needs in NASH: A Qualitative Online Study. Advances in Therapy, 36(2): 478–491.</p><pub-id pub-id-type="doi"/></element-citation></ref><ref id="B25" content-type="article"><label>25</label><element-citation publication-type="journal"><p>Gu Y, Zhou R, Kong T, et al., 2023, Barriers and Enabling Factors in Weight Management of NAFLD Patients Using COM-B Model. Health Expectations, 26(1): 355–365.</p><pub-id pub-id-type="doi"/></element-citation></ref><ref id="B26" content-type="article"><label>26</label><element-citation publication-type="journal"><p>Wang L, Zhou H, Liu Y, et al., 2023, Factors Influencing Adherence to Lifestyle Prescriptions in NAFLD: Qualitative Study Using Health Action Process Approach. Frontiers in Public Health, 11: 1131827.</p><pub-id pub-id-type="doi"/></element-citation></ref><ref id="B27" content-type="article"><label>27</label><element-citation publication-type="journal"><p>Shea S, Lionis C, Atkinson L, et al., 2022, Support Needs and Coping Strategies in NAFLD: Multidisciplinary Perspective. Livers, 3(1): 1–20.</p><pub-id pub-id-type="doi"/></element-citation></ref><ref id="B28" content-type="article"><label>28</label><element-citation publication-type="journal"><p>Jang Y, Lee J, Kim S, et al., 2021, Self-Management Experiences in NAFLD: A Qualitative Study. Nursing Open, 8(6): 3135–3142.</p><pub-id pub-id-type="doi"/></element-citation></ref><ref id="B29" content-type="article"><label>29</label><element-citation publication-type="journal"><p>Wang X, Tang P, Li L, et al., 2023, Relationship between Self-Management Behaviour and Family Function in Diabetic Foot Patients: Mixed-Methods Protocol. BMJ Open, 13(8): e074739.</p><pub-id pub-id-type="doi"/></element-citation></ref><ref id="B30" content-type="article"><label>30</label><element-citation publication-type="journal"><p>Funuyet-Salas J, Martin-Rodriguez A, Pérez-San-Gregorio M, et al., 2021, Psychological Biomarkers Influencing Therapeutic Adherence in NAFLD. Journal of Clinical Medicine, 10(10): 2208.</p><pub-id pub-id-type="doi"/></element-citation></ref><ref id="B31" content-type="article"><label>31</label><element-citation publication-type="journal"><p>Kong L, Zhu W, Li L, et al., 2021, Self-Management Behaviours in Chronic Hepatitis B: Structural Equation Model. International Journal of Nursing Studies, 116: 103382.</p><pub-id pub-id-type="doi"/></element-citation></ref><ref id="B32" content-type="article"><label>32</label><element-citation publication-type="journal"><p>Morgan C, De Wildt G, Prado R, et al., 2020, Barriers and Facilitators to Weight Loss among Overweight Adults: A Qualitative Study. International Journal of Qualitative Studies on Health and Well-Being, 15(1): 1852705.</p><pub-id pub-id-type="doi"/></element-citation></ref><ref id="B33" content-type="article"><label>33</label><element-citation publication-type="journal"><p>Holt G, Hughes D, 2021, Barriers to Weight Management Services in Morbid Obesity: Semi-Structured Interview and Delphi Study. Journal of Human Nutrition and Dietetics, 34(1): 215–223.</p><pub-id pub-id-type="doi"/></element-citation></ref><ref id="B34" content-type="article"><label>34</label><element-citation publication-type="journal"><p>Choi J, Chung G, Kang S, et al., 2020, Association between Anxiety, Depression and NAFLD. Frontiers in Medicine, 7: 585618.</p><pub-id pub-id-type="doi"/></element-citation></ref><ref id="B35" content-type="article"><label>35</label><element-citation publication-type="journal"><p>Radford-Smith D, Patel P, Irvine K, et al., 2022, Depressive Symptoms in NAFLD Identified by Lipid Metabolism Changes. PLoS One, 17(1): e0261555.</p><pub-id pub-id-type="doi"/></element-citation></ref><ref id="B36" content-type="article"><label>36</label><element-citation publication-type="journal"><p>Arora C, Malhotra A, Ranjan P, et al., 2021, Barriers and Facilitators for Lifestyle Adherence in Obese NAFLD Patients. Diabetes and Metabolic Syndrome, 15(4): 102138.</p><pub-id pub-id-type="doi"/></element-citation></ref></ref-list></back></article>
