Factors influencing chronic disease self-management behaviors: a national multilevel analysis in China

Objective This study employed multilevel analysis to examine the impact of the prefecture-level city level variable (number of physicians per 1,000 population) on chronic disease self-management behavior (CDSMB) among Chinese adults, while also investigating the effects of individual-level control variables on CDSMB. Methods A cross-sectional survey of 1,916 adults across 120 cities, using data from the “Psychology and Behavior Investigation of Chinese Residents” (PBICR), evaluated Chronic Disease Self-Management Behavior (CDSMB) via CDSMS. Key predictors included individual-level control variables: health literacy (HLS-SF12), self-efficacy (NGSES), family health (FHS-SF), and the prefecture-level city level variable of physicians per 1,000 population. Hierarchical linear modeling (HLM) was used to analyze the nested data, with adjustments for demographic covariates. Results Vulnerable groups (older adults, rural residents, low-income, education individuals) exhibited significantly poorer self-management ( p < 0.001). At the individual level control variables, health literacy ( β = 3.075, p < 0.001) and self-efficacy ( β = 1.891, p < 0.001) positively predicted CDSMB, while family health showed an unexpected negative effect ( β = −1.784, p < 0.001). At the prefecture-level city level, physicians per 1,000 population ( β = 0.077, p < 0.05) explained 17% of between prefecture-level city level variance in CDSMB. Conclusion Based on the findings highlighting the influence of physicians per 1,000 population and individual-level control variables on chronic disease self-management, targeted optimization of medical resource allocation and focused support for vulnerable groups are needed to improve chronic disease management.