{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T13:59:55Z","timestamp":1787234395784,"version":"build-2736575974"},"reference-count":45,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,10,22]],"date-time":"2025-10-22T00:00:00Z","timestamp":1761091200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"\n Background and objective<\/jats:title>\n Self-management plays a vital role in tuberculosis (TB) care, yet remains suboptimal among patients due to limited disease knowledge and psychosocial challenges. While prior studies have explored the individual roles of knowledge, social support, or depression in TB treatment, few have examined their interactive and sequential effects. This study aimed to investigate whether perceived social support and depression mediate the relationship between TB knowledge and self-management, using the ABC-X family stress model as the theoretical framework.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n A cross-sectional survey was conducted. Using convenience sampling to select 204 patients with primary pulmonary TB hospitalized at a tertiary TB hospital in Ningxia, China. Participants completed validated questionnaires assessing TB knowledge, perceived social support, depression, and self-management ability. Correlation analysis was used to assess associations among key variables. Mediation analysis was performed using SPSS PROCESS macro (Model 6), with 5,000 bootstrap resamples to estimate direct and indirect effects.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n TB knowledge was positively correlated with self-management and perceived social support, and negatively correlated with depression. Perceived social support was negatively correlated with depression and positively correlated with self-management. Depression was negatively correlated with self-management. The chain-mediating path\u2014TB knowledge \u2192 social support \u2192 depression \u2192 self-management\u2014was statistically significant and accounted for 5.00% of the total effect, while the total indirect effect explained 42.74% of the total effect.<\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n This study demonstrated that TB knowledge significantly influences self-management, both directly and indirectly, through the sequential mediating roles of perceived social support and depression. Enhancing TB knowledge alone may be insufficient without concurrently addressing social support and mental health. Multidimensional interventions integrating education, social support enhancement, and psychological care are essential for improving patient adherence and outcomes. The ABC-X model provides a useful framework for guiding future TB self-management interventions.<\/jats:p>\n <\/jats:sec>","DOI":"10.3389\/fpubh.2025.1640626","type":"journal-article","created":{"date-parts":[[2025,10,22]],"date-time":"2025-10-22T05:31:22Z","timestamp":1761111082000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":3,"title":["The chain-mediating roles of social support and depression in the relationship between tuberculosis knowledge and self-management: a cross-sectional study based on the ABC-X model"],"prefix":"10.3389","volume":"13","author":[{"given":"Chune","family":"Gu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bofei","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huijuan","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yaling","family":"Ma","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lei","family":"Guo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,10,22]]},"reference":[{"key":"B1","year":"2023"},{"key":"B2","doi-asserted-by":"publisher","first-page":"15","DOI":"10.19983\/j.issn.2069-8493.2024006","article-title":"Interpretation of WHO global tuberculosis report 2023","volume":"5","author":"Shu","year":"2024","journal-title":"Tuberc Lung Dis"},{"key":"B3","doi-asserted-by":"publisher","first-page":"e063926","DOI":"10.1136\/bmjopen-2022-063926","article-title":"Patient adherence to tuberculosis treatment in the Indian subcontinent: systematic review and meta-synthesis of qualitative research","volume":"13","author":"Shringarpure","year":"2023","journal-title":"BMJ Open"},{"key":"B4","doi-asserted-by":"publisher","first-page":"103","DOI":"10.1186\/s40249-021-00888-3","article-title":"Determinants of self-management behaviors among pulmonary tuberculosis patients: a path analysis","volume":"10","author":"Li","year":"2021","journal-title":"Infect Dis Poverty."},{"key":"B5","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1207\/S15324796ABM2601_01","article-title":"Self-management education: history, definition, outcomes, and mechanisms","volume":"26","author":"Lorig","year":"2003","journal-title":"Ann Behav Med."},{"key":"B6","doi-asserted-by":"publisher","first-page":"328","DOI":"10.1016\/j.pec.2019.09.007","article-title":"Effects of a HAPA-based multicomponent intervention to improve self-management precursors of older adults with tuberculosis: a community-based randomised controlled trial","volume":"103","author":"Chen","year":"2020","journal-title":"Patient Educ Couns."},{"key":"B7","doi-asserted-by":"publisher","first-page":"e027775","DOI":"10.1136\/bmjopen-2018-027775","article-title":"Delineating the concept of self-management in chronic conditions: a concept analysis","volume":"9","author":"Van de Velde","year":"2019","journal-title":"BMJ Open."},{"key":"B8","doi-asserted-by":"publisher","first-page":"1211","DOI":"10.15562\/bmj.v12i2.4302","article-title":"Medication adherence and visiting compliance: interventions self-management education based on health belief model","volume":"12","author":"Iskandar","year":"2023","journal-title":"Bali Med J"},{"key":"B9","doi-asserted-by":"publisher","first-page":"e34277","DOI":"10.2196\/34277","article-title":"Effects of an mHealth intervention for pulmonary tuberculosis self-management based on the integrated theory of health behavior change: randomized controlled trial","volume":"8","author":"Bao","year":"2022","journal-title":"JMIR Public Health Surveill."},{"key":"B10","doi-asserted-by":"publisher","first-page":"112","DOI":"10.7619\/jcmp.20230559","article-title":"A qualitative study on self-management dilemma of newly treated patients with pulmonary tuberculosis","volume":"27","author":"Chen KL Li","year":"2023","journal-title":"J Clin Med Pract."},{"key":"B11","doi-asserted-by":"publisher","first-page":"1903","DOI":"10.1186\/s12889-021-12005-y","article-title":"Barriers and strategies to successful tuberculosis treatment in a high-burden tuberculosis setting: a qualitative study from the patient's perspective","volume":"21","author":"Pradipta","year":"2021","journal-title":"BMC Public Health."},{"key":"B12","doi-asserted-by":"publisher","first-page":"1216","DOI":"10.1093\/nutrit\/nuad120","article-title":"Effectiveness of nutritional support to improve treatment adherence in patients with tuberculosis: a systematic review","volume":"82","author":"Wagnew","year":"2024","journal-title":"Nutr Rev"},{"key":"B13","doi-asserted-by":"publisher","first-page":"1708","DOI":"10.1038\/s41591-018-0224-2","article-title":"A patient-level pooled analysis of treatment-shortening regimens for drug-susceptible pulmonary tuberculosis","volume":"24","author":"Imperial","year":"2018","journal-title":"Nat Med"},{"key":"B14","unstructured":"Handbook for the Use of Digital Technologies to Support Tuberculosis Medication Adherence"},{"key":"B15","author":"Zhang","year":"2020","journal-title":"Rehabilitation Effectiveness Evaluation of Knowledge Attitude Practice Model Based Health Education on Patients with Acute Mycoardial Infarction after PCI"},{"key":"B16","doi-asserted-by":"publisher","first-page":"73","DOI":"10.29390\/cjrt-2021-009","article-title":"Factors affecting self-management in Iranian tuberculosis patients: a path analysis model","volume":"57","author":"Harandi","year":"2021","journal-title":"Can J Respir Ther."},{"key":"B17","doi-asserted-by":"publisher","first-page":"987526","DOI":"10.3389\/fpubh.2022.987526","article-title":"Association between social support and medication literacy in older adults with hypertension","volume":"10","author":"Shen","year":"2022","journal-title":"Front Public Health."},{"key":"B18","doi-asserted-by":"publisher","first-page":"1094575","DOI":"10.3389\/fpsyg.2022.1094575","article-title":"The relationship between HIV-related stigma and HIV self-management among men who have sex with men: the chain mediating role of social support and self-efficacy","volume":"13","author":"Tao","year":"2022","journal-title":"Front Psychol."},{"key":"B19","author":"Liu","year":"2022","journal-title":"The Effects of Web-Based Mindfulness Interventions on Anxiety and Depression in Patients with Hepatocellular Carcinoma after TACE and its Psychological Mechanisms"},{"key":"B20","doi-asserted-by":"publisher","first-page":"985823","DOI":"10.3389\/fpsyt.2022.985823","article-title":"Association between depression or anxiety symptoms and immune-inflammatory characteristics in in-patients with tuberculosis: a cross-sectional study","volume":"13","author":"Liu","year":"2022","journal-title":"Front Psychiatry."},{"key":"B21","doi-asserted-by":"publisher","first-page":"7","DOI":"10.1016\/j.annepidem.2021.06.002","article-title":"Tuberculosis-associated depression: a population-based cohort study of people immigrating to British Columbia, Canada, 1985-2015","volume":"63","author":"Basham","year":"2021","journal-title":"Ann Epidemiol."},{"key":"B22","doi-asserted-by":"publisher","first-page":"e0227472","DOI":"10.1371\/journal.pone.0227472","article-title":"Association between tuberculosis and depression on negative outcomes of tuberculosis treatment: a systematic review and meta-analysis","volume":"15","author":"Ruiz-Grosso","year":"2020","journal-title":"PLoS ONE"},{"key":"B23","doi-asserted-by":"publisher","first-page":"749","DOI":"10.1002\/JLB.MR0119-023R","article-title":"The interplay between depression and tuberculosis","volume":"106","author":"Zhang","year":"2019","journal-title":"J Leukoc Biol."},{"key":"B24","doi-asserted-by":"publisher","first-page":"e003412","DOI":"10.1136\/rmdopen-2023-003412","article-title":"Prevalence of anxiety and depression and the association with self-management behaviour in >12 000 patients with inflammatory rheumatic disease: a cross-sectional nationwide study","volume":"10","author":"Vestergaard","year":"2024","journal-title":"RMD Open."},{"key":"B25","doi-asserted-by":"publisher","first-page":"8488","DOI":"10.3390\/ijerph19148488","article-title":"The mediating role of psychological well-being in the relationship between self-care knowledge and disease self-management in patients with hypertensive nephropathy","volume":"19","author":"Chen","year":"2022","journal-title":"Int J Environ Res Public Health."},{"key":"B26","doi-asserted-by":"publisher","first-page":"24236","DOI":"10.1038\/s41598-021-03811-w","article-title":"The relationship among social support, experienced stigma, psychological distress, and quality of life among tuberculosis patients in China","volume":"11","author":"Chen","year":"2021","journal-title":"Sci Rep."},{"key":"B27","doi-asserted-by":"publisher","first-page":"4728","DOI":"10.1002\/nop2.1723","article-title":"Relationships among disease knowledge, social support, anxiety and self-efficacy in patients after total knee arthroplasty: a chain mediating effect","volume":"10","author":"Li","year":"2023","journal-title":"Nurs Open."},{"key":"B28","volume-title":"Families Under Stress: Adjustment to the Crises of War Separation and Return","author":"Hill","year":"1949"},{"key":"B29","doi-asserted-by":"publisher","first-page":"642","DOI":"10.3969\/j.issn.1671-9638.2018.07.019","volume":"17","year":"2018","journal-title":"Chin J Infect Control"},{"key":"B30","doi-asserted-by":"publisher","first-page":"378","DOI":"10.3761\/j.issn.0254-1769.2010.04.037","article-title":"Sample size estimation for quantitative studies in nursing research","volume":"45","author":"Ni","year":"2010","journal-title":"Chin J Nurs."},{"key":"B31","doi-asserted-by":"publisher","first-page":"1057","DOI":"10.13329\/j.cnki.zyyjk.20230515.001","article-title":"Analysis on current situation and influencing factors of awareness of core knowledge of tuberculosisprevention and treatment among residents in remote areas of western China[J]","volume":"39","author":"Guo","year":"2023","journal-title":"Occup and Health"},{"key":"B32","author":"Wang","year":"2016","journal-title":"Evaluation of Self Health Management Capability on Chronic Patients"},{"key":"B33","doi-asserted-by":"publisher","first-page":"610","DOI":"10.1080\/00223891.1990.9674095","article-title":"Psychometric characteristics of the multidimensional scale of perceived social support","volume":"55","author":"Zimet","year":"1990","journal-title":"J Pers Assess."},{"key":"B34","first-page":"41","article-title":"Perceived social support scale","volume":"10","author":"Jiang","year":"2001","journal-title":"Chin J Behav Med Brain Sci."},{"key":"B35","doi-asserted-by":"publisher","first-page":"361","DOI":"10.1111\/j.1600-0447.1983.tb09716.x","article-title":"The hospital anxiety and depression scale","volume":"67","author":"Zigmond","year":"1983","journal-title":"Acta Psychiatr Scand."},{"key":"B36","doi-asserted-by":"publisher","first-page":"e39920","DOI":"10.1097\/MD.0000000000039920","article-title":"Factors related to self-care in Korean patients with tuberculosis: a systematic review and meta-analysis","volume":"103","author":"Lee","year":"2024","journal-title":"Medicine."},{"key":"B37","doi-asserted-by":"publisher","first-page":"e0243433","DOI":"10.1371\/journal.pone.0243433","article-title":"Perceived stigma among patient with pulmonary tuberculosis at public health facilities in southwest Ethiopia: a cross-sectional study","volume":"15","author":"Mohammedhussein","year":"2020","journal-title":"PLoS ONE."},{"key":"B38","doi-asserted-by":"publisher","first-page":"604","DOI":"10.3969\/j.issn.1000-6621.2020.06.012","article-title":"Study on the influencing factors of perceived social support in patients with drug-resistant tuberculosis","volume":"42","author":"Tang","year":"2020","journal-title":"Chin J Antituberc."},{"key":"B39","doi-asserted-by":"publisher","first-page":"1702","DOI":"10.1186\/s12889-020-09794-z","article-title":"Prevalence of depressive symptoms and associated factors among patients with tuberculosis attending public health institutions in Gede'o Zone, South Ethiopia","volume":"20","author":"Yohannes","year":"2020","journal-title":"BMC Public Health."},{"key":"B40","doi-asserted-by":"publisher","first-page":"94942","DOI":"10.52965\/001c.94942","article-title":"Brief coping scale TCS-9: optimising the assessment of coping strategies. The case of Health Care Workers","volume":"12","author":"Puri","year":"2024","journal-title":"Health Psychol Res."},{"key":"B41","doi-asserted-by":"publisher","first-page":"855515","DOI":"10.3389\/fpubh.2022.855515","article-title":"Mental health status and its impact on TB treatment and its outcomes: a scoping literature review","volume":"10","author":"Agbeko","year":"2022","journal-title":"Front Public Health."},{"key":"B42","doi-asserted-by":"publisher","first-page":"1945","DOI":"10.1080\/17441692.2021.1965182","article-title":"\u2018If not for this support, I would have left the treatment!': qualitative study exploring the role of social support on medication adherence among pulmonary tuberculosis patients in Western India","volume":"17","author":"Nirmal","year":"2022","journal-title":"Glob Public Health."},{"key":"B43","doi-asserted-by":"publisher","first-page":"e542","DOI":"10.1093\/pubmed\/fdad063","article-title":"Factors determining family and social support among pulmonary tuberculosis patients in East Khasi Hills, Meghalaya: a cross-sectional study","volume":"45","author":"Nadon","year":"2023","journal-title":"J Public Health"},{"key":"B44","doi-asserted-by":"publisher","first-page":"2728","DOI":"10.3760\/cma.j.cn115682-20221230-06173","article-title":"Status quo and influencing factors of self-management behavior of patients with diabetic retinopathybased on the ABC-X model[J]","volume":"29","author":"Kang","year":"2023","journal-title":"Chin J Mod Nurs"},{"key":"B45","author":"Wang","year":"2025","journal-title":"Construction and Application of a Self-Management Program Based on the LEARNS Model for First-Treatment Pulmonary Tuberculosis Patients"}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2025.1640626\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,22]],"date-time":"2025-10-22T05:31:30Z","timestamp":1761111090000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2025.1640626\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,22]]},"references-count":45,"alternative-id":["10.3389\/fpubh.2025.1640626"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2025.1640626","relation":{},"ISSN":["2296-2565"],"issn-type":[{"value":"2296-2565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,22]]},"article-number":"1640626"}}