Theories and determinants of self-care and self-efficacy in inflammatory bowel diseases: A systematic review

Objectives: Inflammatory Bowel Disease (IBD) is a chronic condition requiring complex, lifelong self-care. While self-care and self-efficacy are critical for improving patient outcomes, the theoretical underpinnings and key determinants influencing these processes are not well synthesized. A comprehensive understanding is essential for developing effective, patient-centred interventions. This systematic review aimed to evaluate theories and determinants of self-care and self-efficacy in IBD patients. Methods: Following PRISMA 2020 guidelines, we searched PubMed, CINAHL, Scopus, and Web of Science (inception-February 2025) for studies that applied theoretical frameworks or investigated constructs underpinning self-care and self-efficacy in IBD. Given the conceptual and methodological heterogeneity of the included studies, results were synthesised using the Synthesis Without Meta-analysis (SWiM) approach. Methodological quality was assessed using JBI tools and OCEBM evidence levels. Results: Thirteen empirical studies (1994-2025) met the inclusion criteria. Findings revealed a wide diversity of theoretical frameworks (Riegel's Middle-Range Theory of Self-Care, Self-Determination Theory, the Common Sense Model), indicating that no single theory can fully explain self-care in IBD. Key determinants influencing self-care and self-efficacy were identified across multiple domains: psychological factors (perceived control, resilience, emotional distress), relational aspects (autonomy-supportive healthcare feedback), and personal factors (health literacy, pre-illness routines). Self-care behaviours were consistently aligned with more favourable clinical outcomes and health-related quality of life (HRQoL). Conclusions: Self-care in IBD is a complex, multidimensional process influenced by psychological, relational, and clinical factors. An integrated theoretical approach is necessary to guide practice and research. Healthcare providers play a key role by delivering personalised, autonomy-supportive approaches informed by theoretical frameworks and observational evidence to foster self-efficacy and support patient outcomes and HRQoL. Practice implications: Findings support autonomy-supportive communication, multidimensional patient education addressing psychological and relational factors, systematic health literacy assessment, and adaptive stage-sensitive approaches. Intervention developers should design theory-driven programs integrating multiple frameworks to optimize self-efficacy and patient outcomes.