The Role of Nurse-Patient Mutuality on Self-Care Behaviors in Adults Living with Inflammatory Bowel Disease: A Multicenter Cross-Sectional Study

Self-care is a core component of inflammatory bowel disease (IBD) management and includes self-care maintenance (behaviors aimed at preserving health and treatment adherence), monitoring (attention to symptoms and bodily changes), and management (responses to symptom exacerbations). Nurse-patient mutuality, grounded in trust, reciprocity, and shared involvement in care, may support these behaviors, but its role in IBD remains underexplored. This study aimed to examine the association between nurse-patient mutuality and self-care behaviors in adults with IBD.

A multicenter cross-sectional study was conducted across nine Italian IBD outpatient centers between April and June 2024. Adults with a confirmed diagnosis of Crohn's disease or ulcerative colitis completed the Nurse-Patient Mutuality in Chronic Illness (NPM-CI) scale and the Self-Care of Chronic Illness Inventory (SC-CII). Multiple linear regression analyses were performed to examine the association between the three dimensions of mutuality and self-care maintenance, monitoring, and management, adjusting for age, sex, body mass index, disease type, education, and occupation.

A total of 440 patients were included in the analysis; 52% were male, the mean age was 43 years (SD 16.4), 51% had Crohn's disease, and 49% had ulcerative colitis. Among the dimensions of the NPM-CI scale, developing and going beyond was positively associated with self-care maintenance (β = .23, p = .003) and monitoring (β = .18, p = .019); deciding and sharing care was positively associated with self-care monitoring (β = .15, p = .022) and management (β = .28, p < .001); and being a point of reference was positively associated with self-care management (β = .25, p = .001). Crohn's disease, compared with ulcerative colitis, was associated with better self-care maintenance (β =  - .12, p = .012). The models explained 13% of the variance in self-care maintenance, 17% in self-care monitoring, and 26% in self-care management.

Nurse-patient mutuality was significantly associated with self-care behaviors among patients with IBD, with distinct relational dimensions linked to distinct self-care domains. These findings support the relevance of strengthening therapeutic relationships to promote tailored self-care in IBD nursing practice.