Timeliness-incentive home health management for metabolic dysfunction-associated steatotic liver disease

Abstract

BACKGROUND

The guidelines of the National Institute for Health and Care Excellence recommend lifestyle modification as the first-line treatment for patients with metabolic dysfunction-associated steatotic liver disease (MASLD); however, only 30% achieve sustained weight loss; precision nursing strategies are therefore needed to enhance behavioural maintenance and long-term outcomes.

AIM

To establish a home-based management protocol grounded in timeliness-incentive theory and demonstrated its clinical nursing effects through rigorous practice.

METHODS

From August 20 to September 3, 2024, 108 MASLD patients at the Second Affiliated Hospital of Chongqing Medical University were randomly allocated by sealed-envelope to seven-month timeliness-incentive or conventional home care; weight, hepatic steatosis, enzymes, lipids, Health-Promoting Lifestyle Profile II and Exercise of Self-Care Agency scores were assessed pre/post, with SPSS 26.0 deeming two-tailed P < 0.050 significant.

RESULTS

After seven months, the first group had less liver fat than the second group (P < 0.010). Their weight, aspartate aminotransferase, alanine aminotransferase, total cholesterol, triglycerides, low-density lipoprotein cholesterol went down (P < 0.050), and high-density lipoprotein cholesterol went up (P < 0.001). The first group also had better scores for eating, health duty, exercise, stress control, self-care duty, self-care skills, and health knowledge (P < 0.010).

CONCLUSION

Home health management interventions guided by timeliness incentive theory demonstrate significant improvements in liver function, lipid profiles, health-related behaviors, and self-management capabilities among patients with MASLD. These findings support the clinical utility and recommend further promotion of this intervention model.

Key Words: Non-alcoholic fatty liver disease; Home care services; Health behavior; Self-management

Core Tip: In a home-based "timeliness-incentive" randomized clinical trial, 108 metabolic dysfunction-associated steatotic liver disease patients receiving home care plus micro, immediate rewards for 7 months showed markedly lower liver fat, weight, aspartate aminotransferase/alanine aminotransferase, lipids and higher high-density lipoprotein cholesterol vs usual care, alongside superior diet, exercise and self-management scores, proving that low-cost timeliness-incentive tele-health can reverse metabolic-liver injury and should be widely adopted.

INTRODUCTION

Metabolic dysfunction-associated steatotic liver disease (MASLD)—formerly termed non-alcoholic fatty liver disease—represents a spectrum of hepatic steatosis closely linked to systemic metabolic risk factors, including obesity and type 2 diabetes mellitus[1]. To emphasise its metabolic aetiology and frequent coexistence with other cardiometabolic disorders, the nomenclature was revised to metabolic-associated fatty liver disease in 2020[2]. Population-based surveys indicate a global prevalence of approximately 30%[3]. Approximately 37% of these individuals progress to metabolic dysfunction-associated steatohepatitis—historically termed non-alcoholic steatohepatitis—a transition that can culminate in hepatic cirrhosis[4].

Currently, no pharmacological therapy has received global regulatory approval for MASLD[5]. The United Kingdom’s National Institute for Health and Care Excellence recommends lifestyle modification as the cornerstone of management[6]. Consequently, structured dietary and exercise interventions that establish sustainable healthy behaviours constitute the foundation of MASLD treatment.

The timeliness incentive theory is a parsimonious, patient-centred behavioural framework comprising four evidence-based levers: Positive reinforcement, need fulfilment, role modelling, and micro-rewards[7-9]. When clinicians deliver clear, hopeful messages at behaviourally salient moments, patients engage more actively in self-management[10].

This study was designed to evaluate whether home-based management grounded in timeliness-incentive theory was superior to conventional remote management in reducing hepatic steatosis, improving liver-function indices and fostering healthy behaviours among MASLD patients, and to provide an additional evidence-based option for the clinical management of MASLD.

MATERIALS AND METHODS

Study design

This single-blind, randomized, controlled trial was designed to evaluate the efficacy of family-based health management, grounded in timeliness-incentive theory, vs standard family management in improving hepatic steatosis among individuals with MASLD.

Setting and participants

Participants were enrolled by means of consecutive convenience sampling. Individuals diagnosed with MASLD at the health-check-up centre of the Second Affiliated Hospital of Chongqing Medical University (Jiangnan District) between August 20 and September 3, 2024 were invited to participate, and those who provided written informed consent were included.

Sample size

The sample size was determined using the formula for comparing two proportions: The outcome indicators included the effective rate of symptom improvement, laboratory examination results, and ultrasound examination findings. Specifically, symptom improvement was categorized as complete resolution, near resolution, or significant improvement; laboratory examination results were considered normal or reduced by at least one-half; and ultrasound examination findings indicated no fatty liver manifestation or a one-grade reduction. Based on a review of the literature[11], the proportions were determined as P₁ = 94.44% and P₂ = 72.22%. Anticipating a 20% dropout rate during follow-up, the sample size was calculated to be 54 participants per group, resulting in a total sample size of 108.

Randomization and blinding

Two nurses, who were not part of the intervention team, generated 108 random numbers using SPSS 26.0 statistical software. Random numbers were arranged in ascending order; participants drawing the first 54 numbers were allocated to the control group, and the remainder to the intervention group. A nurse external to the intervention team wrote each number on a piece of paper and placed it into an opaque envelope. Eligible participants who met all inclusion and exclusion criteria drew a pre-set random number from the opaque envelope and were thereby randomly assigned to either the intervention or the control group. Allocation was concealed from participants and outcome assessors; because intervention personnel could not be masked, the study was single-blind. The control group continued with standard domiciliary care, whereas the intervention group received a time-sensitive, incentive-structured home-health protocol.

Study population

Inclusion criteria: (1) Meet the diagnostic criteria for MASLD[12]; (2) Age > 18 years; (3) Have no neurological disorder, with the ability to communicate effectively and cooperate with investigators; (4) Proficiency in using WeChat, fitness trackers, and other electronic devices, and possessing reading comprehension skills; and (5) Voluntary participation in the study with signed informed consent.

Exclusion criteria: (1) Any motor system injury or contraindications to exercise; (2) Any diseases of the heart, brain, lungs, or other vital organs; (3) Use of medications that may affect blood lipid and enzyme levels during the trial; or (4) Patients with severe MASLD and other liver diseases (hepatitis, cirrhosis, liver cancer, etc.).

Drop-out criteria: (1) Voluntary withdrawal; or (2) Loss to follow-up.

Interventions

Control group interventions: The usual home care steps were these: First, the research team checked each patient’s heart, lungs, and muscle strength on the day they joined. Then the research team gave each one a simple step count goal that fit their body. The research team showed them how to wear a band and send the steps to the phone app. Next, our food helper looked at what the patient usually ate and the liver fat grade. She wrote a plain menu with less oil and sugar. Last, the research team added each patient to a chat group with the nurse. Every two weeks the nurse posted one short message about the liver. Once a month she held a short live talk. The words were kept easy and matched what the group members already knew.

Experimental group interventions: (1) Formulate a home health management plan for people of MASLD based on the theory of timeliness incentives: The research team first read many papers and talked in a small group to fix the aims, people, times, way, tests, and length. Next, the research team wrote a first plan using the timeliness incentive idea. The research team then sent this plan to six experts two times; they sent back simple fixes and the research team made the changes. Last, the research team tried the plan for two weeks with five patients; their notes helped us finish the test draft (Figure 1); (2) Establish a specialized team: The head nurse provided the team with foundational knowledge of MASLD, principles of timeliness-incentive theory, and basic communication techniques. Following a brief knowledge test and evaluation form, the six highest-scoring candidates were selected to moderate the chat group. Three delivered the monthly live sessions, while the remaining three responded to questions, disseminated practical tips, and provided immediate positive feedback; and (3) Intervention content: On the basis of that in the control group, the intervention based on timeliness incentive theory was given (Figure 2), while all other MASLD-related health education, exercise, and diet programs remained consistent with those provided to the control group. The specific intervention protocol is outlined as follows (Table 1).

Figure 1 Flow chart.

Figure 2 Each stage intervention of timeliness incentive theory.

Table 1 Intervention program based on time-sensitive incentive theory.

Themes	Objective	Content	Form
Emotional motivation	To establish the confidence in patients to overcome the disease and enhance their motivation to adopt healthy behaviors	(1) Introduce the objectives and procedures of home management based on the theory of timeliness incentives, as well as arrangements for related online meetings; (2) Assess the patient's attitude towards the disease and provide psychological counseling if there is anxiety; and (3) Involve family members in the management process to offer psychological support and to supervise and encourage the patient	Face-to-face communication; WeChat group
Need-based motivation	To ensure that patients have a deeper and more comprehensive understanding of the disease, and to enable them to continue receiving professional management plans and timely answers to their questions outside the hospital	(1) Popularizing disease-related knowledge via Tencent meetings, thereby enabling patients to recognize the impact of healthy behaviors, such as diet and exercise, on their condition and enhancing their motivation to adopt healthier practices; (2) Encourage patients to share their diet and exercise within the WeChat group, fostering a supportive environment for mutual communication and supervision; and (3) Provide timely responses to any queries raised by patients	WeChat group, patient communication, Tencent meeting
Role-model motivation	By sharing successful case examples, the research team illustrate to patients that adopting and sustaining healthy behaviors can lead to significant improvements or even complete remission of the disease, thereby increasing patients' self-management compliance	(1) Monthly, 1-2 patients under management are selected to share their experiences online, encouraging all managed patients to adopt and maintain healthy behaviors; and (2) During each session, 3-5 patients are randomly selected to discuss the support they have received and any challenges or obstacles they have faced in maintaining healthy behaviors	WeChat group, Tencent meeting
Benefit motivation	Enable patients to more directly comprehend the crucial value of effective self-management for the disease	(1) Elucidate the multifaceted impact of the disease on the individual, family, and society; (2) Analyze the economic and interest-related benefits of health behaviors for patients; and (3) Offer free MASLD-related examinations1 to patients who demonstrate monthly exercise management compliance, thereby encouraging the maintenance of healthy lifestyle habits	Face-to-face communication; WeChat group

¹Complimentary assessments comprised hepatic ultrasonography, body-composition analysis, liver-fibrosis evaluation, physical-fitness testing, and dietary-plan revision. All investigations were conducted within our department, and expenses for non-complimentary investigations were covered by our departmental budget.

MASLD: Metabolic dysfunction-associated steatotic liver disease.

Outcome indicators

After seven months of intervention, outcome assessors blinded to group allocation re-examined participants using identical equipment to determine between-group differences. The primary outcome was hepatic steatosis grade on ultrasonography; secondary outcomes included body mass index (BMI) , abdominal circumference, fasting lipids [total cholesterol (TC), triglycerides (TG), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C)], liver enzymes [aspartate aminotransferase (AST), alanine aminotransferase (ALT)], Health-Promoting Lifestyle Profile II (HPLP-II) score, and Exercise of Self-Care Agency (ESCA) score.

Analyses of fatty liver improvement: The same doctor, who was blinded to group allocation, scanned every liver before and after the study with a GE LOGIQ-E9 ultrasound machine and graded the fat change in one clear scale. A mild picture kept normal size and bright, even echoes; a moderate picture showed the organ shrinking, its wall looking thicker and its echoes turning darker as fat rose; a severe picture revealed the liver even smaller, the wall much thicker and the echoes much darker while fat reached its highest level.

BMI and biochemical indices: An identical Omron HNH-318 physical examination scale was used to determine the weight, height, and BMI of each patient before and after the intervention. The abdominal circumference was measured using the same soft measuring tape. Fasting venous blood samples were collected to measure TC, TG, LDL-C, HDL-C, ALT, and AST levels.

Analyses of health behaviors: In this study, the HPLP-II was used to assess health-related behaviors before and after the intervention, evaluating six distinct dimensions of health behavior: Physical exercise, health responsibility, stress management, nutrition, interpersonal relationships, and spiritual growth[13]. Total scores range from 52 to 208, with higher values indicating more favourable health behaviours. The scale demonstrated excellent internal consistency (Cronbach's α = 0.94).

Self-care ability assessment: The ESCA was utilized to evaluate the patients. This scale encompasses 43 items distributed across four dimensions: Self-care skills, self-care responsibility, self-concept, and health knowledge. Scoring is conducted using a 5-point Likert scale, with the highest possible total score being 172 points. Elevated scores are indicative of enhanced self-care capabilities. The Cronbach's α coefficient of the scale ranges from 0.86 to 0.920[14].

Statistical analysis

Data input, proofreading, and analysis were conducted using SPSS 26.0 software, with double data entry employed to ensure accuracy. Normally distributed measurement data are given as mean ± SD and checked with the Student’s t test. Data that did not follow a normal distribution are given as median (P25, P75) and checked with the Mann-Whitney U test. Categorical data are given as n (%) and checked with the test. Graded data are checked with the Z test. When the bilateral P < 0.050, it is considered to have a statistically significant difference. The research team ran both intention-to-treat (ITT) and per-protocol (PP) checks. ITT kept every random case. If normally distributed data missed less than 10%, the research team filled with the mean, if not normal with the median, if rank with the mode, and if 10% to 30% missed the research team used multiple imputation. The research team looked at simple stats to be sure the filled numbers made sense. PP kept only cases who finished the seven-month plan and had no blank cells.

Ethical statements

Written informed consent was obtained from each patient included in the study and the study was approved by the Clinical Research Ethics Committee of the Second Affiliated Hospital of Chongqing Medical University (registered at the Chinese Clinical Trial Registry, ChiCTR2500096119) and conformed to the ethical guidelines of the 1975 Declaration of Helsinki.

RESULTS

In this study, both ITT and PP analyses were carried out respectively, and the results of the two showed consistency in whether they were statistically significant or not. Therefore, only the table of ITT analysis results is listed in this section, and the PP analysis will be shown in the attachment. A total of 108 eligible participants were randomly assigned to either the intervention (n = 54) or the control group (n = 54). The median age of the participants was 42 years, 68% were male, and the median BMI was 27. A total of 97 participants (89.8%) finally completed the management, of which 4 participants lost in the intervention group and 8 participants lost in the control group (Figure 3) Comparable baseline data showed no statistically significant difference between the two groups (Table 2). Significant differences were observed in systolic blood pressure (P = 0.060) and diastolic blood pressure (P = 0.001) between the two groups. Specifically, the intervention group exhibited higher median systolic blood pressure and mean diastolic blood pressure compared to the control group. However, considering the minimal impact of blood pressure on the primary study outcomes, this difference is unlikely to have significantly confounded the study results.

Figure 3 Flow diagram. MASLD: Metabolic dysfunction-associated steatotic liver disease; ITT: Intention-to-treat; PP: Per-protocol.

Table 2 Baseline patient characteristics and fatty liver severity, n (%)/mean ± SD/median (P25, P75).

Item	Total (n = 108)	Experimental group (n = 54)	Control group (n = 54)	χ2/t/Z	P value
Age (years)	42 (37, 52)	46 (40, 53)	44 (38, 49)	-1.172	0.242
Male	68 (63)	33 (61.1)	35 (64.8)	0.163	0.690
Smoking	26 (24.1)	12 (22.2)	14 (25.9)	0.203	0.653
Hypertension	15 (13.9)	10 (18.5)	5 (9.3)	1.943	0.164
Systolic blood pressure (mmHg)	127 (113, 134)	131 (118, 142)	120 (111, 129)	-2.722	0.006
Diastolic blood pressure (mmHg)	75 (69, 85)	81 ± 12	74 ± 10	3.292	0.001
Abdominal circumference (cm)	89 (82, 95)	90.02 ± 11.72	87.57 ± 8.35	1.252	0.215
BMI (kg/m2)	27 (24.56, 28.9)	27.72 ± 5.17	26.5 ± 1.85	1.532	0.130
Fasting blood glucose	5.27 (4.79, 5.74)	5.34 (4.94, 5.81)	5.21 (4.67, 5.57)	-1.542	0.124
AST (U/L)	25 (20, 30)	32 (23, 50)	27 (20, 43)	-1.392	0.165
ALT (U/L)	30 (22, 45)	26 (22, 32)	24 (19, 28)	-1.922	0.055
TG (mmol/L)	1.94 (1.38, 2.71)	2.04 (1.43, 2.67)	1.85 (1.28, 2.85)	-0.502	0.617
TC (mmol/L)	5.06 ± 0.93	5.24 ± 0.93	5.05 ± 0.78	1.121	0.266
LDL-C (mmol/L)	3.02 ± 0.71	3.10 ± 0.72	2.94 ± 0.70	1.151	0.250
HDL-C (mmol/L)	1.2 ± 0.23	1.19 ± 0.16	1.16 ± 0.22	0.731	0.469
Fatty liver grading				-0.803	0.426
Mild	32 (29.6)	18 (33.3)	14 (25.9)
Moderate	63 (58.4)	30 (55.6)	33 (61.1)
Severe	13 (12)	6 (11.1)	7 (13)
Total sample size				-0.953	0.341
Primary school and below	20 (18.5)	11 (20.4)	9 (16.7)
Junior high school	47 (43.5)	25 (46.3)	22 (40.7)
University and above	41 (38)	18 (33.3)	23 (42.6)

¹Data checked with the Student’s t test.

²Data checked with the Mann-Whitney U test.

³Data checked with the χ² test.

BMI: Body mass index; AST: Aspartate aminotransferase; ALT: Alanine aminotransferase; TG: Total triglyceride; TC: Total cholesterol; LDL-C: Low-density lipoprotein cholesterol; HDL-C: High-density lipoprotein cholesterol.

Comparisons of patient interventional outcomes

Before the intervention, no significant differences (P > 0.050) were noted between the two groups in terms of lipid metabolism, liver function indicators, or fatty liver grade. Post-intervention, significant differences (P < 0.010) were observed in all measured parameters, with the exception of BMI and AST, with the intervention group showing markedly better results than the control group (Table 3).

Table 3 Comparison of body mass index and biochemical indexes before and after interventions in the control and experimental groups, n (%)/mean ± SD/median (P25, P75).

Item	Experimental group (n = 54)		Control group (n = 54)		2 groups before intervention		2 groups after intervention
	Pre-intervention	Post-intervention	Pre-intervention	Post-intervention	X1/T1/Z1	P1 value	X2/T2/Z2	P2 value
Abdominal circumference	90.02 ± 11.72	78 (73, 83.25)	87.57 ± 8.35	82 (80, 85)	1.251	0.215	-2.972	0.003
BMI (kg/m2)	27.72 ± 5.17	24.83 (23.8, 27.2)	26.5 ± 1.85	25.01 (24.33, 25.87)	1.531	0.130	-0.382	0.703
Fatty liver grading					1.253	0.215	-2.673	0.008
Normal	0	8 (14.8)	0	2 (3.7)
Mild	18 (33.3)	26 (48.1)	14 (25.9)	19 (35.2)
Moderate	30 (55.6)	17 (31.5)	33 (61.1)	28 (51.8)
Severe	6 (11.1)	3 (5.6)	7 (13)	5 (9.3)
ALT (U/L)	26 (22, 32.25)	22 (18, 28.25)	23.5 (18.75, 28)	30.5 (26, 35.25)	-1.922	0.055	-4.802	< 0.001
AST (U/L)	32 (22.75, 50.25)	20 (18.75, 22)	27 (20, 42.5)	20 (19, 22.25)	-1.392	0.165	-0.802	0.425
TG (mmol/L)	2.04 (1.43, 2.67)	1.36 (1.13, 1.99)	1.85 (1.28, 2.85)	2.12 (1.53, 2.36)	-0.502	0.617	-3.302	0.001
TC (mmol/L)	5.24 ± 0.93	4.02 (3.23, 4.25)	5.05 ± 0.78	4.55 (3.95, 4.87)	1.121	0.266	-4.332	< 0.001
LDL-C (mmol/L)	3.10 ± 0.72	2.22 (2.09, 2.69)	2.94 ± 0.70	2.65 (2.29, 2.98)	1.151	0.250	-5.572	< 0.001
HDL-C (mmol/L)	1.19 ± 0.16	1.55 (1.43, 1.7)	1.19 ± 0.16	1.33 (1.16, 1.45)	0.731	0.469	-2.842	0.004

¹Data checked with the Student’s t test.

²Data checked with the Mann-Whitney U test.

³Data checked with the χ² test.

BMI: Body mass index; AST: Aspartate aminotransferase; ALT: Alanine aminotransferase; TG: Total triglyceride; TC: Total cholesterol; LDL-C: Low-density lipoprotein cholesterol; HDL-C: High-density lipoprotein cholesterol.

Intervention-related changes in health behaviors and ESCA

Before the intervention, no significant differences (P > 0.050) were noted between the two groups in health behaviors or self-care ability scores across any dimension. After the intervention, significant differences (P < 0.001) were observed in all dimensions and the total score, except for interpersonal relationships, self-actualization, and self-concept. The intervention group showed significantly higher scores compared to the control group (Tables 4 and 5).

Table 4 Comparisons of scores for different Health-Promoting Lifestyle Profile II dimensions between groups before and after intervention, mean ± SD/median (P25, P75).

Item	Experimental group (n = 54)		Control group (n = 54)		2 groups before intervention		2 groups after intervention
	Pre-intervention	Post-intervention	Pre-intervention	Post-intervention	T1/Z1	P1 value	T2/Z2	P1 value
HPLP-II	118.41 ± 5.59	159.72 ± 4.91	117.78 ± 4.17	146.02 ± 5.12	0.661	0.509	14.191	< 0.001
Interpersonal relationship	24 (23, 25)	27 (26, 29)	24 (23, 25)	27 (26, 29)	-1.332	0.182	-0.782	0.438
Nourishment	22.5 (21, 24)	26 (25, 28)	22 (21, 23)	24 (23, 25)	-1.062	0.288	-5.482	< 0.001
Health responsibility	16 (15, 19)	24 (22.75, 25.25)	16 (15, 19)	22 (20, 22.25)	-0.852	0.394	-5.662	< 0.001
exercise	16.87 ± 1.95	29 (26, 30)	16.65 ± 2.44	24 (23, 26)	0.521	0.602	-7.052	< 0.001
Stress management	17.5 (15, 18.25)	29 (27, 30)	17 (15, 18)	25 (21, 26)	-0.882	0.380	-7.792	< 0.001
self-actualization	21 (19, 23)	25 (23, 27)	21 (21, 22)	26 (22, 27)	-0.992	0.324	-0.042	0.965

¹Data checked with the Student’s t test.

²Data checked with the Mann-Whitney U test.

HPLP-II: Health-Promoting Lifestyle Profile II.

Table 5 Comparisons of scores for different Exercise of Self-Care Agency dimensions between groups before and after intervention, mean ± SD/median (P25, P75).

Item	Experimental group (n = 54)		Control group (n = 54)		2 groups before intervention		2 groups after intervention
	Pre-intervention	Post-intervention	Pre-intervention	Post-intervention	T1/Z1	P1 value	T2/Z2	P1 value
ESCA	92.8 ± 3.07	118.35 ± 5.92	92.56 ± 2.99	105.81 ± 5.03	0.411	0.680	11.851	< 0.001
Self-concept	22 (21, 23)	23 (21.75, 24.25)	22.5 (21, 24)	22.5 (21, 25)	-1.132	0.258	-0.412	0.680
Self-care responsibility	9 (9, 10)	15 ± 2.68	9 (8, 10)	11.74 ± 2.5	-0.482	0.631	6.531	< 0.001
Self-care skills	22 (20.75, 23)	32.5 (29, 34.25)	21 (20.75, 23)	28 (25, 30)	-0.642	0.520	-6.532	< 0.001
Health knowledge	40 (39, 41)	48 (46.75, 51)	39.5 (38, 41)	44 (41, 46)	-0.892	0.376	-6.102	< 0.001

¹Data checked with the Student’s t test.

²Data checked with the Mann-Whitney U test.

ESCA: Exercise of Self-Care Agency.

DISCUSSION

This study underscores the feasibility and efficacy of home-based health management predicated on the timeliness incentive theory for people with metabolism-associated fatty liver disease. The intervention group exhibited a marked improvement in fatty liver grade relative to the control group. While the intervention did not yield statistically significant differences in BMI and AST between the two groups, it did result in significant differences in abdominal circumference, lipid metabolism, and the more sensitive liver function marker ALT. These findings align with those reported by Mardinoglu et al[15]. The reason is that dietary and exercise interventions can effectively enhance liver health and subcutaneous fat levels in patients, thereby facilitating a reduction in abdominal circumference. Healthy eating habits can also boost liver insulin sensitivity, augment glucose and lipid metabolism in the liver, and ultimately lower the grade of fatty liver[16]. In this study, the intervention group integrated exercise and diet interventions with psychological care for participants. Time-sensitive incentive, a psychological nursing method, emphasizes a comprehensive assessment of participants' conditions, the formulation of personalized incentive measures, and precise timing of incentives to enhance nursing efficacy[17]. Additionally, this study provided professional guidance throughout the process, which can help patients establish a correct treatment concept. Improving patients' management compliance plays a positive role in their active cooperation with management[18].

The results showed that the home care plan with quick rewards gave better scores for eating, health duty, moving, and coping with stress than the usual plan, and this matches the work by Yu[19]. This effect is primarily attributed to the timeliness incentive theory, which leverages demand-based incentives to provide people with a comprehensive understanding of disease-related knowledge. This approach enables patients to clearly recognize their own unhealthy habits and guides them in establishing a correct treatment concept. Prior research has demonstrated that emotional motivation serves as an effective means of prompting patients to unlock their intrinsic potential to achieve goals[8]. By engaging in frequent communication with patients to understand their current attitude towards the disease, and by delivering targeted psychological interventions while simultaneously addressing their reasonable needs, a dynamic, personalized exercise regimen can be devised. This approach helps patients establish and adopt healthy behaviors. Utilizing exemplary motivation, patients who keep the rules act as living examples; they set a clear target for the rest, so more people join in, and the WeChat group gives day-to-day cues and checks, so patients keep moving and choose good habits. Additionally, interest-based incentives are integrated to establish a robust psychological compliance framework, ensuring sustained long-term engagement among patients.

This study also revealed that home health managers utilizing the timeliness incentive theory significantly enhanced their self-management behaviors. Relative to the control group, participants in the intervention group exhibited marked improvements in self-care responsibility, self-care skills, and health knowledge, findings that align with the research outcomes of Liu et al[9]. Self-management ability is influenced not only by knowledge level and disease condition but also significantly by external environmental stimuli. The timeliness incentive theory breaks down the overarching "incentive goal" into phased “incentive targets”, with incentive policies tailored to individual needs and varying over time[20]. This approach aims to provide patients with comprehensive support—physiological, psychological, familial, and social—to maximize the incentive effect. Effective psychological comfort should be offered to patients when they are in greatest need of spiritual support, and their self-management potential should be tapped through effective incentives. This enables patients to proactively integrate their desire to enhance self-management into their daily lives, transforming disease-related stress into motivation and bolstering their confidence to overcome the disease, thereby improving their self-management ability[21]. Simultaneously, exemplary cases are utilized to encourage patients to approach their condition with a positive mindset, thereby guiding them to consciously enhance their self-care capabilities[22].

CONCLUSION

This study revealed that home health management predicated on the timeliness incentive theory not only effectively ameliorates fatty liver grade, lipid metabolism indicators, and liver function but also enhances patients' self-management capabilities and fosters the establishment of healthy behaviors, thus meriting clinical adoption.

ACKNOWLEDGEMENTS

Thanks to all participants for their support.