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

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.

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.

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.

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.