Self-Efficacy as a Mediator Between Caregiver Burden, Health Literacy, and Contribution to Self-Care in Inflammatory Bowel Disease

Purpose: Informal caregivers play a critical role in supporting Self-Care behaviors in patients with inflammatory bowel disease (IBD). However, the extent to which caregiver burden, health literacy, and Self-Efficacy predict their contribution to patient Self-Care remains unclear, and the potential mediating role of Self-Efficacy has not yet been established. Methods: A multicenter cross-sectional study was conducted across nine Italian IBD centers. Caregivers completed validated instruments assessing burden (Zarit Burden Interview, score range 0–88; higher scores indicate greater burden), health literacy (Single Item Literacy Screener, 1–5; scores > 2 indicate inadequate literacy), Self-Efficacy (CSE-CSC, standardized 0–100; higher scores indicate greater confidence), and caregiver contribution to Self-Care (CC-SC-CII, standardized 0–100 across maintenance, monitoring, and management; higher scores indicate greater contribution). Structural equation modelling explored direct and indirect associations among study variables. Results: Among 275 caregivers, the mean age was 51 years (SD = 13); 160 (58%) were female and 115 (42%) male. Mean contribution scores were 54.99 (SD = 25.62) for Self-Care Maintenance, 67.33 (SD = 32.28) for Self-Care Monitoring, and 56.18 (SD = 23.15) for Self-Care Management. Mean Self-Efficacy was 72.41 (SD = 18.42). Self-Efficacy significantly predicted Self-Care Monitoring (β = 0.34, p < 0.001) and Self-Care Management (β = 0.42, p < 0.001), while burden showed modest but significant associations across domains. Health literacy demonstrated no significant effects, and no mediation pathways were identified. Conclusion: Self-Efficacy emerged as a central determinant of caregiver contribution to patient Self-Care in IBD, particularly for Self-Care Monitoring and Self-Care Management behaviors. Interventions aimed at strengthening caregiver confidence and tailored to gender- and disease-specific needs may enhance the quality of caregiving and ultimately support better patient outcomes.