Abstract
This systematic review and meta-analysis aimed to evaluate the impact of narrative interventions on self-efficacy and self-management behaviors in patients with chronic diseases. We systematically searched EMBASE, the Cochrane Library, CINAHL, PsycINFO, China National Knowledge Infrastructure (CNKI), and PubMed from conception to 2025, supplemented by manual searches of reference lists. Randomized controlled trials (RCTs) assessing the effects of narrative interventions on self-efficacy or self-management in adults with chronic diseases were included. Data were pooled using random-effects meta-analysis. A total of 34 RCTs involving 4584 participants were included. The meta-analysis showed that narrative-based interventions significantly enhanced patients’ self-efficacy (22 studies; SMD = 0.66, 95% CI: 0.35–0.96, p < .001; I
2
= 59.6%) and self-management behaviors (12 studies; SMD = 1.73, 95% CI: 1.03–2.42, p < .001; I
2
= 85.1%). Meta-regression indicated a positive regulatory trend of national income level on self-efficacy (p = .055), although the effect was not statistically significant, and no significant moderating effect was observed for self-management. Other variables—including age, disease type, intervention type, duration, and publication period—showed no significant moderating impact on either outcome (p > .05). Subgroup analysis further revealed that the improvement in self-efficacy was significantly greater in upper- to middle-income countries (SMD = 1.04) than in high-income countries (SMD = 0.39; subgroup difference p = .019), and the effect was significant among patients with heart disease (SMD = 1.16), cancer (SMD = 0.98) and stroke (SMD = 0.71). For self-management, the effect varied significantly across subgroups defined by intervention type, duration, publication period and disease type, with the largest effects observed among patients with neurological diseases (SMD = 3.16) and cancer (SMD = 2.73). The results of this systematic review and meta-analysis suggest that narrative-based interventions may improve self-efficacy and self-management behaviors among patients with chronic diseases. However, considerable heterogeneity remains, and further high-quality studies are needed to confirm these findings.