The Role of Powerlessness in Self-Management Behaviours Among Patients with Malignant Fungating Wounds: A Cross-Sectional Study.

Objective: This cross-sectional study aimed to examine self-management behaviours in patients with malignant fungating wounds and to explore the structural pathways linking self-efficacy, powerlessness, and social support to self-management behaviours. Methods: A cross-sectional study was conducted in an outpatient oncology setting. Data were collected between January and October 2024. Mediation analysis was conducted using structural equation modelling, with indirect effects evaluated through bootstrapping with 5000 resamples. Results: 303 participants were included in the analysis. They achieved a mean self-management behaviour score of 97.72 ± 12.67, indicating a moderate level. Self-management behaviour was negatively correlated with powerlessness (r = -0.72) and positively correlated with self-efficacy (r = 0.60) and social support (r = 0.48). Structural equation modelling revealed that powerlessness had a significant direct negative effect on self-management behaviour (β = -1.33). Importantly, both self-efficacy and social support showed significant indirect effects on self-management behaviour through powerlessness (β = 0.69 and 0.69, respectively). The model explained 83.3% of the variance in self-management behaviours. Conclusion: Feelings of powerlessness emerged as a potential psychological mediator in the association between psychosocial determinants and self-management behaviours in this population. These findings underscore the critical need for targeted interventions that explicitly address powerlessness. Healthcare providers can strengthen the theoretical foundation for enhancing self-management practices and offering new pathways to improved health outcomes in patients with malignant fungating wounds.