Self-Care and Illness Perception in Inflammatory Bowel Disease: Identifying Adaptive and Maladaptive Profiles Through Person-Centered Analysis

Abstract

Abstract Self-care and illness perception are key determinants of adaptation to inflammatory bowel disease (IBD), but their relationship may be heterogeneous and poorly captured by average-level associations. This multicenter cross-sectional study examined whether self-care behaviors were associated with illness perception and explored whether distinct patient profiles could be identified from their combined behavioral and cognitive-emotional patterns. Between April and June 2024, adult patients were recruited consecutively from nine Italian IBD units and completed validated measures of self-care, illness perception, self-care self-efficacy, and psychological distress. Structural equation modeling was used to test the association between self-care domains and illness perception, followed by unsupervised cluster analysis. Among 450 participants with complete data, the structural equation model showed satisfactory fit, but no self-care domain was significantly associated with illness perception. Four clinically interpretable profiles emerged: Engaged Copers, Overwhelmed and Passive, Detached and Vulnerable, and Minimizers with Functional Engagement. The profiles differed markedly in illness perception and self-care behaviours, with large effect sizes, whereas anxiety and self-care self-efficacy showed statistically significant but small between-profile differences. No statistically significant omnibus differences were observed in generational distribution, exercise habits, or disease activity. These findings suggest that self-care and illness perception are not related through a simple linear association. Person-centered profiling may support tailored self-management education and psychological assessment in routine IBD care.