Effectiveness of nursing interventions based on the integrated theory of health behavior change for chronic disease patients: a systematic review and meta-analysis of randomized controlled trials

Background/objectives Non-communicable chronic diseases are the leading cause of mortality and disability in China, necessitating long-term self-management. However, traditional education and single-dimensional interventions often fail to sustain behavioral changes. The Integrated Theory of Health Behavior Change offers a patient-centered framework that combines knowledge, self-regulation, and social support. This study aimed to systematically evaluate the effectiveness of nursing interventions based on the Integrated Theory of Health Behavior Change on patients with chronic diseases through a meta-analysis in accordance with PRISMA 2020. Methods Eleven databases, including MEDLINE, Web of Science, EMbase, Cochrane Library, CINAHL, PsycINFO, CNKI, Wanfang, VIP, SinoMed, and the Chinese Medical Journal Full-text Database, were systematically searched. The search spanned from each database’s inception to December 3, 2025. Two researchers screened studies according to the inclusion and exclusion criteria independently and extracted data. Study quality was assessed using the Cochrane Risk of Bias tool (RoB 2.0), and meta-analysis was conducted using RevMan 5.4 software. Heterogeneity was assessed using the Q test and I 2 statistic; subgroup and sensitivity analyses were carried out to investigate potential sources of heterogeneity. Results Eleven studies involving 1,139 chronic disease patients were included. Meta-analysis revealed that nursing interventions based on the Integrated Theory of Health Behavior Change enhanced self-management ability [SMD = 1.84, 95%CI(1.21, 2.47), p < 0.001; I 2 = 91%], reduced anxiety [SMD = −0.99, 95%CI(−1.50, −0.49), p < 0.001; I 2 = 84%] and depression levels [SMD = −1.14, 95%CI(−1.34, −0.94), p < 0.001; I 2 = 42%], and enhanced health literacy [SMD = 2.03, 95%CI(1.66, 2.40), p < 0.001; I 2 = 0%] in chronic disease patients. It also enhanced health-promoting behaviors [MD = 13.51, 95% CI(7.53, 19.49), p < 0.001; I 2 = 82%] and improved quality of life [SMD = 1.58, 95% CI(0.56, 2.60), p = 0.002; I 2 = 95%]. Conclusion The findings suggest that nursing interventions based on the Integrated Theory of Health Behavior Change may help chronic disease patients promote healthy behaviors, improve health outcomes, and improve quality of life. Interpret these findings in light of the small number of included studies, the risk of bias, and the heterogeneity observed across several outcomes. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/view/CRD420251272614 , CRD420251272614.