Family Function and Self-Management in Glaucoma Patients: Chain Mediation of Psychological Capital and Coping Style

Introduction

Glaucoma is a chronic eye disease characterized by progressive deterioration of the optic nerve, which ultimately results in irreversible loss of visual fields.¹ As the second leading cause of irreversible blindness globally, glaucoma threatens individual autonomy and presents a substantial burden to the public healthcare systems.^2,3 Effective self-management, including medication adherence, routine follow-ups, symptom monitoring, and adaptation to the psychosocial challenges of chronic disease, is essential to delay disease progression and preserve visual function and quality of life in these patients.^4–6 However, many glaucoma patients demonstrate poor self-management due to insufficient disease knowledge, complex medical treatment, low self-efficacy, difficulties associated with adapting to visual impairments, and misbelief regarding unavoidable vision loss.^7–11 Despite increasing recognition of these challenges, the psychosocial mechanisms underlying self-management in glaucoma remain insufficiently understood.

Research Gap

While the importance of self-management is well-documented, a significant gap remains in understanding the psychosocial mechanisms that drive these behaviors in glaucoma patients. Existing literatures have established that family support is beneficial and effective family functioning, the collective ability of a family to mobilize material resources and provide emotional and informational support, can affect patient emotional state and behavioral responses, facilitating adaptive psychological outcomes and health-related behaviors in patients.^12–16 However, there were significant gaps in understanding the impact of family functioning on self-management efficacy in glaucoma patients, especially the potential mediators linking family functioning to patient self-management. All of these warrant further investigations.

Application of Personal and Family Self-Management Theory

The personal and family self-management theory (PFSMT) is a theoretical structure that integrates and builds upon earlier studies concerning self-management at both individual and family levels, emphasizing the practices of individuals, dyadic relationships, and family systems.¹² The theory is structured around three fundamental components, namely context, process, and outcome, and illustrates how individual, contextual, and environmental factors contribute to the formation of self-management abilities, which subsequently affect health behaviors and long-term outcomes.

Glaucoma management could be particularly suitable for application of PFSMT since its control depends not only on individual motivation but also on family support and sustained behavioral regulation. Within the PFSMT framework, family functioning represents a contextual resource; psychological capital (hope, resilience, optimism, self-efficacy) and coping styles function as process-level mechanisms;¹⁷ and self-management constitutes the behavioral outcomes. Application of PFSMT could enable a structured and theory-driven examination of how family-level influences translate into individual behavioral outcomes in glaucoma management.

Psychological Capital and Coping Styles in Chain Mediation Pathway

Psychological capital has been consistently associated with improved health behaviors in chronic disease management.^18–20 Families with high levels of functioning can foster psychological capital among their members through sustained emotional support and effective communication. This enhanced psychological capital contributes to reduced psychological distress, improved mental well-being, and ultimately, strengthened self-management capacity.^21–24

Coping styles represent concrete behavioral and cognitive response to illness-related stress. Adaptive coping facilitates treatment adherence and emotional adjustment, whereas maladaptive coping undermines self-management efforts.²⁵ Empirical evidence indicates a strong association between coping styles and patients’ self-management capacity.^26,27

Family functioning may shape self-management by enhancing psychological capital, which in turn impact coping styles.²⁸ Psychological capital and coping styles are key internal resources for management illness-related stress. Psychological capital may influence the selection and effectiveness of coping styles.²⁹ Patients with stronger psychological resources are more likely to adopt active and problem-focused coping behaviors,¹⁹ ultimately enhancing their capacity for effective self-management.³⁰ Coping style may represent a downstream behavioral manifestation of psychological capital. Understanding this chain mediation pathway allows for a more comprehensive understanding than merely examining each mediator separately.

Conceptual Framework Development

Drawing upon the proven efficacy of PFSMT in chronic disease management, this study adopted the framework by defining family functioning as the contextual factor, psychological capital and coping styles as the process variables, and self-management as the resulting outcome. We investigated how family functioning, psychological capital, and coping styles affect self-management in glaucoma patients using structural equation modeling. Our hypotheses were:

H1: Family functioning directly and positively influences self-management.

Building on these hypotheses, a preliminary theoretical framework has been developed (Figure 1).

Figure 1 Assumed structural equation model.

Materials and Methods

Data Origins

Glaucoma patients participated in a cross-sectional study at the Department of Ophthalmology, First Hospital of Jilin University, China, using convenience sampling. The inclusion criteria were as follows: (1) patients diagnosed with glaucoma; (2) those who had undergone medical, surgical, or laser interventions; (3) those aged ≥18 years; and (4) those with adequate comprehension and communication skills. The exclusion criteria were as follows: (1) patients with other acute or chronic ocular conditions; (2) those with coexisting severe physical illnesses; and (3) those diagnosed with additional mental health disorders. The survey was administered via an online platform with all scale items set as mandatory. Participants could not submit the questionnaire unless every item was answered. Consequently, no item-level missing data were present in the collected questionnaires. Of the 355 initial questionnaires, 19 (5.35%) were excluded due to straight-lining responses (n = 7), logical contradictions (n = 6), or completion time < 1 minute (n = 6). The final valid sample consisted of 336 responses (effective response rate = 94.65%). Since there was no missing value in the valid cases, no imputation was performed. The subsequent principal component analysis was conducted on the complete dataset (N=336). In line with Kendall’s guidelines,³¹ the recommended participant count is typically calculated as 5–10 participants for each independent variable. This study incorporated 21 independent variables in total, consisting of 7 participant characteristics, 5 dimensions of family functioning, 4 dimensions of psychological capital, 3 dimensions of self-management, and both positive and negative coping styles. Based on this calculation, the estimated required sample size is 105 to 210 participants. Considering a potential 20% invalid response rate, the required number of participants becomes 126 to 252. Therefore, our sample size fulfills the study’s criteria.

Investigation Instruments

The study participants were glaucoma patients. Most of whom had varying degrees of visual impairment. To ensure data quality and response authenticity, we adopted the following measures, including 1) all scale items were kept in their original format without any adaptation; 2) patients with mild visual impairment were allowed to use the device’s built-in zoom function or screen reader to complete the questionnaire independently; 3) for patients with severe visual impairment or those unable to read the screen, family members, caregivers, or research assistants would assist them, including operating the electronic device and reading the items aloud line by line. The patients responded orally. The family members, caregivers, and research assistants were instructed not to interfere with patient’s independent response but only selected the answers based on patient responses. This approach respected the patients’ autonomous responses while minimizing the impact of visual impairment on data collection.

Family Function Scale

The Family Care Index Scale, created by Smilkstein,³² was used to evaluate the family functioning of participants. The scale comprised five key aspects: adaptation, partnership, growth, affection, and resolve. Each dimension is assessed through a single item, measured using a 3-point Likert scale from 0 to 2, with higher scores suggesting increased degrees of family functioning. The scale is simple to administer and offers a consistent measure reflecting a person’s view of their family functioning. The scale showed a Cronbach’s α value of 0.884 in this study, indicating a high level of internal consistency. This suggests that the items within the scale reliably measure aspects of family function in the study population.

Psychological Capital Scale

Psychological capital was assessed using the Chinese Psychological Capital Questionnaire.³³ This questionnaire comprises four core elements: self-efficacy, hope, resilience, and optimism. It uses a 7-point Likert scale, with 1 indicating “not at all” and 7 representing “totally.” Items with negative wording were reverse scored, and the average score across all responses was subsequently computed. Elevated scores indicate greater psychological capital. In the present research, the Cronbach’s α coefficients for both the whole questionnaire and its individual dimensions ranged from 0.905 to 0.976, indicating excellent internal consistency. These high values suggest that the questionnaire and its subscales reliably assess psychological capital among the participants.

Coping Style Scale

The Simple Coping Style Questionnaire, designed by Xie³⁴ based on the characteristics of Chinese individuals, was used to measure coping styles. The scale includes two categories of coping styles: 12 styles for positive coping and 8 styles for negative coping. Each item is measured using a 4-point Likert scale from 1 (never used) to 4 (frequently used). Higher scores on the positive coping dimension suggest a more adaptive approach to coping, whereas higher scores on the negative dimension imply a less effective, maladaptive style. In the present study, the overall Cronbach’s α coefficient was 0.830, with values of 0.882 and 0.765 for the positive and negative coping subscales, respectively. These results indicate good internal consistency for the total scale, with particularly strong reliability for the positive coping dimension and acceptable reliability for the negative coping dimension.

Self-Management Scale

The Glaucoma Patient Self-Management Behavior Questionnaire, designed by Wu,³⁵ was used to assess the self-management skills of participants. This tool evaluates three critical aspects: life adjustment, promotion of physical function, and medical management of glaucoma. Each item is evaluated using a 4-point Likert scale, extending from 1 (not at all) to 4 (completely achievable), where elevated scores represent a greater ability of self-management. In this research, the Cronbach’s α for the scale was 0.918, showing strong internal consistency. This suggests that the items within the scale reliably measure self-management behaviors among glaucoma patients.

Statistical Analysis

Data were analyzed using SPSS 26.0 (IBM Corp., Armonk, NY, USA) and Amos 26.0 (IBM Corp.), with the significance threshold set at 0.05. Initial examination involved descriptive statistics (percentages, means, and standard deviations) to evaluate participants’ demographics and their performance across variables like family functioning, psychological capital, coping styles, and self-management. Then, Pearson correlation analysis was performed to investigate the interactions among these variables. Thereafter, structural equation modeling using Amos was performed to analyze the mediating roles of psychological capital and coping styles, including the investigation of their chain mediation effect within the model. The Bootstrap method was used to evaluate the significance of the mediating effects, with 5000 resamples used for validation. A 95% confidence interval (CI) excluding zero was considered to indicate a statistically significant mediating effect. Common method bias was assessed using Harman’s single-factor test based on an unrotated principal component analysis. To evaluate the measurement model, confirmatory factor analysis (CFA) was conducted for the latent constructs, including family functioning, psychological capital, and self-management. Internal consistency was assessed using Cronbach’s α and composite reliability (CR). Convergent validity was evaluated based on the average variance extracted (AVE), and discriminant validity was examined using the Fornell–Larcker criterion. Positive coping was treated as an observed variable using the total score of the corresponding subscale, rather than as a latent construct, to maintain model parsimony. Therefore, item-level CFA indices (eg, factor loadings, CR, and AVE) were not estimated for this variable.

Results

Patient Demographics

The research comprised 336 glaucoma patients, including 154 males (45.83%) and 182 females (54.17%). Among them, 160 (47.62%) were aged below 60 years, 213 (63.39%) had attained a college-level education or lower, and 223 (66.37%) had a personal monthly income of less than 5000 yuan. In addition, 217 (64.58%) of the respondents lived with their families. Notably, 132 (39.29%) were classified as having moderate-stage glaucoma, with 138 (41.07%) having a disease duration of 1–5 years. Table 1 summarizes demographic and clinical characteristics in detail.

Table 1 Demographics of Glaucoma Patients (N=336)

To assess potential common method bias, Harman’s single-factor test was conducted. The results indicated that multiple factors with eigenvalues greater than 1 were extracted, and the first factor accounted for 34.42% of the total variance, below the commonly accepted threshold of 40% (Table 2). These findings suggested that common method bias was unlikely to be a serious concern in this study, although it could not be completely ruled out.

Table 2 Harman’s Single-Factor Test to Assess Potential Common Method Bias

Measurement Model Evaluation

The measurement model demonstrated satisfactory reliability and validity (Table 3). All standardized factor loadings ranged from 0.724 to 0.929, exceeding the recommended threshold of 0.70.

Table 3 Measurement Model Results

Cronbach’s α values for all constructs were above 0.80, indicating good internal consistency. CR values ranged from 0.831 to 0.937, exceeding the recommended threshold of 0.70. The AVE values ranged from 0.608 to 0.787, all above the recommended threshold of 0.50, indicating satisfactory convergent validity. The square roots of AVE for each construct were greater than the corresponding inter-construct correlations, suggesting adequate discriminant validity (Table 4). Positive coping was entered into the structural model as an observed composite variable. Therefore, CFA-based indices (eg, factor loadings, CR, and AVE) were not estimated for this construct.

Table 4 Discriminant Validity Assessed Using the Fornell–Larcker Criterion

Correlation Analysis

Descriptive statistics and Pearson correlation coefficients for all key investigated factors are shown in Table 5. Self-management showed significant positive correlations with family functioning (r = 0.506, P < 0.01), psychological capital (r = 0.681, P < 0.01), and positive coping styles (r = 0.656, P < 0.01) and a strong inverse relationship with negative coping styles (r = –0.169, P < 0.01). Family functioning was strongly positively linked to psychological capital (r = 0.359, P < 0.01) and positive coping styles (r = 0.563, P < 0.01) and significantly negatively associated with negative coping styles (r = –0.157, P < 0.01). Psychological capital showed a significant positive correlation with positive coping styles (r = 0.527, P < 0.01) but a reverse correlation with negative coping styles (r = –0.116, P < 0.05).

Table 5 Descriptive Statistics and Correlations of the Main Variables

Structural Equation Modeling

An initial structural equation model was specified according to the proposed theoretical framework. To control for the confounding effects of visual function on core variables, this study incorporated Hodapp-Parrish-Anderson (HPA) glaucoma classification as a control variable into the structural equation model, correcting for differences in visual function among patients with early, moderate, and severe glaucoma. Positive coping was included in the structural model as an observed variable. The confirmatory factor analysis results showed that the model fit appropriately, as evidenced by the following fit indices: GFI = 0.90, NFI = 0.92, IFI = 0.94, TLI = 0.92, CFI = 0.94, RMSEA = 0.09, and SRMR = 0.044. However, the path coefficients from family functioning to negative coping styles (P = 0.06) and from psychological capital to negative coping styles (P = 0.32) did not reach statistical significance and were subsequently excluded from the final model. The revised model, as shown in Figure 2, showed strengthened fit indices (GFI = 0.903, NFI = 0.93, IFI = 0.94, TLI = 0.93, CFI = 0.94, and RMSEA = 0.09), indicating an acceptable overall model fit. All retained factor loadings and path coefficients reached statistical significance, confirming the adequacy of the final model specification.

Figure 2 Final model with standardized path coefficients and statistical significance indicators.

As shown in Table 6, the final structural model (SRMR = 0.041) revealed notably positive associations between self-management and family functioning (standardized β = 0.167, P < 0.01), psychological capital (β = 0.502, P < 0.001), and positive coping styles (β = 0.335, P < 0.001). Furthermore, family functioning was positively associated with psychological capital (β = 0.393, P < 0.001) and positive coping styles (β = 0.450, P < 0.001). Furthermore, psychological capital was markedly and positively associated with positive coping styles (β = 0.372, P < 0.001).

Table 6 Path Coefficient Test for the Final SEM Model

The mediating effects were evaluated using the bias-corrected percentile bootstrap approach with 5000 resamples. Table 7 shows that the direct effect of family functioning on self-management was statistically significant [β = 0.167, 95% CI (0.042, 0.293), P < 0.01], constituting 29.56% of the total effect. Both psychological capital [indirect effect = 0.198, 95% CI (0.123, 0.293), P < 0.001] and positive coping styles [indirect effect = 0.151, 95% CI (0.080, 0.235), P < 0.001] emerged as significant mediators in the connection between family functioning and self-management, representing 35.04% and 26.73% of the total effect, respectively. Moreover, a significant sequential mediating effect through psychological capital and positive coping styles was detected [indirect effect = 0.049, 95% CI (0.025, 0.087), P < 0.001], explaining 8.67% of the total effect.

Table 7 Mediator Effect and Magnitude of Effect

Discussion

Anchored in the personal and family self-management theory, this study investigates the multifaceted mechanisms influencing self-management among glaucoma patients by developing a theoretical model that integrates contextual factors (family functioning), process variables (psychological capital and coping styles), and outcome measures (self-management). The results show that family functioning, psychological capital, and positive coping styles are significant positive predictors of self-management, whereas adverse coping styles are inversely associated with self-management. Furthermore, the association between family functioning and self-management is mediated by psychological capital and positive coping styles, which also operate as sequential mediators within this relational pathway. These findings highlight the critical role of strengthening family functioning, cultivating psychological capital, and enhancing positive coping styles in effectively promoting self-management in individuals with glaucoma.

First, consistent with prior empirical evidence, glaucoma patients reporting higher levels of family functioning showed significantly enhanced self-management behaviors, thus providing support for Hypothesis 1.⁸ The ecological systems theory offers a theoretical foundation for this finding; it posits that individual behavior is influenced by multiple nested environmental contexts, including the microsystem (eg, family), mesosystem, exosystem, and macrosystem.³⁶ As a fundamental element of the microsystem, the family may play a pivotal role in promoting self-management through two key pathways: by providing emotional support, which alleviates disease-related stress and strengthens coping capacity, and by assisting in the formulation of problem-solving styles, which enhance the efficacy of daily disease management practices. Therefore, by establishing a model of collaborative management between the individual and the family, families with high levels of functioning can transform individualized disease management into a collective practice within the family health community, ultimately achieving effective glaucoma control.

The study showed that psychological capital mediates the connection between family functioning and self-management, validating the accuracy of Hypothesis 2. This relationship can be interpreted through the framework of social cognitive theory, which posits that an individual’s external environment (eg, family functioning), internal psychological resources (eg, psychological capital), and behaviors (eg, self-management) mutually influence one another.³⁷ High-functioning families are characterized by strong emotional connections and open communication among members, which create a supportive environment conducive to psychological well-being and consequently facilitate the development of psychological capital in family members. People with higher psychological capital often show increased optimism and hope for the future, along with a strong sense of self-efficacy. They show greater confidence in their ability to regulate intraocular pressure and adhere to treatment regimens; furthermore, they exhibit greater motivation and determination in managing their condition. These findings further reinforce prior evidence indicating that well-functioning families contribute to the enhancement of individuals’ psychological capital, which in turn facilitates more effective self-management.¹⁹

This study also identified that coping styles mediate the connection between family functioning and self-management, thus supporting Hypothesis 3. Notably, family functioning was found to be strongly linked to the adoption of positive coping approaches; however, its relationship with negative coping styles did not reach statistical significance. Members of well-functioning families are more inclined to provide emotional and instrumental support, which facilitates glaucoma patients’ comprehension of their health condition and enhances their awareness of effective health management styles. This supportive environment fosters a positive outlook, encouraging patients to adopt constructive coping styles when facing challenges associated with their condition.⁸ This positive coping style facilitates the enhancement of self-management capabilities by strengthening patients’ emotional regulation and behavioral control, ultimately contributing to improved well-being and long-lasting medical benefits in glaucoma patients.³⁸ Accordingly, the use of positive coping styles further reinforces the positive impact of family functioning on self-management in individuals with glaucoma. The negative coping style refers to maladaptive strategies, such as skipping appointment, ignoring symptoms, or substance use, used by patients and family members to manage stress and pressure from illness. Our current analysis did not show a statistically significant correlation between family functioning and negative coping styles. However, the small P value (0.06) could still suggest that further investigations are required, such as in a large sample of patients or stratified analysis in each item of these 8 negative coping styles.

We further identified psychological capital and positive coping styles as sequential mediators in the pathway linking family functioning to self-management, thus offering empirical support for Hypothesis 4. A plausible explanatory mechanism is that in families exhibiting high levels of functional cohesion, harmonious interpersonal dynamics and effective collaborative problem-solving significantly contribute to the development and reinforcement of the patient’s psychological capital.³⁹ Subsequently, the enhanced psychological capital endows patients with greater psychological resilience to confront illness-related challenges. Psychological capital not only strengthens patients’ capacity to navigate adversity but also encourages a cognitive reappraisal of difficulties as opportunities for personal development, thus facilitating the adoption of positive coping styles. Components of psychological capital, including hope, self-efficacy, resilience, and optimism, can facilitate positive coping by providing patients with the motivation, confidence, and emotional resource to manage health challenges. Hope enables goal-directed planning and creative problems-solving ability. Self-efficacy fosters confidence in performing health behaviors. Resilience helps patients recover from illness. Optimism encourages proactive actions in patients. Positive coping behaviors further contribute to the strengthening of patients’ self-management capacities through positive feedback mechanisms, ultimately fostering a virtuous cycle of “family support → psychological resources → behavioral adaptation → health benefits.”

The findings of this study offer strong theoretical backing for enhancing self-management skills in glaucoma patients. First, the research emphasizes the role of family functioning in patients’ self-management behaviors, revealing that family support delivers both emotional encouragement and hands-on help, which boosts the patient’s disease management in daily routines. This finding further confirms the important role of the family as an external resource in health behavior decision-making, helping to improve the application framework of social support theory in chronic disease management. Second, this study highlights the contribution of psychological capital to self-management. Psychological capital enhances patients’ self-efficacy and intrinsic motivation, while also helping them develop more positive disease cognition and attitudes. This enables patients to be more resilient and adaptive when faced with disease recurrence or treatment challenges. This finding provides a theoretical basis for further exploration of how internal psychological resources affect health behaviors and underscores the unique value of the “positive psychology” perspective in chronic disease management research. In addition, the study points out the significance of positive coping approaches in facilitating psychological stability and behavioral discipline, suggesting that emotional and behavioral management abilities are key to achieving efficient self-management. This provides new empirical support for the construction of the “cognitive–emotional–behavioral” chain in the health behavior theory, enriching the understanding of individual self-regulation mechanisms in the management of persistent medical conditions. In conclusion, this research not only deepens the theoretical understanding of how the family, psychological factors, and behavioral factors interact to influence patients’ self-management behaviors but also provides an important foundation for future exploration of multi-factorial mechanisms and the development of integrated intervention models.

Notwithstanding its contributions, there are a few noteworthy limitations of this study that warrant attention. First, glaucoma patients were selected solely from a single hospital in the Jilin Province, which introduces a strong regional limitation. This may prevent the findings from fully reflecting the overall characteristics and behavioral patterns of glaucoma patients throughout the nation. Therefore, future studies should consider incorporating a more comprehensive, multi-center sampling approach that includes various regions and medical institutions to confirm that the findings are applicable across a wider demographic. Second, the research implemented a cross-sectional methodology, capturing data at a single moment. Such a design hinders in-depth analysis of cause-and-effect relationships and variable progression over time. For a clearer view of the cause-and-effect pathways among variables, future investigations should implement longitudinal designs to monitor variable progression and relationships. Third, our structural equation model showed an appropriate acceptable fit. However, the RMSEA = 0.09 suggested a marginally or mediocrely fit, requiring further refinement by including additional paths, removing misfitting items in future large-scale studies. Finally, in the analysis using structural equation modeling, the limitations of sample size and study design made it difficult to conduct detailed subgroup analyses based on different age groups or other demographic characteristics. Therefore, future studies should aim for larger sample sizes and design more targeted research plans that allow for independent modeling and comparative analysis of different subgroups. This would provide a theoretical foundation and practical guidance for developing more precise intervention strategies tailored to different patient groups with varying characteristics. Finally, current study used HPA staging as an indicator of visual status to effectively reflect glaucoma-related visual field damage. However, we did not measure best-corrected visual acuity. Central visual acuity might independently influence certain self-management behaviors (eg, reading small text on medication labels). Future research is recommended to include both visual field staging and visual acuity as covariates.

Clinical Practice Relevance

From a clinical practice perspective, this study provides scientific and practical guidance for developing and implementing approaches to foster self-management in patients with glaucoma, with significant real-world applicability. First, the research underscores the essential role of assistance from the family in disease management. Family members not only provide important emotional support to patients but also play the roles of health behavior supervisors and behavior guides during treatment. Based on these findings, clinical healthcare providers should actively involve families in the treatment process, encouraging their participation in supporting patients’ treatment and daily life management. By establishing a collaborative mechanism involving healthcare providers, clinical pharmacists, nurses, patients, and families, patients’ treatment adherence and long-term self-management outcomes can be improved. Clinical pharmacists and nurses can play a critical role in ensuring treatment adherence in glaucoma patients. They can provide clear treatment explanations and education to patients in plain language and write down important instructions to patients. Pharmacists can monitor the side effects from the medications and address any structural barriers to medication and treatment access. Nurses can also connect patients and families with the social workers if social support is required. In addition, close follow-ups can be made with phone calls or instant messages to ensure treatment adherence. Second, we identified psychological capital as an intrinsic driving force for effective self-management, providing clear direction for clinical psychological interventions. In clinical practice, psychological capital can be fostered by administering mental health education courses, forming patient support groups, and using other methods to systematically enhance patients’ self-efficacy, hope, optimism, and resilience. This fosters patients’ capacity for psychological adjustment and flexibility when dealing with disease uncertainty and treatment challenges, allowing them to maintain long-term positive health behaviors. In addition, our findings also uphold the importance of emotional and behavioral management strategies in clinical interventions. Healthcare institutions should provide personalized health guidance services for patients, utilizing psychotherapeutic approaches along with cognitive–behavioral therapy to support patients with precisely identifying and modifying negative emotions and harmful behaviors. This will help them develop positive emotional expression and healthy coping styles.

Conclusion

This research explored the association between family functioning and self-management, with particular attention to the intermediary roles of psychological capital and coping styles. The outcomes indicate that family functioning exerts not only a significant direct influence on self-management in individuals with glaucoma but also an indirect influence via the successive mediation of psychological capital and positive coping styles. These results underscore the essential role of promoting self-management behaviors in this group through the enhancement of family functioning, growth of psychological capital, and promotion of adaptive coping styles.