Purpose: Although the factors influencing chronic disease self-management have been extensively investigated, the ways in which personality traits, family health, and health literacy influence self-management require further exploration. This study aimed to explore the relationships and pathways among personality traits, family health, health literacy, and chronic disease self-management, with the goal of providing insights for chronic disease management. Patients and Methods: This study was based on a national cross-sectional survey conducted in 2021, which included 1063 young and middle-aged individuals (aged 19– 59) with chronic diseases. Structural equation modeling was used to analyze the path relationships between personality traits, family health, health literacy, and chronic disease self-management levels. Results: Agreeableness directly and negatively predicted self-management outcomes (estimate: − 0.557, 95% CI: − 0.964 to − 0.149). When examining health as the mediating variable between personality traits and self-management, it was observed that although different personality traits exert either positive or negative influences on family health, family health invariably had negative impact on self-management to varying extents (β_extraversion: − 0.111, P< 0.01; β_{agreeableness}: − 0.083, P< 0.05; β_{conscientiousness}: − 0.113, P< 0.01; β_neuroticism: − 0.111, P< 0.01; β_openness: − 0.107, P< 0.01). However, when considering the chain mediation effect, family health could positively influence health literacy, which subsequently had a beneficial impact on self-management. Additionally, health literacy served as an independent mediator in the relationship between extraversion and openness and self-management, with indirect effects of 0.163 and 0.274, respectively. Conclusion: Different personality traits exerted varying effects on self-management, which could be either direct or indirect, through the mediating roles of family health and health literacy. Family health seemed to be a double-edged sword for self-management. Future chronic disease self-management should consider the importance of family health, health literacy, and the complex pathways through which personality traits influence management behaviors, to maximize self-management outcomes.

(1) The formation pathways and underlying mechanisms of health behaviors among young and middle-aged adults with chronic diseases under a temporal perspective remain underexplored. Based on Temporal Self-Regulation Theory and its subsequent extensions, this study aimed to investigate the time perspective among Chinese young and middle-aged adults with chronic diseases and analyzed the relationships between time perspective, illness perception, health behavior motivation, and health behaviors, thereby providing valuable empirical evidence for health behavior modification in this population. (2) This study was a cross-sectional survey conducted from March to April 2025. Structural Equation Modeling was employed to investigate the relationships among the variables. (3) This study enrolled a total of 391 participants with high levels of future and past-positive perspectives. Time perspective, directly related to health behaviors, namely past-negative, present-impulsive, and present-fatalistic perspectives, exerted negative associations with health behaviors, respectively, whereas future and past-positive perspectives showed positive associations with health behavior. Analysis of the mediating effect found that illness perception served as a mediator between the time perspective of past-negative, present-impulsive, and present-fatalistic perspectives, and health behaviors. And health behavior motivation acted as a mediator in the relationship between past-negative, present-impulsive, and past-positive perspectives, and health behaviors. Furthermore, illness perception and health behavior motivation formed a chain mediation pathway between time perspective and health behaviors. (4) Time perspective was associated with health behaviors, not only exerting directed effects but also manifesting a double-edged sword effect through illness perception and health behavior motivation. Subsequent interventions targeting health behaviors among young and middle-aged populations in China should incorporate considerations of the temporal perspective’s uniqueness and its intricate mechanisms of action on health behaviors.