Background <p>This study aims to investigate the impact of patient self-management assessed through the self-management in tuberculosis patients (SMSTP) scale on the outcomes of intensive-phase antituberculosis treatment in newly diagnosed tuberculosis patients. Additionally, we explored the correlation between self-management and the risk of a sputum smear not converting to negative after 2 months of treatment and constructed a regression prediction model for predictive analysis.</p> Methods <p>A prospective cohort study was conducted that strictly adhered to the inclusion and exclusion criteria. Baseline data were collected from 61 eligible participants, 59 of whom completed follow-up during the intensive phase and were ultimately included in the analysis. Logistic regression was employed to analyze the association between self-management status and sputum smear nonconversion after intensive-phase treatment. A predictive model was constructed to evaluate the prognostic value of self-management for smear nonconversion.</p> Results <p>The sputum smear conversion rate after intensive-phase antituberculosis treatment was 76.3%. The total self-management ability score was 66.03 ± 8.55 points, and it was identified as a predictive factor for smear nonconversion (OR = 0.917, 95% CI: 0.847–0.992).</p> Conclusions <p>The total self-management ability score is associated with sputum smear conversion following intensive-phase antituberculosis treatment. Targeted interventions to improve self-management may enhance treatment outcomes in patients.</p> Trial registration <p>Chinese Clinical Trial Registry, ChiCTR2500096661. Registered 27 January 2025; Retrospectively registered.</p>