Background: Cirrhotic ascites significantly affects patients' daily living activities. Family involvement in patient care is a newly emerging mitigation strategy. Aim of the study: To evaluate the effect of a family-involved educational approach on diuretic medication adherence, ascites severity, and activities of daily living (ADL) among liver cirrhosis patients. Study design: Pre-posttest quasi-experimental design. Tools: Five tools were used: I) Structured Interviewing Questionnaire covering socio-demographic and medical history, II) Knowledge Assessment Tool (0-50 points, satisfactory ≥80%), III) Morisky Medication Adherence Scale (MMAS-8) for adherence levels, IV) Ascites Degree Tool for grading ascites severity and V) ADL scale to evaluate functional abilities. Sample: Purposive sample of 60 liver cirrhosis patients and 114 family members from Minia University Hospital, Egypt. Results: Patients were predominantly male (65%), with a mean age of 52.5 years. The majority of family members were wife/husband (44.7%) or son/daughter (39.4%). The percentage of participants with high medication adherence increased from 12% at baseline to 73% at 8 weeks (χ² = 62.5, p < 0.001). Severe ascites decreased from 40% to 15% (χ² = 27.3, p < 0.001), and satisfactory ADL improved from 18% to 68% (f = 5.8, p = 0.022). Patients with more involved family members and a shorter disease duration exhibited significantly better health outcomes. Conclusion: The family-involved educational approach significantly improved medication adherence, reduced ascites severity, and enhanced ADL. Recommendation: Incorporating family-based educational interventions into standard care can improve outcomes in liver cirrhosis patients. Replication of the study in diverse populations and different research designs.