Factors Influencing Self-Management Behavior Among Patients with End-Stage Renal Disease Receiving Hemodialysis: A Cross-sectional Study

Hemodialysis is a critical life-sustaining treatment for individuals with end-stage renal disease. Despite advances in hemodialysis care, many of these individuals continue to demonstrate suboptimal self-management behaviors. Understanding the factors influencing self-management behaviors is essential for developing nursing interventions that effectively address people's needs. This study developed and examined a structural model of self-management behaviors among people with end-stage renal disease undergoing hemodialysis in Thailand. A cross-sectional design was employed. A total of 550 participants were recruited from 11 hemodialysis units using cluster and purposive sampling techniques. Data were collected between March and August 2024 utilizing the Demographic Questionnaire, Family State and Functioning Assessment Scale, Hemodialysis Knowledge Questionnaire, Patient Health Questionnaire, Social Support Questionnaire, Hemodialysis Self-Management Self-Efficacy Questionnaire, 14-item Health Literacy Scale, and the Hemodialysis Self-Management Instrument. Descriptive statistics and structural equation modeling were used for data analysis. The structural model demonstrated a good fit with the empirical data. It revealed that health literacy, hemodialysis-related knowledge, social support, and depression exerted direct positive effects on self-management behaviors. Family functioning positively influenced self-management through indirect effects on depression and social support. Conversely, depression demonstrated a negative indirect effect on self-management behaviors mediated through social support. Collectively, the model accounted for 58.7% of the variance in self-management behaviors. These findings underscore the need for clinical nurses to promote health literacy, treatment-specific knowledge, and robust family support to mitigate depressive symptoms and optimize adherence to self-management. Healthcare policies should prioritize integrating health literacy enhancement, patient education, and family-centered care models into routine hemodialysis services. Furthermore, implementing targeted psychosocial interventions to manage depression and strengthening healthcare team networks may significantly improve long-term patient self-management outcomes.