Behavioral Pathways Associated with Nutritional Self-Management Among Patients Undergoing Maintenance Hemodialysis: A Cross-Sectional IMB Model-Guided Path Analysis

Purpose

To examine factors associated with nutritional self-management behavior and their hypothesized relationships within the Information–Motivation–Behavioral Skills (IMB) framework among patients undergoing maintenance hemodialysis (MHD). Patients and Methods: This single-center cross-sectional study included a convenience sample of 215 patients undergoing MHD at a tertiary hospital in Shenzhen, China, between January and May 2026. Questionnaires assessed hemodialysis knowledge, health beliefs, social support, self-management, and nutritional self-management behavior. Pearson correlations and multiple linear regression were analyzed. Because the initially planned latent-variable structural equation model showed inadequate measurement-model fit, an observed-variable path analysis using composite scores was conducted. Indirect associations were estimated using 5000 bias-corrected bootstrap resamples.