Self-Management and Its Predictors in Maintenance Hemodialysis Patients: Based on Triadic Reciprocal Determinism

This study aimed to identify the predictors of self-management in patients undergoing maintenance hemodialysis, with the goal of informing future interventions to improve self-management capabilities.

A cross-sectional survey was conducted involving 341 patients undergoing maintenance hemodialysis.

Based on the framework of triadic reciprocal determinism, self-management was evaluated using the Self-Management Scale, while fluid intake motivation was assessed via the Compliance Scale for Fluid Intake Motivation. Autonomous perception was measured using the Chinese version of the PEA Scale. Intergroup comparisons were performed using independent-samples t-tests and one-way analysis of variance (ANOVA). Pearson correlation analysis was applied to examine the correlations among self-management, fear of disease progression, fluid intake motivation, and autonomous perception. Variable selection was performed using the Random Forest model and Lasso analysis, after which the identified variables were incorporated into a multiple linear stepwise regression for multivariate analysis.

The mean total self-management score among patients with maintenance hemodialysis was 52.39 ± 6.97 (SD), indicating a moderate level of self-management. Multiple linear stepwise regression analysis identified residence, educational level, motivation for fluid intake, and autonomous perception as the main predictors of self-management (P < 0.05). Together, these factors explained 28.5% of the total variance in self-management.

Self-management among patients undergoing maintenance hemodialysis is at a moderate level. Guided by this predictive model, healthcare providers can develop targeted nursing strategies to assist patients with self-management practices and ultimately enhance their self-management outcomes.