Self-Management Intentions and Behaviors Among CKD Patients at Predialysis and Dialysis Stages: A Cross-Sectional...

To explore factors and pathways of self-management intentions and behaviors in patients with chronic kidney disease at predialysis and dialysis stages using protection motivation theory.

A cross-sectional study.

This cross-sectional study was conducted in Changning District, Shanghai, China. A total of 550 patients with CKD (216 dialysis and 334 predialysis) were recruited from local healthcare institutions via self-administered questionnaires. Self-management behaviors were assessed using stage-appropriate instruments validated for predialysis and dialysis populations, respectively. Protection motivation theory constructs were measured and analyzed using confirmatory factor analysis and structural equation modeling to explore pathways across groups.

The structural equation model demonstrated acceptable fit (χ ²/df = 3.052, CFI = 0.903, RMSEA = 0.054). Compared with predialysis patients, dialysis patients reported lower perceived severity but higher response efficacy and self-management intention. Self-efficacy and response efficacy were positively associated with intention. Furthermore, perceived vulnerability, self-efficacy, and intention were positively related to self-management behavior.

Response efficacy emerged as a key factor associated with self-management intention. These findings suggest that nursing interventions should prioritize demonstrating the effectiveness of self-management behaviors. However, as this was a cross-sectional study conducted in a single district, causal inferences should be drawn with caution.

Healthcare providers should transition to stage-tailored cognitive interventions. For predialysis patients, education must tangibilize the benefits of early behavioral activation. For dialysis patients, nurses should implement concrete "efficacy-focused feedback loops"-such as explicitly linking a patient's routine objective data (e.g., stabilized lab results or reduced interdialytic weight gain) directly to their adherence efforts-to reinforce response efficacy. Furthermore, policymakers should champion standardized, efficacy-driven CKD management frameworks adaptable across hospital and community settings.

Patients and healthcare staff contributed to the study design and recruitment process. The Shanghai Municipal Health Commission of Changning District assisted with participant recruitment, while staff from the Nephrology Departments of Tongren Hospital and Zhongshan Hospital provided essential support. Their involvement shaped the study's data collection and ensured that the findings were relevant to clinical practice.