Stigma, self-efficacy, and patient activation in young and middle-aged patients undergoing maintenance hemodialysis

The incidence of chronic kidney disease among young individuals in China is rising, with activation patterns differing from those of older adults. Evidence on activation in young and middle-aged patients receiving maintenance haemodialysis (MHD) is limited.

This study assessed activation levels and their relationship with disease stigma and self-efficacy.

A cross-sectional study was conducted between January and May 2025 at five public nonprofit hospitals in Shanghai. Patient activation (PA), self-efficacy, and stigma were measured using the Patient Activation Measure Scale, Perceived Medical Condition Self-Management Scale, and Social Impact Scale. Data were analysed with descriptive statistics, t-tests, ANOVA, and multivariate regression.

A total of 393 patients were enrolled. Most (43.0%) were at activation level 4, while 11.5% were at level 1. Mean scores were 61.80 ± 17.10 (PA), 26.43 ± 4.26 (self-efficacy), and 64.70 ± 11.20 (stigma). Higher PA was positively associated with self-efficacy (β = 0.473, p < 0.001) and negatively with stigma (β = -0.402, p < 0.001). After adjusting for age, education, and haemodialysis knowledge, self-efficacy and stigma remained strong predictors, jointly explaining 53.2% of the variance in patient activation. Mediation analysis further revealed that self-efficacy partially mediated the relationship between stigma and PA, with the indirect effect accounting for 40.3% of the total effect (β = -0.211, 95% CI: -0.267 to -0.158).

Self-efficacy and stigma are key predictors of activation in young and middle-aged patients with MHD, underscoring their importance for improving chronic disease care. Furthermore, self-efficacy mediates 40.3% of the total effect of stigma on patient activation.