Behavioral Pathways Associated with Nutritional Self-Management Among Patients Undergoing Maintenance Hemodialysis: A...

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).

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.

The mean nutritional self-management behavior score was 86.47 ± 9.86 (scoring rate, 72.06%). In the regression model, health beliefs (β = 0.190, P = 0.003) and self-management (β = 0.365, P < 0.001) were positively associated with nutritional self-management behavior. In the path model, health beliefs had the largest coefficient for self-management (β = 0.437, P = 0.001), and self-management had the largest coefficient for nutritional self-management behavior (β = 0.380, P < 0.001). Hemodialysis knowledge, health beliefs, and social support showed significant indirect associations through self-management; the largest was for health beliefs (β = 0.166). Explained variance was 25.7% for self-management and 33.2% for nutritional self-management behavior.

These cross-sectional associations provide preliminary evidence consistent with the hypothesized IMB framework. Longitudinal and intervention studies are needed to establish temporal relationships and evaluate potential intervention strategies.