Factors Influencing Self-Management Behavior Among Patients with End-Stage Renal Disease Receiving Hemodialysis: A Cross-sectional Study

Pailin Pinthong; Orn-Anong Wichaikhum; Chomphoonut Srirat; Chiraporn  Tachaudomdach; Allison  P Squires

doi:10.60099/prijnr.2026.282059

Authors

Pailin Pinthong PhD (Candidate), Faculty of Nursing, Chiang Mai University, Chiang Mai, Thailand. https://orcid.org/0009-0004-8282-1685
Orn-Anong Wichaikhum Faculty of Nursing, Chiang Mai University, Chiang Mai, Thailand. https://orcid.org/0000-0002-9492-4233
Chomphoonut Srirat Faculty of Nursing, Chiang Mai University, Chiang Mai, Thailand. https://orcid.org/0000-0002-7893-1572
Chiraporn Tachaudomdach Faculty of Nursing, Chiang Mai University, Chiang Mai, Thailand. https://orcid.org/0000-0002-1294-280X
Allison P Squires NYU Rory Meyers College of Nursing, New York University, New York, NY, USA.

DOI:

https://doi.org/10.60099/prijnr.2026.282059

Keywords:

Behaviors, End-stage renal disease, hemodialysis, Nursing, self-management, Structural model, Thailand

Abstract

Hemodialysis is a critical life-sustaining treatment for individuals with end-stage renal disease. Despite advances in hemodialysis care, many of these individuals continue to demonstrate suboptimal self-management behaviors. Understanding the factors influencing self-management behaviors is essential for developing nursing interventions that effectively address people's needs. This study developed and examined a structural model of self-management behaviors among people with end-stage renal disease undergoing hemodialysis in Thailand. A cross-sectional design was employed. A total of 550 participants were recruited from 11 hemodialysis units using cluster and purposive sampling techniques. Data were collected between March and August 2024 utilizing the Demographic Questionnaire, Family State and Functioning Assessment Scale, Hemodialysis Knowledge Questionnaire, Patient Health Questionnaire, Social Support Questionnaire, Hemodialysis Self-Management Self-Efficacy Questionnaire, 14-item Health Literacy Scale, and the Hemodialysis Self-Management Instrument. Descriptive statistics and structural equation modeling were used for data analysis.

The structural model demonstrated a good fit with the empirical data. It revealed that health literacy, hemodialysis-related knowledge, social support, and depression exerted direct positive effects on self-management behaviors. Family functioning positively influenced self-management through indirect effects on depression and social support. Conversely, depression demonstrated a negative indirect effect on self-management behaviors mediated through social support. Collectively, the model accounted for 58.7% of the variance in self-management behaviors. These findings underscore the need for clinical nurses to promote health literacy, treatment-specific knowledge, and robust family support to mitigate depressive symptoms and optimize adherence to self-management. Healthcare policies should prioritize integrating health literacy enhancement, patient education, and family-centered care models into routine hemodialysis services. Furthermore, implementing targeted psychosocial interventions to manage depression and strengthening healthcare team networks may significantly improve long-term patient self-management outcomes.

References

Francis A, Harhay MN, Ong ACM,ummalapalli SL, Ortiz A, Fogo AB, et al. Chronic kidney disease and the global public health agenda: an international consensus. Nat Rev Nephrol. 2024;20(7):473-85. doi: 10.1038/s41581-024-00820-6.

Bello AK, Okpechi IG, Osman MA, Cho Y, Htay H, Jha V, et al. Epidemiology of haemodialysis outcomes. Nat Rev Nephrol. 2022;18(6):378-95. doi: 10.1038/s41581-022-00542-7.

Satirapoj B. editor. Thailand Renal Replacement Therapy (TRT) Registry 2024 Annual Data Report. The Subcommittee of the Thailand Renal Replacement Therapy (TRT) Registry 2025: The Nephrology Society of Thailand [Internet]. 2026Mar. [cited 2026Jun.10]. Available from https://www.nephrothai.org/annual-report-thailand-renal-replacement-therapy-2007-2019-th/.

Li PK, Ng JK, Cai GY, Chen W, Chow KM, Fan S, et al. Navigating the global economic landscape of dialysis: a summary of expert opinions from the 4th International Congress of Chinese Nephrologists. Kidney Dis (Basel). 2024;10(5):384-97. doi: 10.1159/000540152.

Friedrich NK, Schmitt N, Hruby H, Kugler C. Self-management interventions for adult haemodialysis patients: a scoping review of randomized controlled trials. BMC Nephrol. 2025;26(1):285. doi: 10.1186/s12882-025-04229-6.

Duzalan ÖB, Cosar AA, Sarikaya S. Hemodialysis patients’ experiences of diet and fluid restriction: a qualitative study. Prog Nutr. 2021;23(2):e2021254. doi:10.23751/pn.v23iS2.11985.

Ma LC, Liu YM, Lin YC, Liao CT, Hung KC, Chen R, et al. Factors influencing self-management behaviors among hemodialysis patients. J Pers Med. 2022;12(11):1816. doi: 10.3390/jpm12111816.

Li H, Jiang Y.-f, Lin C-C. Factors associated with self-management by people undergoing hemodialysis: A descriptive study. Intern J Nurs Studies. 2014;51: 208–216. doi.org/10.1016/j.ijnurstu.2013.05.012.

Hafezieh A, Dehghan M, Taebi M, Iranmanesh S. Self-management, self-efficacy and knowledge among patients under haemodialysis: a case in Iran. J Res Nurs. 2020;25(2):128-38. doi: 10.1177/1744987120904770.

Chueakjoho S, Udchumpisai M. Relationships between knowledge, resilience quotient, and family support with self-management behaviors among older adults with chronic kidney disease undergoing hemodialysis. J Res Nurs Midwifery Health Sci. 2023;43(1):133-45 (in Thai).

Park Y, Jung S. Predictors of self-management behaviors among patients undergoing hemodialysis. Sci Rep. 2025;15(1):13823. doi: 10.1038/s41598-025-97414-4.

Mahanupab P, Chintanawat R, Juntasopeepun P. Health literacy and self-management in older persons receiving hemodialysis. J Thai Nurs Midwifery Counc. 2022;37(1):109-24 (in Thai).

Ali ME, Ibrahim MH, Helmy NM. Assessment of self-management among chronic renal failure patients at Ismailia General Hospital. Trends Nurs Health Care J. 2022;5(2):129–47

Alkubati SA, Al-Sayaghi KM, Salameh B, Halboup AM, Ahmed WAM, J Alkuwaisi M, et al. Prevalence of depression and its associated factors among hemodialysis patients in Hodeida City, Yemen. J Multidiscip Healthc. 2024;17:689-99. doi: 10.2147/JMDH.S452935.

Photharos N, Wacharasin C, Duongpaeng S. Model of self-management behavior in people experiencing early-stage chronic kidney disease. Pac Rim Int J Nurs Res. 2018;22(4):360-71.

Liang Z, Shi Y, Zhang Y, Zhang H, Zhuo Y, Lv N, et al. Influencing factors of self-management behavior among Chinese patients with chronic disease: a cross-sectional study. Public Health Nurs. 2025;42(2):800-10. doi: 10.1111/phn.13482.

Ryan P, Sawin KJ. The Individual and Family Self-Management Theory: background and perspectives on context, process, and outcomes. Nurs Outlook. 2009;57(4):217-225.e6. doi: 10.1016/j.outlook.2008.10.004.

Curtin RB, Sitter DC, Schatell D, Chewning BA. Self-management, knowledge, and functioning and well-being of patients on hemodialysis. Nephrol Nurs J. 2004;31(4):378-86.

Chen W-C, Lin C-C, Wu C-C, Song Y-C. Psychometric testing of the hemodialysis self-management instrument (HDSMI-18): A confirmatory factor analysis. Nursing Open. 2021;8:2832–2839.

Natashia D, Yen M, Chen H-M, Fetzer SJ. Self-management behaviors in relation to psychological factors and interdialytic weight gain among patients undergoing hemodialysis in Indonesia. J Nurs Scholars. 2019;51(4): 417–426. doi.org/10.1111/jnu.12464.

Wikipedia. Comorbidity [internet]. 2022July. [cited 2026July.19]. Available from https://en.wikipedia.org/wiki/Comorbidity.

Mousa I, Ataba R, Al-ali K, Alkaiyat A, Zyoud S H. Dialysis-related factors affecting self-efficacy and quality of life in patients on haemodialysis: A cross-sectional study from Palestine. Renal Replacement Therapy. 2018;4. doi.org/10.1186/s41100-018-0162-y.

Chen C, Zheng J, Dries snack M, Liu X, Liu J, Liu K, et al. Health literacy as predictors of fluid management in people receiving hemodialysis in China: A structural equation modeling analysis. Patient Ed and Counsel. 2021;104:1159-1167. doi.org/10.1016/j.pec.2020.10.015.

Bandura A. Self-efficacy: Toward a unifying theory of behavioral change. Psych Review. 1977;84(2):191-215.

Gela D, Mengistu D. Self-management and associated factors among patients with end-stage renal disease undergoing hemodialysis at health facilities in addis ababa, Ethiopia. Intern J of Nephrol and Renovascular Dis. 2018;11:329–336.

Memon MA, Ting H, Cheah JH, Thurasamy R, Chuah F, Cham TH. Sample size for survey research: review and recommendations. J Appl Struct Equ Model. 2020;4(2):i-xx. doi: 10.47263/JASEM.4(2)01.

Hair JF, Black WC, Babin BJ, Anderson RE. Multivariate data analysis. 8th ed. Hampshire (UK): Cengage Learning; 2019.

Subcommittee on Standards for Hemodialysis, Continuous Renal Replacement Therapy, and Apheresis, The Nephrology Society of Thailand. Guidelines for Extracorporeal Hemodialysis for Medical Personnel [Internet]. 2025Oct. [cited 2026Jul.19]. Available from https://www.nephrothai.org/wp content/uploads/2025edited_27-10-25.pdf.

Aree-Ue S, Youngcharoen P. The 6-item cognitive function test-Thai version: psychometric property testing. Rama Nurs J. 2020;26(2):188-202 (in Thai).

Suka M, Odajima T, Kasai M, Garashi A, Ishikawa H, Kusama M, et al. The 14-item health literacy scale for Japanese adults (HLS-14). Environ Health and Preventive Med. 2014;18:407-415.

Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001;16(9):606-13. doi: 10.1046/j.15251497.2001.016009606.x.

Lotrakul M, Sumrithe S, Saipanish R. Reliability and validity of the Thai version of the PHQ-9. BMC Psych. 2008;8:46. doi: 10.1186/1471-244X-8-46.

Supphapitiphon S, Buathong N, Suppapitiporn S. Reliability and validity of the family state and functioning assessment scale. Chulalongkorn Med J. 2019;63(2):103-9. doi: 10.14456/clmj.1476.15.

Beaton DE, Bombardier C, Guillemin F, Ferraz MB. Guidelines for the process of cross-cultural adaptation of self-report measures. Spine (Phila Pa 1976). 2000;25(24):3186-91. doi: 10.1097/00007632-200012150-00014.

Methakanjanasak N. Self-management of end-stage renal disease patients receiving hemodialysis [Dissertation]. [Chiang Mai, Thailand]: Chiang Mai University; 2005.

Toljamo M, Hentinen M. Adherence to self-care and social support. Journal of Clinical Nursing. 2001;10(5):618-629.

Kline RB. Principles and practice of structural equation modeling. 5th ed. New York: Guilford Press; 2023.

Yasin F, Khraim F, Santos M, Forgrave D, Hamad A. Factors influencing self-care management in adult hemodialysis patients: An integrative review. Qatar Med J. 2024(1);12.

Karami H, Abbasi P. Perceived Social Support and Its Associated Factors in Patients Undergoing Hemodialysis: A Cross-Sectional Study. Patient Experience Jl. 2025;12(3):51-60. doi: 10.35680/ 2372-0247.2057.

Oh M, Park, G-A . The Moderating Effect of Self-Efficacy on Physical Function, Aging Anxiety, and Active Aging in Community-Dwelling Older Adults. Healthcare 2025;13(108):1-12. doi.org/10.3390/healthcare13020108.