A Causal Model of Self-Management Behavior in Persons Receiving Hemodialysis

Abstract Background End-stage renal disease and hemodialysis treatment were complex and impacted on the ineffective self-management behavior of hemodialysis patients. The aim of this study was to test the structural model for hemodialysis self-management behavior in Thailand. Methods This study utilized a cross-sectional design with cluster sampling based on purposive selection, involving 11 hemodialysis units and 550 patients from public hospitals in Northeast Thailand. Data collection from March to August 2024 utilized seven instruments: 1) the 14-item Health Literacy Scale (HLS-14), 2) the Patient Health Questionnaire (PHQ-9), 3) the Family State and Functioning Assessment Scale (FSFAS), 4) the Hemodialysis Knowledge Questionnaire (HDKQ), 5) the Hemodialysis Self-Management Self-Efficacy Questionnaire (HSMSEQ), 6) the Social Support Questionnaire (SSQ), and 7) the Hemodialysis Self-Management Instrument (HDSMI-18), which were analyzed using structural equation modeling. Results Indicate that the modified model successfully fits the empirical data. Health literacy, hemodialysis knowledge, social support, and depression exerted a positive direct effect on hemodialysis self-management behavior. Additionally, family function positively influenced hemodialysis self-management behavior indirectly through depression and social support, while depression negatively affected hemodialysis self-management behavior indirectly via social support. Conclusion Increasing personal skills such as health literacy and hemodialysis knowledge, including motivating family function and providing social support, especially from the healthcare team, has a positive effect on managing depression and improving hemodialysis self-management behavior. The findings show that health systems around the world can help hemodialysis patients better manage their hemodialysis self-management by creating policies in dialysis units that support health literacy and hemodialysis knowledge, improve teaching methods, regularly assess depression levels, and encourage family or friends to stay involved in long-term care.