Self-Efficacy as a Mediator Between Knowledge, Self-Management, and Quality of Life in Children Undergoing Hemodialysis

Background: Children undergoing hemodialysis face significant challenges to their quality of life (QoL). Understanding the mechanisms linking their knowledge, self-management, and quality of life is crucial for developing effective interventions. Aim: This study aimed to examine the mediating role of self-efficacy in the relationship between knowledge, self-management, and quality of life in children undergoing hemodialysis. Subjects and Method: A descriptive, cross-sectional study was conducted across three pediatric hemodialysis units in Egypt. A purposive sample of 51 children (aged 8-18 years) on chronic hemodialysis completed structured interviews using validated tools: the Knowledge about Chronic Kidney disease Questionnaire, the Reported Self-Management Practices Scale, the Pediatric Rating of Chronic Illness Self-Efficacy, and the Pediatric Quality of Life Inventory 3.0 End-Stage Renal Disease module. Results: Strong positive correlations existed among all variables (r > 0.745, p<0.001). Multiple regression revealed self-efficacy as the sole significant predictor of QoL (β=0.499, p=0.013), explaining 69.6% of the variance. Mediation analysis showed self-efficacy completely mediated the knowledge-QoL relationship (indirect effect: B=1.743, 95% CI [0.822, 2.465]) and partially mediated the self-management-quality of life relationship (indirect effect: B=0.687, 95% CI [0.243, 1.164]). Conclusions: Self-efficacy is the pivotal mechanism through which knowledge and self-management translate into improved quality of life. Recommendations: Interventions for this population must be deliberately designed to build confidence and mastery, moving beyond simple knowledge transfer.