Patient activation and its influencing factors among maintenance hemodialysis patients: a cross-sectional study in China

OBJECTIVE: To investigate the current status of patient activation and identify its influencing factors among patients undergoing maintenance hemodialysis (MHD). METHODS: A cross-sectional study was conducted among 200 MHD patients from four tertiary hospitals in Taiyuan, China, between May and July 2024. Convenience sampling was used. Data were collected using the Patient Activation Measure (PAM-13), Self-Efficacy for Managing Chronic Disease Scale (SECD6), Hemodialysis Self-Management Instrument (HD-SMI), Herth Hope Index (HHI), and Social Support Rating Scale (SSRS). Sociodemographic and clinical variables were also recorded. Univariate analyses, Pearson correlation, and multiple linear regression were employed to explore the relationships between patient activation and potential associated factors. RESULTS: The mean PAM score was 50.29 ± 12.01, with 71.5% of patients classified as Level 1 or 2, indicating low to moderate activation. Higher patient activation was significantly associated with higher education level, potassium-lowering drug use, full self-care ability, and target-range hemoglobin levels. Correlation analysis showed that PAM scores were positively correlated with SECD6, HD-SMI, HHI, and SSRS scores (p < 0.001). Multiple regression identified education level, potassium-lowering drug use, self-care ability, hemoglobin level, self-efficacy, self-management, hope, and social support as significant independent predictors, collectively explaining 41.7% of the variance in activation scores. CONCLUSION: Patient activation among the surveyed MHD patients was generally low and influenced by a combination of clinical, functional, and psychosocial factors. These findings highlight the need for targeted, multidimensional interventions to enhance patient engagement and self-management in the MHD population.