Self-control motivation in dietary management among hemodialysis patients: a mixed-methods study

This study assessed dietary behavior and psychological motivation among patients receiving maintenance hemodialysis (MHD). Using an explanatory sequential mixed-methods design, we examined whether Motivation for Dietary Self-Control (MDSC) mediated the association between Dietary Goal-Desire Incongruence (DG-DI) and Satisfaction with Dietary Behavior (SWDB). In the quantitative phase (n = 190), the mean scores were 28.21 ± 8.05 for DG-DI, 38.06 ± 9.99 for MDSC, and 29.81 ± 8.49 for SWDB. Hypothesis-driven mediation analysis showed that MDSC accounted for 75.6% of the total effect of DG-DI on SWDB (indirect effect = -0.31, 95% CI: -0.43 to -0.20). Older age, unemployment, and longer dialysis duration were independently associated with poorer dietary psychological outcomes. In the qualitative phase (n = 12), Colaizzi’s method identified three themes: positive motivations for dietary control, negative determinants of dietary control, and challenges in sustaining motivation. These findings indicate that self-control motivation may be a modifiable intervention target and that incorporating motivational enhancement into dietary counseling may improve dietary adherence among patients receiving MHD.