Analysis of the Relationship Between Self-Efficacy,Adherence With Diet Therapy and Fluid Control inPatients Receiving Hemodialysis Treatment: A StructuralEquation Analysis

Abstract

Purpose: Hemodialysis treatment presents physical, emotional, and social challenges for patients, impacting their overall well-being and daily life. Successful management requires adherence to fluid restrictions, dietary guidelines, and regular medicationintake. This study explored the associations between self-efficacy, dietary adherence, and fluid control in patients undergoinghemodialysis.Methods: This cross-sectional, descriptive study was conducted from 15 April 2024 to 15 June 2024, involving 197 patients re-ceiving hemodialysis at a public hospital and a private dialysis center in Erzurum, eastern Turkey. Data were collected using aPersonal Information Form, the General Self-Efficacy Scale, the Fluid Control in Hemodialysis Patients Scale, and the AttitudeScale for Dietary Therapy of Hemodialysis Patients. Descriptive statistics and structural equation modeling were used for analy-sis. A Bayesian estimator assessed direct and indirect relationships between variables. The model's reliability and validity wereassessed using various statistical tests.Results: Participants had an average age of 53.3 years and an average duration on dialysis of 6.7 years. Of the participants, 91.4%regularly monitored their weight, and 65% regularly monitored edema. The average scores were 28.35 (5.92, SD) on the GeneralSelf-Efficacy Scale, 45.8 (8.12) on the Attitude Scale for Dietary Therapy, and 49.0 (9.05) on the Fluid Control Scale. Self- efficacyhad a significant positive indirect association with fluid control through dietary adherence (β = 0.126, 95% confidence interval[0.008, 0.277]). The total association between self-efficacy and fluid control was also significant (β = 0.624, 95% confidence inter-val [0.483, 0.755]), with dietary adherence partially mediating this relationship. Self-efficacy accounted for 31% of the variance indietary adherence, and the overall model explained 41% of the variance in fluid control.Conclusion: Higher self-efficacy was associated with better dietary adherence and improved fluid control. Dietary adherencepartially mediated the association between self-efficacy and fluid control. Healthcare providers may consider strategies to en-hance self-efficacy in hemodialysis patients to support dietary adherence and fluid control, potentially improving treatmentoutcomes, and quality of life.