Barriers and facilitators to self-management in chronic kidney disease patients undergoing hemodialysis: Insights from a qualitative study

BACKGROUND: Chronic kidney disease (CKD) is a global health challenge, with many patients dependent on hemodialysis (HD) for survival. Although HD prolongs life, it presents significant physical, psychological, and social difficulties, complicating self-management which is a vital aspect of CKD care. Self-management involves addressing symptoms, adhering to treatments, and managing psychosocial impacts. This study investigates barriers and facilitators of self-management in HD patients to inform care improvements. MATERIALS AND METHODS: A qualitative content analysis captured the experiences of 15 participants, including HD patients, family caregivers, and nurses from two Iranian hospitals. Purposive sampling ensured diverse perspectives. Data were collected via 17 semi-structured interviews and analyzed using Graneheim and Lundman’s five-step framework. RESULTS: Key factors influencing self-management were categorized into four domains with eight subcategories. Patient-related factors included psychological challenges (depression, anxiety, denial, and cognitive impairments) and physical complications (comorbidities and side effects). Family and social support played critical roles, with emotional, informational, and financial support as facilitators, while socioeconomic constraints and stigma posed barriers. Healthcare system inefficiencies, such as inadequate education, limited resources, and poor interprofessional collaboration, were impediments, though informal and non-governmental organizations provided some mitigation. Daily life challenges, including difficulty organizing routines, balancing responsibilities, and maintaining social roles, highlighted the need for tailored interventions. CONCLUSION: Psychological, social, and systemic factors shape self-management in HD patients. Addressing barriers like inadequate education, emotional distress, and resource limitations while leveraging family support is crucial for enhancing patients’ ability to manage their condition effectively.