Stigma, self-efficacy, and patient activation in young and middle-aged patients undergoing maintenance hemodialysis

Background: The incidence of chronic kidney disease among young individuals in China is rising, with activation patterns differing from those of older adults. Evidence on activation in young and middle-aged patients receiving maintenance haemodialysis (MHD) is limited. Objectives: This study assessed activation levels and their relationship with disease stigma and self-efficacy. Methods: A cross-sectional study was conducted between January and May 2025 at five public nonprofit hospitals in Shanghai. Patient activation (PA), self-efficacy, and stigma were measured using the Patient Activation Measure Scale, Perceived Medical Condition Self-Management Scale, and Social Impact Scale. Data were analysed with descriptive statistics, t -tests, ANOVA, and multivariate regression. Results: A total of 393 patients were enrolled. Most (43.0%) were at activation level 4, while 11.5% were at level 1. Mean scores were 61.80 ± 17.10 (PA), 26.43 ± 4.26 (self-efficacy), and 64.70 ± 11.20 (stigma). Higher PA was positively associated with self-efficacy (β = 0.473, p < 0.001) and negatively with stigma (β = −0.402, p < 0.001). After adjusting for age, education, and haemodialysis knowledge, self-efficacy and stigma remained strong predictors, jointly explaining 53.2% of the variance in patient activation. Mediation analysis further revealed that self-efficacy partially mediated the relationship between stigma and PA, with the indirect effect accounting for 40.3% of the total effect (β = −0.211, 95% CI: −0.267 to −0.158). Conclusion: Self-efficacy and stigma are key predictors of activation in young and middle-aged patients with MHD, underscoring their importance for improving chronic disease care. Furthermore, self-efficacy mediates 40.3% of the total effect of stigma on patient activation.