Factors Associated with Self-Management Behavior in Hemodialysis Patients in Eastern China: A COM-B Model-Based Cross-Sectional Study

Background: Self-management behavior is closely linked to clinical outcomes and quality of life in hemodialysis patients, but evidence from high-resource East Asian regions, where behavioral execution remains paradoxically difficult, is limited. Objective: To identify factors associated with self-management behavior and examine dimensional interactions based on the COM-B model among hemodialysis patients in Eastern China. Methods: This cross-sectional study enrolled 345 hemodialysis patients from two tertiary hospitals in Hangzhou (September 2023 – September 2024). Data were collected using electronic questionnaires, including a general information form and the Chinese Hemodialysis Self-Management Behavior Scale. Descriptive statistics, univariate analysis, and forced-entry multiple linear regression were performed. Results: Mean self-management score was 2.88± 0.60 (moderate; range 1– 4). Dimension scores: partnership (3.24± 0.65), emotional management (3.09± 0.70), problem-solving (2.86± 0.68), and self-care behavior (2.57± 0.68). Independent factors identified by multiple regression were education (β=0.230), marital status (β=0.213), income (β=0.206), dialysis vintage (β=0.203), and complications (β=− 0.202), all P< 0.05. Hierarchical regression showed no significant interactions among COM-B dimensions (ΔR 2 =0.000– 0.004, all P> 0.05), suggesting additive rather than multiplicative effects – a pattern not previously reported. The model explained 32.0% of the variance (adjusted R 2 =0.289). Education and dialysis vintage reflect capability; marital status and income reflect opportunity; complications affect both capability and motivation. Conclusion: Self-management behavior was moderate, with self-care being the weakest domain. Education (capability) was the strongest positive factor, while complications (capability/motivation depletion) showed the most prominent negative effect. Causal inferences are precluded by the cross-sectional design. In similar eastern urban settings, low education, low income, divorce/widowhood, and heavy comorbidity burden represent potential intervention targets. Future research should design and validate stratified interventions across COM-B dimensions.