The influencing factors of phosphate control behavior among patients undergoing hemodialysis: based on the health belief model.

PURPOSE: Improving the adherence to phosphate management is crucial for reducing the incidence of mortality and complications and improving quality of life for patients undergoing hemodialysis. This study aimed to investigate the factors related to the phosphate control behavior and explore how the Health Belief Model constructs mediating the influence of phosphate-related knowledge on behavior in hemodialysis patients.

METHODS

It was a multicenter cross-sectional study; 333 patients undergoing maintenance hemodialysis were recruited from 3 hemodialysis units of Peking University Third Hospital. Questionnaires were used to examine the phosphate management-related knowledge, health belief and behavior. Hierarchical multiple regression analysis was used to identify independent factors associated with phosphate control behavior. Parallel mediation model was used to test perceived threat, benefit, barrier, self-efficacy as potential mediators between phosphate knowledge and behavior.

RESULTS

The adherence of phosphate restriction diet got the lowest score (3.56 ± 0.88). Hierarchical multiple regression analysis showed that health belief explained 17.0% of the variance in phosphate control behavior. Parallel mediation analysis showed that the direct effect of knowledge on behavior was statistically significant (β = 0.19, SE= 0.05). Perceived threat (β = 0.07, p < 0.001) and self-efficacy (β = 0.08, p < 0.001) acted as independent mediators in the relationship between knowledge and behavior. Perceived barrier which did not influenced by knowledge had independent effects on behavior.

CONCLUSION

Perceived threat and self-efficacy mediated the effect of knowledge on phosphate control behavior, while perceived barrier influenced the behavior independently. HBM might be effective at developing phosphate control behavior change interventions.