Factors associated with self-advocacy among patients receiving maintenance hemodialysis: a multicenter cross-sectional study using latent profile and network analysis.

BACKGROUND

To explore the current status of self-advocacy among patients undergoing maintenance hemodialysis (MHD) and to identify latent profile characteristics and symptom networks associated with self-advocacy.

METHODS

A convenience sampling method was used to recruit patients undergoing MHD from three tertiary hospitals in Chengdu between May and July 2024. Data were collected using a general information questionnaire, the Patient Self-Advocacy Scale, the Perceived Social Support Scale, the Self-Perceived Burden Scale, and the Hemodialysis Self-Management Instrument. Latent profile analysis (LPA) was conducted using Mplus 8.3 to identify subgroups of self-advocacy. SPSS 26.0 was used for univariate and unordered multinomial logistic regression analyses to examine factors associated with self-advocacy profiles. Network analysis was performed using R software to reveal the symptom network structure and central node of each subgroup.

RESULTS

Self-advocacy behaviors among 429 patients undergoing MHD were classified into three latent profiles: the Self-Advocacy-Passive Acceptance Type (26.5%), the Self-Advocacy-Moderate Participation Type (58.5%), and the Self-Advocacy-Active Striving Type (15.0%). Multivariate regression analysis showed that gender, age, educational level, perceived social support, self-perceived burden, and self-management ability were significantly associated with self-advocacy profiles. Network analysis indicated that the central node of the Passive Acceptance Type was family support, that of the Moderate Participation Type was problem-solving ability, and that of the Active Striving Type was emotional burden. The network structure demonstrated good stability and accuracy.

CONCLUSION

Overall, the level of self-advocacy among patients undergoing MHD was relatively low and exhibited substantial heterogeneity. Healthcare professionals should implement targeted symptom management strategies based on the specific characteristics of different subgroups. These findings may inform interventions based on the Capability, Opportunity, Motivation-Behavior (COM-B) model aimed at enhancing patients' capability, opportunity, and motivation for self-advocacy.