{"id":"https://openalex.org/W7225265502","doi":"https://doi.org/10.3390/healthcare14213758","title":"Exploring Factors Related to Self-Advocacy Among Patients Receiving Maintenance Hemodialysis in China: A Qualitative Study Based on the COM-B Model","display_name":"Exploring Factors Related to Self-Advocacy Among Patients Receiving Maintenance Hemodialysis in China: A Qualitative Study Based on the COM-B Model","publication_year":2026,"publication_date":"2026-11-04","ids":{"openalex":"https://openalex.org/W7225265502","doi":"https://doi.org/10.3390/healthcare14213758"},"language":"en","primary_location":{"id":"doi:10.3390/healthcare14213758","doi":"https://doi.org/10.3390/healthcare14213758","is_oa":true,"landing_page_url":"https://doi.org/10.3390/healthcare14213758","pdf_url":null,"source":{"id":"https://openalex.org/S4210214101","display_name":"Healthcare","issn_l":"2227-9032","issn":["2227-9032"],"is_oa":true,"is_in_doaj":false,"is_core":true,"listed_in":["cwts-core","poland-40","russia-white-list-3","vabb-shw"],"host_organization":"https://openalex.org/P4310310987","host_organization_name":"Multidisciplinary Digital Publishing Institute","host_organization_lineage":["https://openalex.org/P4310310987"],"host_organization_lineage_names":["Multidisciplinary Digital Publishing Institute"],"type":"journal"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Healthcare","raw_type":"journal-article"},"volume":null,"type":"article","is_traditional":true,"indexed_in":["crossref"],"open_access":{"is_oa":true,"oa_status":"gold","oa_url":"https://doi.org/10.3390/healthcare14213758","any_repository_has_fulltext":false},"authorships":[{"author_position":"first","author":{"id":"https://openalex.org/A5160580612","display_name":"Jiayu Wei","orcid":"https://orcid.org/0009-0003-0678-7203","observed_orcids":["https://orcid.org/0009-0003-0678-7203"]},"institutions":[{"id":"https://openalex.org/I190242452","display_name":"Guangdong Pharmaceutical University","ror":"https://ror.org/02vg7mz57","country_code":"CN","type":"education","lineage":["https://openalex.org/I190242452"]}],"countries":["CN"],"is_corresponding":false,"raw_author_name":"Jiayu Wei","raw_affiliation_strings":["School of Nursing, Guangdong Pharmaceutical University, Guangzhou 510310, China"],"raw_orcid":"https://orcid.org/0009-0003-0678-7203","affiliations":[{"raw_affiliation_string":"School of Nursing, Guangdong Pharmaceutical University, Guangzhou 510310, China","institution_ids":["https://openalex.org/I190242452"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5101982339","display_name":"Jing Yu","orcid":"https://orcid.org/0000-0003-3217-5828","observed_orcids":["https://orcid.org/0000-0003-3217-5828"]},"institutions":[{"id":"https://openalex.org/I190242452","display_name":"Guangdong Pharmaceutical University","ror":"https://ror.org/02vg7mz57","country_code":"CN","type":"education","lineage":["https://openalex.org/I190242452"]}],"countries":["CN"],"is_corresponding":false,"raw_author_name":"Jing Yu","raw_affiliation_strings":["School of Nursing, Guangdong Pharmaceutical University, Guangzhou 510310, China"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"School of Nursing, Guangdong Pharmaceutical University, Guangzhou 510310, China","institution_ids":["https://openalex.org/I190242452"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5160570444","display_name":"Huisi Tang","orcid":null,"observed_orcids":[]},"institutions":[{"id":"https://openalex.org/I190242452","display_name":"Guangdong Pharmaceutical University","ror":"https://ror.org/02vg7mz57","country_code":"CN","type":"education","lineage":["https://openalex.org/I190242452"]}],"countries":["CN"],"is_corresponding":false,"raw_author_name":"Huisi Tang","raw_affiliation_strings":["School of Nursing, Guangdong Pharmaceutical University, Guangzhou 510310, China"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"School of Nursing, Guangdong Pharmaceutical University, Guangzhou 510310, China","institution_ids":["https://openalex.org/I190242452"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5105345974","display_name":"Yiting Zhuo","orcid":null,"observed_orcids":[]},"institutions":[{"id":"https://openalex.org/I190242452","display_name":"Guangdong Pharmaceutical University","ror":"https://ror.org/02vg7mz57","country_code":"CN","type":"education","lineage":["https://openalex.org/I190242452"]}],"countries":["CN"],"is_corresponding":false,"raw_author_name":"Yiting Zhuo","raw_affiliation_strings":["School of Nursing, Guangdong Pharmaceutical University, Guangzhou 510310, China"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"School of Nursing, Guangdong Pharmaceutical University, Guangzhou 510310, China","institution_ids":["https://openalex.org/I190242452"]}]},{"author_position":"last","author":{"id":"https://openalex.org/A5044852675","display_name":"Jialian Huang","orcid":"https://orcid.org/0000-0003-2292-5496","observed_orcids":["https://orcid.org/0000-0003-2292-5496"]},"institutions":[{"id":"https://openalex.org/I190242452","display_name":"Guangdong Pharmaceutical University","ror":"https://ror.org/02vg7mz57","country_code":"CN","type":"education","lineage":["https://openalex.org/I190242452"]}],"countries":["CN"],"is_corresponding":true,"raw_author_name":"Jialian Huang","raw_affiliation_strings":["School of Nursing, Guangdong Pharmaceutical University, Guangzhou 510310, China"],"raw_orcid":"https://orcid.org/0000-0003-2292-5496","affiliations":[{"raw_affiliation_string":"School of Nursing, Guangdong Pharmaceutical University, Guangzhou 510310, China","institution_ids":["https://openalex.org/I190242452"]}]}],"institutions":[],"countries_distinct_count":1,"institutions_distinct_count":1,"corresponding_author_ids":["https://openalex.org/A5044852675"],"corresponding_institution_ids":["https://openalex.org/I190242452"],"apc_list":{"value":2700,"currency":"CHF","value_usd":3258},"apc_paid":{"value":2700,"currency":"CHF","value_usd":3258},"fwci":0.0,"has_fulltext":false,"cited_by_count":0,"citation_normalized_percentile":{"value":0.866387,"is_in_top_1_percent":false,"is_in_top_10_percent":false},"cited_by_percentile_year":null,"biblio":{"volume":"14","issue":"21","first_page":"3758","last_page":"3758"},"is_retracted":false,"is_paratext":false,"is_xpac":false,"primary_topic":{"id":"https://openalex.org/T10291","display_name":"Dialysis and Renal Disease Management","score":0.9473000168800354,"subfield":{"id":"https://openalex.org/subfields/2727","display_name":"Nephrology"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},"topics":[{"id":"https://openalex.org/T10291","display_name":"Dialysis and Renal Disease Management","score":0.9473000168800354,"subfield":{"id":"https://openalex.org/subfields/2727","display_name":"Nephrology"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T13111","display_name":"Nursing care and research","score":0.011099999770522118,"subfield":{"id":"https://openalex.org/subfields/2922","display_name":"Research and Theory"},"field":{"id":"https://openalex.org/fields/29","display_name":"Nursing"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T10827","display_name":"Patient-Provider Communication in Healthcare","score":0.010099999606609344,"subfield":{"id":"https://openalex.org/subfields/3600","display_name":"General Health Professions"},"field":{"id":"https://openalex.org/fields/36","display_name":"Health Professions"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}}],"keywords":[{"id":"https://openalex.org/keywords/self-advocacy","display_name":"self-advocacy","score":0.9869999885559082},{"id":"https://openalex.org/keywords/maintenance-hemodialysis","display_name":"maintenance hemodialysis","score":0.9950000047683716},{"id":"https://openalex.org/keywords/patient-centered-care","display_name":"patient-centered care","score":0.753000020980835},{"id":"https://openalex.org/keywords/com-b-model","display_name":"COM-B model","score":0.9670000076293945},{"id":"https://openalex.org/keywords/capability-opportunity-and-motivation","display_name":"capability, opportunity and motivation","score":0.7770000100135803},{"id":"https://openalex.org/keywords/cognitive-overload","display_name":"cognitive overload","score":0.7960000038146973},{"id":"https://openalex.org/keywords/family-support","display_name":"family support","score":0.8399999737739563},{"id":"https://openalex.org/keywords/patient-provider-relationship","display_name":"patient-provider relationship","score":0.9340000152587891},{"id":"https://openalex.org/keywords/financial-burden","display_name":"financial burden","score":0.8209999799728394},{"id":"https://openalex.org/keywords/patient-empowerment","display_name":"patient empowerment","score":0.6940000057220459},{"id":"https://openalex.org/keywords/end-stage-renal-disease","display_name":"end-stage renal disease","score":0.6039999723434448}],"concepts":[{"id":"https://openalex.org/C190248442","wikidata":"https://www.wikidata.org/wiki/Q839486","display_name":"Qualitative research","level":2,"score":0.6564000248908997},{"id":"https://openalex.org/C73282008","wikidata":"https://www.wikidata.org/wiki/Q1759895","display_name":"Coping (psychology)","level":2,"score":0.592199981212616},{"id":"https://openalex.org/C74196892","wikidata":"https://www.wikidata.org/wiki/Q7781188","display_name":"Thematic analysis","level":3,"score":0.5914999842643738},{"id":"https://openalex.org/C71924100","wikidata":"https://www.wikidata.org/wiki/Q11190","display_name":"Medicine","level":0,"score":0.5697000026702881},{"id":"https://openalex.org/C169900460","wikidata":"https://www.wikidata.org/wiki/Q2200417","display_name":"Cognition","level":2,"score":0.5126000046730042},{"id":"https://openalex.org/C2779134260","wikidata":"https://www.wikidata.org/wiki/Q12136","display_name":"Disease","level":2,"score":0.4797999858856201},{"id":"https://openalex.org/C160735492","wikidata":"https://www.wikidata.org/wiki/Q31207","display_name":"Health care","level":2,"score":0.4327000081539154},{"id":"https://openalex.org/C159110408","wikidata":"https://www.wikidata.org/wiki/Q121176","display_name":"Nursing","level":1,"score":0.39730000495910645},{"id":"https://openalex.org/C2778063415","wikidata":"https://www.wikidata.org/wiki/Q391744","display_name":"Hemodialysis","level":2,"score":0.39309999346733093},{"id":"https://openalex.org/C15744967","wikidata":"https://www.wikidata.org/wiki/Q9418","display_name":"Psychology","level":0,"score":0.37950000166893005},{"id":"https://openalex.org/C87156501","wikidata":"https://www.wikidata.org/wiki/Q7268708","display_name":"Qualitative property","level":2,"score":0.36500000953674316},{"id":"https://openalex.org/C512399662","wikidata":"https://www.wikidata.org/wiki/Q3505712","display_name":"Family medicine","level":1,"score":0.3587999939918518},{"id":"https://openalex.org/C142546437","wikidata":"https://www.wikidata.org/wiki/Q2661195","display_name":"Descriptive research","level":2,"score":0.3458000123500824},{"id":"https://openalex.org/C70410870","wikidata":"https://www.wikidata.org/wiki/Q199906","display_name":"Clinical psychology","level":1,"score":0.3199999928474426},{"id":"https://openalex.org/C133462117","wikidata":"https://www.wikidata.org/wiki/Q4929239","display_name":"Data collection","level":2,"score":0.31029999256134033},{"id":"https://openalex.org/C2776035688","wikidata":"https://www.wikidata.org/wiki/Q1606558","display_name":"Affect (linguistics)","level":2,"score":0.2953000068664551},{"id":"https://openalex.org/C2775944032","wikidata":"https://www.wikidata.org/wiki/Q22907659","display_name":"Patient satisfaction","level":2,"score":0.2815999984741211},{"id":"https://openalex.org/C2779473830","wikidata":"https://www.wikidata.org/wiki/Q1540899","display_name":"MEDLINE","level":2,"score":0.2799000144004822},{"id":"https://openalex.org/C3018916638","wikidata":"https://www.wikidata.org/wiki/Q752118","display_name":"Emotional support","level":3,"score":0.2777999937534332},{"id":"https://openalex.org/C39896193","wikidata":"https://www.wikidata.org/wiki/Q380344","display_name":"Descriptive statistics","level":2,"score":0.27559998631477356},{"id":"https://openalex.org/C14262774","wikidata":"https://www.wikidata.org/wiki/Q4880695","display_name":"Behavior change","level":2,"score":0.2734000086784363},{"id":"https://openalex.org/C2987552334","wikidata":"https://www.wikidata.org/wiki/Q383126","display_name":"Chronic disease","level":2,"score":0.2711000144481659},{"id":"https://openalex.org/C2778087770","wikidata":"https://www.wikidata.org/wiki/Q2297111","display_name":"Social support","level":2,"score":0.26109999418258667},{"id":"https://openalex.org/C2984915365","wikidata":"https://www.wikidata.org/wiki/Q5141203","display_name":"Cognitive impairment","level":3,"score":0.25600001215934753}],"mesh":[],"locations_count":1,"locations":[{"id":"doi:10.3390/healthcare14213758","doi":"https://doi.org/10.3390/healthcare14213758","is_oa":true,"landing_page_url":"https://doi.org/10.3390/healthcare14213758","pdf_url":null,"source":{"id":"https://openalex.org/S4210214101","display_name":"Healthcare","issn_l":"2227-9032","issn":["2227-9032"],"is_oa":true,"is_in_doaj":false,"is_core":true,"listed_in":["cwts-core","poland-40","russia-white-list-3","vabb-shw"],"host_organization":"https://openalex.org/P4310310987","host_organization_name":"Multidisciplinary Digital Publishing Institute","host_organization_lineage":["https://openalex.org/P4310310987"],"host_organization_lineage_names":["Multidisciplinary Digital Publishing Institute"],"type":"journal"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Healthcare","raw_type":"journal-article"}],"best_oa_location":{"id":"doi:10.3390/healthcare14213758","doi":"https://doi.org/10.3390/healthcare14213758","is_oa":true,"landing_page_url":"https://doi.org/10.3390/healthcare14213758","pdf_url":null,"source":{"id":"https://openalex.org/S4210214101","display_name":"Healthcare","issn_l":"2227-9032","issn":["2227-9032"],"is_oa":true,"is_in_doaj":false,"is_core":true,"listed_in":["cwts-core","poland-40","russia-white-list-3","vabb-shw"],"host_organization":"https://openalex.org/P4310310987","host_organization_name":"Multidisciplinary Digital Publishing Institute","host_organization_lineage":["https://openalex.org/P4310310987"],"host_organization_lineage_names":["Multidisciplinary Digital Publishing Institute"],"type":"journal"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Healthcare","raw_type":"journal-article"},"sustainable_development_goals":[{"display_name":"Good health and well-being","score":1.0,"id":"https://metadata.un.org/sdg/3"}],"study_designs":[],"awards":[],"funders":[],"has_content":{"pdf":false,"grobid_xml":false},"content_urls":null,"referenced_works_count":31,"referenced_works":["https://openalex.org/W1965146438","https://openalex.org/W1972019212","https://openalex.org/W1991330770","https://openalex.org/W2122295735","https://openalex.org/W2136608905","https://openalex.org/W2138664283","https://openalex.org/W2168521523","https://openalex.org/W2754799758","https://openalex.org/W3027792204","https://openalex.org/W3048960044","https://openalex.org/W3112525979","https://openalex.org/W4246697554","https://openalex.org/W4307217168","https://openalex.org/W4308709550","https://openalex.org/W4309243553","https://openalex.org/W4388523062","https://openalex.org/W4389142968","https://openalex.org/W4389684075","https://openalex.org/W4390052050","https://openalex.org/W4398175379","https://openalex.org/W4404474121","https://openalex.org/W4408579880","https://openalex.org/W4409497387","https://openalex.org/W4410542560","https://openalex.org/W4411830793","https://openalex.org/W4414193577","https://openalex.org/W4415178884","https://openalex.org/W4415211448","https://openalex.org/W4415567604","https://openalex.org/W7139995008","https://openalex.org/W7203864936"],"related_works":["https://openalex.org/W7201888445","https://openalex.org/W7139995008","https://openalex.org/W7162811864","https://openalex.org/W2377606244","https://openalex.org/W2352740575","https://openalex.org/W2364171221","https://openalex.org/W3211756415","https://openalex.org/W7167798288","https://openalex.org/W7156099826","https://openalex.org/W4413842512"],"abstract_inverted_index":{"Background:":[0],"Patient-centered":[1],"care":[2,46],"requires":[3,209],"patients":[4,27,60,72,134,165,204],"receiving":[5,61,73,205],"maintenance":[6],"hemodialysis":[7],"(MHD)":[8],"to":[9,53,66,168,215],"communicate":[10,220],"their":[11,184,237,252],"health":[12,217],"needs":[13],"and":[14,34,110,130,138,171,199,219,230,250,254],"actively":[15],"participate":[16,35],"in":[17,36,47,84,256],"disease":[18,37],"management.":[19,38],"Self-advocacy":[20],"is":[21,41],"a":[22,81,100,179],"behavioral":[23],"process":[24],"through":[25,107],"which":[26],"seek":[28],"health-related":[29],"information,":[30],"express":[31],"individualized":[32],"needs,":[33],"Enhancing":[39],"self-advocacy":[40,58,202,208],"essential":[42],"for":[43,183,236],"advancing":[44],"patient-centered":[45],"MHD.":[48,62,206],"Objectives:":[49],"This":[50],"study":[51],"sought":[52],"investigate":[54],"the":[55,76,92,120,123,194],"factors":[56,192],"influencing":[57],"among":[59,203],"Methods:":[63],"From":[64],"February":[65],"May":[67],"2026,":[68],"we":[69,98],"recruited":[70],"18":[71],"MHD":[74],"from":[75],"blood":[77],"purification":[78],"center":[79],"of":[80,173,181,196,234],"tertiary":[82],"hospital":[83],"Guangzhou,":[85],"China,":[86],"using":[87,113],"purposive":[88],"sampling.":[89],"Guided":[90,118],"by":[91,119],"Capability,":[93],"Opportunity,":[94],"Motivation\u2013Behavior":[95],"(COM-B)":[96],"model,":[97,122],"conducted":[99],"descriptive":[101],"qualitative":[102],"study.":[103],"We":[104],"collected":[105],"data":[106],"semi-structured":[108],"interviews":[109],"analyzed":[111],"them":[112],"inductive\u2013deductive":[114],"thematic":[115],"analysis.":[116],"Results:":[117],"COM-B":[121],"findings":[124,188,249],"encompassed":[125],"three":[126],"dimensions:":[127],"capability,":[128,133,197],"opportunity,":[129,151,198],"motivation.":[131],"Regarding":[132,150,163],"experienced":[135],"cognitive":[136],"overload":[137],"difficulty":[139],"translating":[140],"experiences":[141],"into":[142],"expression,":[143],"while":[144,176],"some":[145],"acquired":[146],"proactive":[147],"coping":[148],"strategies.":[149],"family":[152,225],"relationships":[153,160],"constrained":[154],"patient":[155],"voice,":[156],"whereas":[157],"ongoing":[158],"patient\u2013provider":[159,228],"fostered":[161],"empowerment.":[162],"motivation,":[164],"showed":[166],"sensitivity":[167],"relational":[169],"costs":[170],"awareness":[172],"financial":[174],"burden,":[175],"also":[177,223],"demonstrating":[178],"sense":[180,233],"responsibility":[182,235],"health.":[185,238],"Conclusions:":[186],"The":[187],"revealed":[189],"that":[190],"multiple":[191],"across":[193],"dimensions":[195],"motivation":[200],"influenced":[201],"Promoting":[207],"not":[210],"only":[211],"improving":[212,227],"patients\u2019":[213,232],"ability":[214],"understand":[216],"information":[218],"effectively,":[221],"but":[222],"strengthening":[224],"support,":[226],"interactions,":[229],"supporting":[231],"Future":[239],"research":[240],"could":[241],"explore":[242],"targeted":[243],"support":[244],"strategies":[245],"based":[246],"on":[247],"these":[248],"evaluate":[251],"feasibility":[253],"effectiveness":[255],"dialysis":[257],"care.":[258]},"counts_by_year":[],"updated_date":"2026-11-06T12:05:46.655746","created_date":"2026-11-05T00:00:00"}