Keywords
Elderly hemodialysis
Fistula maintenance
Self-management
Family care level
Published : 2026-08-16
Abstract
Objective: To analyze contextual factors influencing self-management of arteriovenous fistulas (AVFs) among elderly patients on maintenance hemodialysis based on the Individual and Family Self-Management Theory (IFSMT), to develop an intervention model centered on patient-family-healthcare collaboration for AVF maintenance, and to evaluate its effectiveness. Methods: This study consisted of two phases. The first phase was a cross-sectional survey involving 165 participants, with 157 valid questionnaires collected to identify contextual factors affecting AVF self-management in elderly maintenance hemodialysis (MHD) patients. The second phase was a randomized controlled trial designed to assess the effectiveness of the intervention model developed based on IFSMT. Elderly AVF patients admitted to the hemodialysis unit of a tertiary hospital in Hebei Province between September 2025 and March 2026 were randomly assigned to either a control group or an intervention group using a random number table, with 63 patients in each group; ultimately, 60 patients completed follow-up in each group. The control group received standard care, while the intervention group received the IFSMT-based intervention in addition to standard care over a three-month period. Results: The mean self-management score for elderly AVF patients was 45.662 ± 7.701, indicating a moderate overall level. Factors including dialysis duration, daily care, daily AVF exercise, daily AVF self-checking, history of AVF failure or complications, anxiety, depression, general self-efficacy, and family support were identified as significant contextual factors influencing AVF self-management. After the intervention, the incidence of AVF abnormalities and failure was significantly lower in the intervention group compared to the control group (p < 0.05). The total scores and subscale scores of the AVF self-management scale were higher in the intervention group than in the control group (p < 0.05). The self-efficacy scores and family support index scores were also significantly higher in the intervention group (p < 0.05). Additionally, quality-of-life scores were higher in the intervention group (p < 0.05). Conclusion: The self-management program based on IFSMT can improve AVF maintenance outcomes, reduce the occurrence of AVF complications and failure rates, enhance patients’ self-management capacity and general self-efficacy, and improve family support and quality of life.
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