{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,11]],"date-time":"2026-10-11T14:16:55Z","timestamp":1791728215740,"version":"4.3.4"},"reference-count":40,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2024,3,24]],"date-time":"2024-03-24T00:00:00Z","timestamp":1711238400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of Renal Care"],"published-print":{"date-parts":[[2024,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Health literacy, self\u2010efficacy and self\u2010management are known to influence health\u2010related well\u2010being. However, the precise influence of self\u2010management, health literacy and self\u2010efficacy on health outcomes in Asian countries is under\u2010researched.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objectives<\/jats:title><jats:p>To examine the impact of health literacy and self\u2010efficacy (independent variables) and self\u2010management (mediator) on patients' health outcomes (dependent variable).<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>An observational, cross\u2010sectional design was conducted between 1 March 2022 and 31 August 2022.<\/jats:p><\/jats:sec><jats:sec><jats:title>Participants<\/jats:title><jats:p>Outpatients receiving haemodialysis (<jats:italic>n<\/jats:italic>\u2009=\u2009200) at a Taiwanese medical centre were assessed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Measurements<\/jats:title><jats:p>The survey included demographic questions and standardised scales: the 3\u2010item Brief Health Literacy Screen, the 8\u2010item Perceived Kidney\/Dialysis Self\u2010Management Scale as a measure of self\u2010efficacy, and the 20\u2010item Haemodialyses Self\u2010Management Instrument. Health outcomes were responses on the 12\u2010item Short\u2010Form Health Survey version 2 and clinical blood results from the past 3 months.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Participants aged over 60 exhibited common comorbidities, with 34% showing low health literacy. Biochemical markers (e.g., haemoglobin and albumin) significantly correlated with physical and mental health scores. Mediating coefficients revealed that self\u2010management significantly influenced associations between health outcomes, health literacy (<jats:italic>\u03b2<\/jats:italic>\u2009=\u20090.31; <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.01), and self\u2010efficacy (<jats:italic>\u03b2<\/jats:italic>\u2009=\u20090.19; <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.01).<\/jats:p><\/jats:sec><jats:sec><jats:title>Implications for Practice<\/jats:title><jats:p>Self\u2010management can modify the overall influence of health literacy and self\u2010efficacy on patients' quality of physical and emotional health. When managing a chronic condition, \u2018knowing\u2019 how to self\u2010manage does not always result in \u2018doing so\u2019 by the patient. Continuous monitoring and promoting self\u2010management behaviours and support by nurses are crucial to enhance health outcomes.<\/jats:p><\/jats:sec>","DOI":"10.1111\/jorc.12493","type":"journal-article","created":{"date-parts":[[2024,3,24]],"date-time":"2024-03-24T10:40:00Z","timestamp":1711276800000},"page":"342-352","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Health\u2010literacy, self\u2010efficacy and health\u2010outcomes of patients undergoing haemodialysis: Mediating role of self\u2010management"],"prefix":"10.1111","volume":"50","author":[{"given":"Shu\u2010Hua","family":"Hsu","sequence":"first","affiliation":[{"name":"Division of Nephrology, Hualien Tzu Chi Hospital Buddhist Tzu Chi Medical Foundation  Hualien Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yu\u2010Li","family":"Lin","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Hualien Tzu Chi Hospital Buddhist Tzu Chi Medical Foundation  Hualien Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9242-9167","authenticated-orcid":false,"given":"Malcolm","family":"Koo","sequence":"additional","affiliation":[{"name":"Department of Nursing Tzu Chi University of Science and Technology  Hualien Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3046-4143","authenticated-orcid":false,"given":"Debra K.","family":"Creedy","sequence":"additional","affiliation":[{"name":"School of Nursing &amp; Midwifery Griffith University Griffith Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5131-3344","authenticated-orcid":false,"given":"Ying","family":"Tsao","sequence":"additional","affiliation":[{"name":"Department of Nursing Tzu\u2010Chi University Hualien Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,3,24]]},"reference":[{"key":"e_1_2_14_2_1","doi-asserted-by":"publisher","DOI":"10.3390\/nursrep11010019"},{"key":"e_1_2_14_3_1","doi-asserted-by":"publisher","DOI":"10.4278\/0890-1171-12.1.8"},{"key":"e_1_2_14_4_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12882-022-02705-x"},{"issue":"8","key":"e_1_2_14_5_1","first-page":"588","article-title":"Brief questions to identify patients with inadequate health literacy","volume":"36","author":"Chew L.D.","year":"2004","journal-title":"Family Medicine"},{"key":"e_1_2_14_6_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.ajkd.2015.07.015"},{"key":"e_1_2_14_7_1","doi-asserted-by":"publisher","DOI":"10.1080\/21642850.2020.1794879"},{"key":"e_1_2_14_8_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11136-009-9582-z"},{"key":"e_1_2_14_9_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1003954"},{"key":"e_1_2_14_10_1","doi-asserted-by":"publisher","DOI":"10.1002\/nop2.1566"},{"key":"e_1_2_14_11_1","doi-asserted-by":"publisher","DOI":"10.2147\/ijnrd.S184671"},{"key":"e_1_2_14_12_1","doi-asserted-by":"publisher","DOI":"10.1111\/sdi.12675"},{"key":"e_1_2_14_13_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12882-020-01746-4"},{"key":"e_1_2_14_14_1","volume-title":"Introduction to mediation, moderation, and conditional process analysis: a regression\u2010based approach","author":"Hayes A.F.","year":"2022"},{"key":"e_1_2_14_15_1","doi-asserted-by":"publisher","DOI":"10.1111\/acem.14428"},{"key":"e_1_2_14_16_1","doi-asserted-by":"publisher","DOI":"10.1177\/20543581221086685"},{"key":"e_1_2_14_17_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.NPR.0000733676.28520.db"},{"key":"e_1_2_14_18_1","doi-asserted-by":"publisher","DOI":"10.1097\/jnr.0000000000000523"},{"key":"e_1_2_14_19_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40620-022-01356-3"},{"key":"e_1_2_14_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jfma.2021.12.010"},{"key":"e_1_2_14_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijnurstu.2013.05.012"},{"key":"e_1_2_14_22_1","doi-asserted-by":"publisher","DOI":"10.1136\/fmch-2020-000351"},{"key":"e_1_2_14_23_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpsychores.2023.111379"},{"key":"e_1_2_14_24_1","doi-asserted-by":"publisher","DOI":"10.1111\/wvn.12634"},{"key":"e_1_2_14_25_1","doi-asserted-by":"publisher","DOI":"10.3390\/jpm12111816"},{"key":"e_1_2_14_26_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12882-022-02679-w"},{"key":"e_1_2_14_27_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.heliyon.2023"},{"key":"e_1_2_14_28_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0270100"},{"key":"e_1_2_14_29_1","doi-asserted-by":"publisher","DOI":"10.1111\/nuf.12331"},{"key":"e_1_2_14_30_1","doi-asserted-by":"publisher","DOI":"10.1111\/nhs.12672"},{"key":"e_1_2_14_31_1","doi-asserted-by":"publisher","DOI":"10.1093\/abm\/kaz023"},{"key":"e_1_2_14_32_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12955-021-01794-w"},{"key":"e_1_2_14_33_1","doi-asserted-by":"publisher","DOI":"10.5812\/numonthly.7(3)2015.27445"},{"key":"e_1_2_14_34_1","doi-asserted-by":"publisher","DOI":"10.6225\/jnhr.5.1.51"},{"key":"e_1_2_14_35_1","doi-asserted-by":"publisher","DOI":"10.1093\/ndt\/gfx293"},{"key":"e_1_2_14_36_1","doi-asserted-by":"publisher","DOI":"10.1002\/9781119547143.ch62"},{"key":"e_1_2_14_37_1","doi-asserted-by":"publisher","DOI":"10.1177\/1359105310367832"},{"key":"e_1_2_14_38_1","doi-asserted-by":"publisher","DOI":"10.1037\/pas0000572"},{"key":"e_1_2_14_39_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.kint.2017.03.018"},{"key":"e_1_2_14_40_1","doi-asserted-by":"publisher","DOI":"10.1111\/jocn.16046"},{"key":"e_1_2_14_41_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-021-85267-6"}],"container-title":["Journal of Renal Care"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/jorc.12493","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T07:17:47Z","timestamp":1760167067000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/jorc.12493"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,3,24]]},"references-count":40,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2024,12]]}},"alternative-id":["10.1111\/jorc.12493"],"URL":"https:\/\/doi.org\/10.1111\/jorc.12493","archive":["Portico"],"relation":{},"ISSN":["1755-6678","1755-6686"],"issn-type":[{"value":"1755-6678","type":"print"},{"value":"1755-6686","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,3,24]]},"assertion":[{"value":"2023-10-26","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-03-13","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-03-24","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}