{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T06:06:21Z","timestamp":1779257181656,"version":"3.51.4"},"reference-count":42,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T00:00:00Z","timestamp":1779148800000},"content-version":"vor","delay-in-days":138,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["72304071"],"award-info":[{"award-number":["72304071"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Nursing Research and Practice"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>To explore factors and pathways of self\u2010management intentions and behaviors in patients with chronic kidney disease at predialysis and dialysis stages using protection motivation theory.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>A cross\u2010sectional study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This cross\u2010sectional study was conducted in Changning District, Shanghai, China. A total of 550 patients with CKD (216 dialysis and 334 predialysis) were recruited from local healthcare institutions via self\u2010administered questionnaires. Self\u2010management behaviors were assessed using stage\u2010appropriate instruments validated for predialysis and dialysis populations, respectively. Protection motivation theory constructs were measured and analyzed using confirmatory factor analysis and structural equation modeling to explore pathways across groups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The structural equation model demonstrated acceptable fit (\n                      <jats:italic>\u03c7<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \/df\u2009=\u20093.052, CFI\u2009=\u20090.903, RMSEA\u2009=\u20090.054). Compared with predialysis patients, dialysis patients reported lower perceived severity but higher response efficacy and self\u2010management intention. Self\u2010efficacy and response efficacy were positively associated with intention. Furthermore, perceived vulnerability, self\u2010efficacy, and intention were positively related to self\u2010management behavior.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Response efficacy emerged as a key factor associated with self\u2010management intention. These findings suggest that nursing interventions should prioritize demonstrating the effectiveness of self\u2010management behaviors. However, as this was a cross\u2010sectional study conducted in a single district, causal inferences should be drawn with caution.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Implications for the profession and patient care<\/jats:title>\n                    <jats:p>Healthcare providers should transition to stage\u2010tailored cognitive interventions. For predialysis patients, education must tangibilize the benefits of early behavioral activation. For dialysis patients, nurses should implement concrete \u201cefficacy\u2010focused feedback loops\u201d\u2014such as explicitly linking a patient\u2019s routine objective data (e.g., stabilized lab results or reduced interdialytic weight gain) directly to their adherence efforts\u2014to reinforce response efficacy. Furthermore, policymakers should champion standardized, efficacy\u2010driven CKD management frameworks adaptable across hospital and community settings.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patient or Public Contribution<\/jats:title>\n                    <jats:p>Patients and healthcare staff contributed to the study design and recruitment process. The Shanghai Municipal Health Commission of Changning District assisted with participant recruitment, while staff from the Nephrology Departments of Tongren Hospital and Zhongshan Hospital provided essential support. Their involvement shaped the study\u2019s data collection and ensured that the findings were relevant to clinical practice.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1155\/nrp\/6668409","type":"journal-article","created":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T05:08:32Z","timestamp":1779253712000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Self\u2010Management Intentions and Behaviors Among CKD Patients at Predialysis and Dialysis Stages: A Cross\u2010Sectional Study Based on Protection Motivation 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