{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T20:35:16Z","timestamp":1792787716855,"version":"4.5.0"},"reference-count":28,"publisher":"SAGE Publications","issue":"11","license":[{"start":{"date-parts":[[2026,7,18]],"date-time":"2026-07-18T00:00:00Z","timestamp":1784332800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"name":"Jinshan Branch of Shanghai Sixth People\u2019s Hospital Project","award":["SLJY-YJKT-202504"],"award-info":[{"award-number":["SLJY-YJKT-202504"]}],"id":[{"id":"https:\/\/ror.org\/049zrh188","id-type":"ROR","asserted-by":"crossref"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Int J Artif Organs"],"published-print":{"date-parts":[[2026,11]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>The incidence of chronic kidney disease among young individuals in China is rising, with activation patterns differing from those of older adults. Evidence on activation in young and middle-aged patients receiving maintenance haemodialysis (MHD) is limited.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives:<\/jats:title>\n                    <jats:p>This study assessed activation levels and their relationship with disease stigma and self-efficacy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>\n                      A cross-sectional study was conducted between January and May 2025 at five public nonprofit hospitals in Shanghai. Patient activation (PA), self-efficacy, and stigma were measured using the Patient Activation Measure Scale, Perceived Medical Condition Self-Management Scale, and Social Impact Scale. Data were analysed with descriptive statistics,\n                      <jats:italic toggle=\"yes\">t<\/jats:italic>\n                      -tests, ANOVA, and multivariate regression.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      A total of 393 patients were enrolled. Most (43.0%) were at activation level 4, while 11.5% were at level 1. Mean scores were 61.80\u2009\u00b1\u200917.10 (PA), 26.43\u2009\u00b1\u20094.26 (self-efficacy), and 64.70\u2009\u00b1\u200911.20 (stigma). Higher PA was positively associated with self-efficacy (\u03b2\u2009=\u20090.473,\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009&lt;\u20090.001) and negatively with stigma (\u03b2\u2009=\u2009\u22120.402,\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009&lt;\u20090.001). After adjusting for age, education, and haemodialysis knowledge, self-efficacy and stigma remained strong predictors, jointly explaining 53.2% of the variance in patient activation. Mediation analysis further revealed that self-efficacy partially mediated the relationship between stigma and PA, with the indirect effect accounting for 40.3% of the total effect (\u03b2\u2009=\u2009\u22120.211, 95% CI: \u22120.267 to \u22120.158).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Self-efficacy and stigma are key predictors of activation in young and middle-aged patients with MHD, underscoring their importance for improving chronic disease care. Furthermore, self-efficacy mediates 40.3% of the total effect of stigma on patient activation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/03913988261465308","type":"journal-article","created":{"date-parts":[[2026,7,18]],"date-time":"2026-07-18T12:20:21Z","timestamp":1784377221000},"page":"774-782","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Stigma, self-efficacy, and patient activation in young and middle-aged patients undergoing maintenance hemodialysis"],"prefix":"10.1177","volume":"49","author":[{"given":"Yuanying","family":"Wang","sequence":"first","affiliation":[{"name":"Hemodialysis Room, Jinshan Branch of Shanghai Sixth People\u2019s Hospital, Shanghai, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ling","family":"Zhou","sequence":"additional","affiliation":[{"name":"Hemodialysis Room, Jinshan Branch of Shanghai Sixth People\u2019s Hospital, Shanghai, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiping","family":"Jin","sequence":"additional","affiliation":[{"name":"Hemodialysis Room, Jinshan Branch of Shanghai Sixth People\u2019s Hospital, Shanghai, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Danfeng","family":"Huang","sequence":"additional","affiliation":[{"name":"Nursing Department, Shanghai Public Clinical Health Center, Shanghai, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-8126-4187","authenticated-orcid":false,"given":"Lin","family":"Huang","sequence":"additional","affiliation":[{"name":"Hemodialysis Room, Jinshan Branch of Shanghai Sixth People\u2019s Hospital, Shanghai, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,7,18]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.3897\/pharmacia.68.e65501"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2022.6817"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(20)30045-3"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1186\/s41100-022-00428-1"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.gerinurse.2022.09.008"},{"key":"e_1_3_2_7_2","first-page":"303","article-title":"World Health Day 2012 focuses on ageing and health","volume":"18","author":"World Health Organization","year":"2012","unstructured":"World Health Organization. World Health Day 2012 focuses on ageing and health. East Mediterr Health J 2012; 18: 303.","journal-title":"East Mediterr Health J"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyg.2022.873444"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.heliyon.2024.e25817"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.puhe.2022.06.021"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2017-017695"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1186\/s41100-022-00431-6"},{"issue":"1","key":"e_1_3_2_13_2","article-title":"Enhancing the cardiovascular safety of hemodialysis care using multimodal provider education and patient activation interventions: protocol for a cluster randomized controlled trial","volume":"12","author":"Veinot TC","year":"2023","unstructured":"Veinot TC, Gillespie B, Argentina M, et al. Enhancing the cardiovascular safety of hemodialysis care using multimodal provider education and patient activation interventions: protocol for a cluster randomized controlled trial. JMIR Res Protoc 2023; 12(1): e46187.","journal-title":"JMIR Res Protoc"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.4103\/0366-6999.204103"},{"key":"e_1_3_2_15_2","doi-asserted-by":"publisher","DOI":"10.2991\/978-94-6463-467-9_17"},{"key":"e_1_3_2_16_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12882-025-03952-4"},{"key":"e_1_3_2_17_2","doi-asserted-by":"publisher","DOI":"10.1186\/s13020-023-00819-4"},{"key":"e_1_3_2_18_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2024-095456"},{"issue":"9","key":"e_1_3_2_19_2","first-page":"1","article-title":"Patient activation among prevalent hemodialysis patients: an observational cross-sectional study","author":"Hussein WF","year":"2022","unstructured":"Hussein WF, Bennett PN, Sun SJ, et al. Patient activation among prevalent hemodialysis patients: an observational cross-sectional study. J Patient Exp 2022; (9): 1\u201320.","journal-title":"J Patient Exp"},{"issue":"5","key":"e_1_3_2_20_2","first-page":"453","article-title":"Guidelines for early screening, diagnosis, and prevention of chronic kidney disease (2022 edition)","author":"Expert Group of Shanghai Nephrology Clinical Quality Control Center","year":"2022","unstructured":"Expert Group of Shanghai Nephrology Clinical Quality Control Center. Guidelines for early screening, diagnosis, and prevention of chronic kidney disease (2022 edition). Chin J Nephrol 2022; (5): 453\u2013464","journal-title":"Chin J Nephrol"},{"key":"e_1_3_2_21_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1475-6773.2004.00269.x"},{"key":"e_1_3_2_22_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.kint.2017.03.018"},{"key":"e_1_3_2_23_2","doi-asserted-by":"publisher","DOI":"10.1097\/MRR.0b013e32829fb3db"},{"key":"e_1_3_2_24_2","doi-asserted-by":"publisher","DOI":"10.1093\/abm\/kay091"},{"key":"e_1_3_2_25_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11606-018-4657-6"},{"key":"e_1_3_2_26_2","doi-asserted-by":"publisher","DOI":"10.1111\/ajr.12828"},{"key":"e_1_3_2_27_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.pec.2025.108821"},{"key":"e_1_3_2_28_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12889-019-8025-1"},{"key":"e_1_3_2_29_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11606-013-2647-2"}],"container-title":["The International Journal of Artificial Organs"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/03913988261465308","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/03913988261465308","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/03913988261465308","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T06:52:21Z","timestamp":1791183141000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/03913988261465308"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,18]]},"references-count":28,"journal-issue":{"issue":"11","published-print":{"date-parts":[[2026,11]]}},"alternative-id":["10.1177\/03913988261465308"],"URL":"https:\/\/doi.org\/10.1177\/03913988261465308","relation":{},"ISSN":["0391-3988","1724-6040"],"issn-type":[{"value":"0391-3988","type":"print"},{"value":"1724-6040","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,18]]}}}