{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T17:27:57Z","timestamp":1786728477506,"version":"build-2736575974"},"reference-count":42,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","license":[{"start":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T00:00:00Z","timestamp":1775001600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND:<\/jats:title>\n                    <jats:p>Chronic kidney disease (CKD) is a global health challenge, with many patients dependent on hemodialysis (HD) for survival. Although HD prolongs life, it presents significant physical, psychological, and social difficulties, complicating self-management which is a vital aspect of CKD care. Self-management involves addressing symptoms, adhering to treatments, and managing psychosocial impacts. This study investigates barriers and facilitators of self-management in HD patients to inform care improvements.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>MATERIALS AND METHODS:<\/jats:title>\n                    <jats:p>A qualitative content analysis captured the experiences of 15 participants, including HD patients, family caregivers, and nurses from two Iranian hospitals. Purposive sampling ensured diverse perspectives. Data were collected via 17 semi-structured interviews and analyzed using Graneheim and Lundman\u2019s five-step framework.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS:<\/jats:title>\n                    <jats:p>Key factors influencing self-management were categorized into four domains with eight subcategories. Patient-related factors included psychological challenges (depression, anxiety, denial, and cognitive impairments) and physical complications (comorbidities and side effects). Family and social support played critical roles, with emotional, informational, and financial support as facilitators, while socioeconomic constraints and stigma posed barriers. Healthcare system inefficiencies, such as inadequate education, limited resources, and poor interprofessional collaboration, were impediments, though informal and non-governmental organizations provided some mitigation. Daily life challenges, including difficulty organizing routines, balancing responsibilities, and maintaining social roles, highlighted the need for tailored interventions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSION:<\/jats:title>\n                    <jats:p>Psychological, social, and systemic factors shape self-management in HD patients. Addressing barriers like inadequate education, emotional distress, and resource limitations while leveraging family support is crucial for enhancing patients\u2019 ability to manage their condition effectively.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.4103\/jehp.jehp_2276_24","type":"journal-article","created":{"date-parts":[[2026,5,8]],"date-time":"2026-05-08T02:00:09Z","timestamp":1778205609000},"update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Barriers and facilitators to self-management in chronic kidney disease patients undergoing hemodialysis: Insights from a qualitative study"],"prefix":"10.4103","volume":"15","author":[{"given":"Leila","family":"Rafiee-Vardanjani","sequence":"first","affiliation":[{"name":"Department of Nursing, Student Research Committee, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran"},{"name":"Department of Adults and Geriatric Nursing, School of Nursing and Midwifery, Shahrekord University of Medical Sciences, Shahrekord, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Narges","family":"Arsalani","sequence":"additional","affiliation":[{"name":"Department of Nursing, Iranian Research Center on Aging, School of Behavioral Sciences and Mental Health, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Farahnaz","family":"Mohammadi-Shahboulaghi","sequence":"additional","affiliation":[{"name":"Department of Nursing, Iranian Research Center on Aging, School of Behavioral Sciences and Mental Health, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kian Norouzi","family":"Tabrizi","sequence":"additional","affiliation":[{"name":"Department of Nursing, Iranian Research Center on Aging, School of Behavioral Sciences and Mental Health, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,4]]},"reference":[{"key":"R1-20260508","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1016\/j.kisu.2021.11.003","article-title":"Epidemiology of chronic kidney disease: An update 2022","volume":"12","author":"Kovesdy","year":"2022","journal-title":"Kidney Int Suppl (2011)"},{"key":"R2-20260508","doi-asserted-by":"crossref","first-page":"1048","DOI":"10.1016\/j.kint.2019.07.012","article-title":"A single number for advocacy and communication-worldwide more than 850 million individuals have kidney diseases","volume":"96","author":"Jager","year":"2019","journal-title":"Kidney Int"},{"key":"R3-20260508","first-page":"95","article-title":"Perspective of 20 years hemodialysis registry in Iran, on the road to progress","volume":"14","author":"Nafar","year":"2020","journal-title":"Iran J Kidney Dis"},{"issue":"6","key":"R4-20260508","first-page":"433","article-title":"Epidemiology and characteristics of end-stage renal disease in iran: A narrative review","volume":"14","author":"Hoseini","year":"2022","journal-title":"Iranian Journal of Kidney Diseases."},{"key":"R5-20260508","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1093\/ndt\/gfz266","article-title":"Fibroblast growth factor 23 and new-onset chronic kidney disease in the general population: The prevention of renal and vascular endstage disease (PREVEND) study","volume":"36","author":"De Jong","year":"2021","journal-title":"Nephrol Dial Transplant"},{"key":"R7-20260508","doi-asserted-by":"crossref","first-page":"530","DOI":"10.1111\/1744-9987.12672","article-title":"Neurological and psychological changes in hemodialysis patients before and after the treatment","volume":"22","author":"Lai","year":"2018","journal-title":"Ther Apher Dial"},{"key":"R8-20260508","doi-asserted-by":"crossref","first-page":"e0260914","DOI":"10.1371\/journal.pone.0260914","article-title":"Do patients with high versus low treatment and illness burden have different needs? 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