The Mediating Role of Benefit Finding in the Relationship Between Family Care and Self-Management Behaviors in Patients with Chronic Kidney Disease

The Mediating Role of Benefit Finding in the Relationship Between Family Care and Self-Management Behaviors in Patients with Chronic Kidney Disease | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article The Mediating Role of Benefit Finding in the Relationship Between Family Care and Self-Management Behaviors in Patients with Chronic Kidney Disease Weiwei Yang, Xuhua Zhou, Chengxin Fu, Huaihong Yuan This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5267980/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract This study aimed to investigate the mediating role of benefit finding on the relationship between family care and self-management behaviors in patients with chronic kidney disease (CKD) to inform improvements in patients' self-management behaviors. This survey was conducted from November 2023 to February 2024 with a cross-sectional design and convenience sampling among patients with chronic kidney disease in a tertiary care hospital in Chengdu City. Participants were prompted to complete a demographic questionnaire, the Family APGAR Index (APGAR), the Benefit Finding Scale (BFS), and the Chronic Disease Self-management Behavior Measuring Scale (CDSMBMS). The analysis of the data was carried out using SPSS 29.0 and AMOS Statistics 28.0. A total of 529 patients were enrolled in this research, with a majority of females (53.1%). The mean total score of CDSMBMS was 19.19 ± 7.54. Family care and benefit finding were significantly positively associated with self-management behaviors (all p < 0.01). In addition, benefit finding fully mediated the association between family care and self-management behaviors (β = 0.258, p = 0.000, 95% CI = 0.184–0.342). Our findings indicate that benefit finding plays a full mediator in the relationship between family care and self-management behaviors among patients with CKD. Thus, healthcare professionals should develop evidence-based interventions in future studies to enhance family care and benefit finding to promote self-management behaviors in people with CKD. Health sciences/Nephrology/Kidney diseases/Chronic kidney disease Health sciences/Health care/Patient education Health sciences/Health care/Health services Chronic kidney disease Family care Benefit finding Self-management behaviors Mediation analysis Figures Figure 1 Figure 2 Introduction Chronic kidney disease (CKD) is considered one of the most common chronic diseases and is associated with adverse health outcomes such as cardiovascular events, anemia, and death 1 – 4 . According to statistics, the global prevalence of CKD is approximately 14.3%, and the number of cases is growing year by year, which has become an ever-increasing global public health problem 5 , 6 . Therefore, the treatment, care, and complication prevention of CKD are exceptionally significant. However, as a complex chronic disease, the crucial factor in the prevention and treatment of CKD is the patient's self-management behaviors, in addition to long-term standardized therapy and nursing care 7 , 8 . Self-management behaviors refer to the processes and activities in which individuals engage positively in self-care to improve their health, which is an effective strategy for reducing negative events and achieving a better quality of life 9 , 10 . Self-management behaviors implemented by CKD patients usually include exercise, a healthy diet, symptom control, psychological recovery, and medication adherence 11 . As an influential and modifiable factor in prolonged rehabilitation and caring, self-management behaviors play a crucial role in the health consequences of CKD patients 12 , 13 . Numerous studies have revealed that good self-management behaviors can not only directly facilitate chronic CKD patients to learn about the disease and change their undesirable lifestyles, but also alleviate the burden of symptoms, slow down the disease process, reduce healthcare costs, and enhance the quality of life 14 – 16 . Thus, healthcare professionals should strengthen the identification of factors influencing CKD self-management behaviors and develop effective intervention strategies to improve the performance of CKD patients. Family care is generally defined as an individual's subjective satisfaction with family functioning 17 , 18 . A study in Mexico found that family care was a vital factor in the maintenance and change of self-management behaviors 19 . Previous studies of patients with chronic diseases have also indicated that family care has a positive effect on self-management behaviors 20 , 21 . In other words, patients with a high level of family care can better regulate their emotional state and lifestyle, contributing to medical compliance and thus enhancing disease self-management behaviors 22 , 23 . However, the mechanism of family care on self-management behaviors in CKD is still unknown. Therefore, understanding the relationship between family care and self-management behaviors in CKD patients can provide patients with personalized care and health advice to promote their self-care. Benefit finding is a cognitive adaptation process that an individual undergoes when confronted with an external stressful event or situation, and is employed to describe the positive psychological changes that occur after a negative event 24 , 25 . As an intrinsic motivator, benefit finding has been demonstrated to improve medication adherence, disease self-monitoring, and health self-management 26 , 27 . In addition, earlier studies had proven the relationships between benefit finding and patient self-management behaviors and family care, respectively 25 , 28 , 29 . However, to our knowledge, the underlying mechanisms of the associations between benefit finding, family care, and self-management behaviors are still unclear. Based on the above empirical research, the hypothesis framework of this study (Fig. 1 ) was developed. The aim of this research was to explore the links between family care, benefit finding and self-management behaviors, and the mediating role of benefit finding, in order to provide healthcare professionals with key information for designing effective care packages to reduce adverse health outcomes due to low levels of self-management in CKD. Methods Study design and sample population Our research was a cross-sectional survey and convenience sampling was employed to recruit CKD inpatients from the Department of Nephrology and maintenance hemodialysis outpatients at the Hemodialysis Center of a grade A tertiary hospital in Chengdu, Sichuan Province, China. This study was approved by the Biomedical Ethics Review Committee of the West China Hospital of Sichuan University (2023-2077). The inclusion criteria for patients were: (1) diagnosed with CKD by a physician; (2) able to communicate in Chinese or Sichuan dialect; (3) voluntary participation in this study. Patients were excluded for any of the following: (1) age < 18 years; (2) severe physical illness; (3) severe visual or hearing impairment; (4) cognitive disorders. The sample size is based on Barrett's recommendations for sample sizes in the structural equation model (SEM). To obtain a stable SEM, a minimum sample size would be 200 30 . Thus, the final consideration of this study was 200 samples. Research tools Demographic characteristics The demographic information included patients' age, gender, education level, marital status, place of residence, occupational status, current residence, and per capita household income. The following clinical characteristics were also assessed in this study: whether the patients were first diagnosed with CKD, whether the patients had complications or comorbidities, whether they had received any health education about CKD, whether they had been diagnosed with CKD for the first time in the current treatment, patient category (inpatient or outpatient), the clinical stage, duration of illness, and the current treatment. Benefit finding scale (BFS) This study adopted the Chinese version of the Benefit Finding Scale (BFS) developed by Antoni MH. in 2001 31 , which has been widely employed to assess patients' degree of benefit finding. The BFS is a one-dimensional scale with a total of 19 items. Each item is rated on a 4-point Likert scale, with responses ranging from “not at all” (1 point) to “very much” (4 points). The total score is between 19 and 76, with higher scores suggesting that patients perceive more benefit from the disease. In this study, the Cronbach's alpha coefficient was 0.942. The family APGAR index (APGAR) The APGAR, also known as the Family Functioning Assessment Scale, was used to gauge the individuals' subjective satisfaction with their family function. This scale was created by Smilkstein and later translated into a Mandarin version by Lv Fan 32,33 . The instrument comprises 5 items, categorized into 5 major domains: adaptation, partnership, growth, affection, and Intimacy. Responses to each item are evaluated on a 3-point scale from “almost rarely” (0 points) to “often” (2 points), with a total score of 0 to 10. Scores of 7-10 denote good family function (high family care) and high subjective satisfaction with family function. Moderate family dysfunction is shown by scores between 4 and 6, severe family dysfunction is represented by scores between 0 and 3, and both moderate and severe family dysfunction indicate low family care. The Cronbach's alpha value for our research was 0.867. The chronic disease self-management behavior measuring scale (CDSMBMS) The present research utilized the Chronic Disease Self-Management Behavior Scale (CDSMBMS) compiled by Lorig to measure individuals' self-management behaviors for chronic diseases 34 . The scale consists of 15 items divided into three core components related to self-management behaviors: exercise (6 items), cognitive symptom management practices (6 items), and communication with healthcare providers (3 items). Items within the exercise dimension are scored on a 5-point scale ranging from 0 to 4, where 0 denotes "no exercise" and 4 indicates "3 hours per week". The items related to cognitive symptom management practices and communication with healthcare providers are scored on a 6-point scale, ranging from 0 to 5, with 0 representing 'never' and 5 equaling 'very often'. The total score for the CDSMBMS varies from 0 to 69, with higher scores corresponding to better self-management behaviors. In the current survey, the Cronbach's alpha coefficient was calculated to be 0.718. Data collection Data collection was carried out from November 2023 to February 2024. Two researchers underwent identical training to ensure the use of consistent terminology. They refrained from conducting surveys during mealtimes, treatment sessions, and lunch breaks. Before the examination, participants were thoroughly informed about the purpose, significance, procedures, and ethical implications of the study. After obtaining written informed consent, the uniformly trained investigators utilized a web-based questionnaire for data collection. Participants completed the electronic questionnaires on "Wenjuanxing" (www.wjx.cn), one of the largest online survey platforms in China, known for its user-friendly interface and its capability to customize questions to meet survey requirements. In cases where participants faced difficulties in completing the electronic questionnaire or lacked electronic devices, the researchers read the questions nonjudgmentally, allowing participants to respond verbally. Subsequently, the researchers assisted participants in completing the questionnaire accurately and truthfully. Each questionnaire was designed to take approximately 15 to 30 minutes; all collected data were anonymized and used exclusively by the research team. A total of 561 questionnaires were distributed for this study. The researchers excluded any returned questionnaires that were logically inconsistent, incomplete, or repetitive. Ultimately, 529 valid questionnaires were remained, yielding a validity rate of 94.30%. Data analysis SPSS version 29.0 was utilized for data analysis. The demographic and clinical characteristics of the sample were described using frequency and percentage. To evaluate the normality of the data for three variables—family care, benefit finding, and self-management behaviors—charts (histograms and Q-Q plots) were employed. After conducting normality tests, all variables exhibited either normal or approximately normal distributions. Therefore, the three continuous variables were expressed as the mean ± standard deviation (SD). Pearson correlation analysis was conducted to explore the relationships between family care, benefit finding, and self-management behaviors. AMOS Statistics 28.0 was employed to construct the SEM, and maximum likelihood estimation was implemented to fit the data. The bias-corrected bootstrap method was applied to test the mediating effect, setting the confidence interval at 95% with 5000 bootstrap multiple replicate samples, and statistical significance was established at a p-value of less than 0.05 (two-tailed). The goodness-of-fit of the SEM was assessed using indices including the chi-square to degree of freedom ratio (χ²/df < 3), root mean square error of approximation (RMSEA 0.90), adjusted goodness-of-fit index (AGFI > 0.90), Tucker-Lewis fit index (TLI > 0.90), and comparative fit index (CFI > 0.90). Results Sample characteristics A sum of 529 respondents participated in this study. Table 1 shows the general characteristics of the respondents. The proportion of males was 46.9%, 57.5% of the participants were under 45 years old and the average age was 41.78 years (SD = 13.69; range 18–90). Nearly half of the subjects' educational level was college or above (48.6%). The questionnaire revealed that 72.2% of the patients were married, 79.2% lived in urban areas, 47.6% were employed, and 43.9% had a per capita monthly household income of more than 5,000 yuan (5,000 yuan is about USD 690), 44.6% of the patients had CKD for less than one year, 39.3% of the patients had stage 5 CKD, 58.8% had received health education about CKD, 44.6% had complications or comorbidities, 34.6% received hemodialysis treatment, and 94.5% of the patients had health insurance. Correlation between self-management behaviors and family care and benefit finding The mean total scores for family care, benefit finding, and self-management behaviors among the patients with CKD were 7.67 (SD = 2.39), 46.90 (SD = 11.40), and 19.19 (SD = 7.54), respectively. Table 2 shows significant correlations between family care, benefit finding, and self-management behaviors among the patients. The results indicated that family care was positively related to benefit finding (r = 0.342, p < 0.01), and benefit finding was positively associated with self-management behaviors (r = 0.459, p < 0.01). There was a positive correlation between family care and self-management behaviors (r = 0.115, p < 0.01). Mediation model construction The analysis of the data revealed a significant correlation among family care, benefit finding, and self-management behaviors, thus warranting a mediation effect analysis. Following the validation procedure for the mediation effect, AMOS 28.0 software was selected to construct the model to investigate the direct and indirect impacts of family care, benefit finding, and self-management behaviors (Figure 2). Benefit finding was then directly used as a latent variable. The exogenous latent variable of family care was conceptualized using five dimensions: adaptation, partnership, growth, affection, and resolve. The latent variable of self-management behaviors was operationalized with three dimensions: exercise, cognitive symptom management practices, and communication with healthcare providers. The model fit indices showed that the proposed model was adequate, as evidenced by a CMIN/DF (Chi-square Degrees of Freedom Ratio) of 2.959, an RMSEA (Root Mean Square Error) of 0.061, a GFI (Goodness of Fit Index) of 0.970, an AGFI (Adjusted Goodness of Fit Index) of 0.946, a TLI (Tucker-Lewis Index) of 0.952, and a CFI (Comparative Fit Index) of 0.967. Figure 2 illustrated that benefit finding was the mediating variable between family care and self-management behaviors. Path testing for SEM In the path analysis of SEM, family care could positively predict benefit finding (β =0.368, p < 0.001), and benefit finding could positively predict self-management behaviors (β = 0.701, p 0.05). Table 3 and Figure 2 present the results. The mediating role of benefit finding on the relationship between family care and self-management behaviors The mediating effect among family care, benefit finding, and self-management behaviors was examined using the bias-corrected percentile bootstrap method with 5,000 resamples and a 95% confidence interval. Table 4 showed that benefit finding was a significant mediating variable between family care and self-management behaviors, with an indirect effect size of 0.258 (95% CI: 0.184 to 0.342). Additionally, the direct effect of family care on self-management behaviors was not statistically significant ( p = 0.317). Thus, it was concluded that benefit finding played a fully mediating role in this indirect impact pathway between family care and self-management behaviors. Discussion This study verified that the level of family care in patients with CKD had an indirect positive effect on self-management behaviors through the mediating variable of benefit finding, and explained the psychosocial mechanism by which family care affected self-management behaviors through benefit finding so that healthcare professionals could improve self-management behaviors of the patients with CKD by enhancing the levels of family care and benefit finding. In this study, the average score of self-management behaviors in the patients with CKD was low, which was similar to the results of previous studies 35 . According to the self-management theory model, self-management behaviors are those in which patients fully mobilize their subjective initiative, utilize social resources, and participate in maintaining and promoting their health 8 , 36 , 37 . Six essential skills in self-management are required: problem-solving, decision-making, resource utilization, forming patient-provider partnerships, action planning, and self-customization 38 . Patients with CKD should primarily focus on psychological adjustment, developing self-care skills, encouraging medical compliance behaviors, modifying unhealthy lifestyles, self-symptom management, proactive self-monitoring of medical conditions, and other self-management behaviors 8 , 39 , 40 . This kind of management was extremely comprehensive and involved the intersection of multiple disciplines 41 , which made the implementation of self-management relatively difficult for patients, coupled with the fact that there were problems in the domestic healthcare system such as a lack of effective implementation of health education, irregularities in follow-up management, and system imperfections 42 . These challenges might contribute to low levels of self-management behaviors. Therefore, the level of self-management behaviors among people with CKD still deserves further attention and improvement. The APGAR scores demonstrated a high level of family care for the participants in our study, implying that the family function of patients with CKD was in good shape, consistent with a study of older adults in Zhejiang, China 43 . The high level of family care may be explained by the fact that traditional Chinese culture vigorously promotes the family values of respecting the elderly, cherishing the young, and helping and caring for each other 44 , 45 . Previous studies have pointed to a positive association between family functioning and family support and a negative correlation between family support and negative emotions such as illness distress in patients with type 2 diabetes 46 , 47 . When suffering from a severe blow of the illness, patients could get main social support from the family, as well as full understanding and assistance from their family members, so the patients with CKD had a high degree of satisfaction with their family function. Our study revealed that the medium level of benefit finding among patients with CKD corresponded with the result of a study involving the patients receiving maintenance hemodialysis in Shanghai, China 48 , and was lower than that of older Chinese patients with chronic diseases 49 . The differing results may be attributed to the heterogeneity of the population, with the average age of patients included in this study being younger. Previous research has indicated that older patients tended to have a higher perception of benefit finding from their disease 48 , 50 , 51 . Compared with elderly patients, younger individuals tended to have less life experience, weaker mental toughness and resilience, and were more likely to exhibit negative attitudes in coping with illness. This, in turn, made it more challenging for them to perceive the benefits of disease for self-growth 52 . The results of this study highlighted a positive predictive relationship between family care and benefit finding among the patients with CKD — in other words, higher levels of family care were associated with higher levels of benefit finding. Family care is an individual's subjective satisfaction with family function, which often leads to positive coping with negative life events 18 , 53 . In the patients with CKD, comprehensive care, strong financial support, and sincere emotional comfort provided by family members were beneficial in reducing patients' self-perceived burden of illness, alleviating negative emotions, and decreasing the sense of stigma 52 , which ultimately contributed to perceived benefits from the disease experience. Our findings provided initial evidence that benefit finding in patients with CKD positively predicted self-management behaviors. Specifically, higher levels of benefit finding were associated with improved self-management behaviors. This was in line with previous research on elderly patients with chronic liver disease 29 . Benefit finding, a subset of positive psychology, serves as an intrinsic motivational factor that can encourage patients to psychologically attune themselves and engage in various beneficial behaviors in the face of adversity 54 . Related studies have illustrated that patients with higher levels of benefit finding were more likely to adopt active coping strategies in both cognition and behavior; these included maintaining a positive attitude, taking the initiative to learn about their condition, and being more willing to follow medical advice, as well as correcting harmful dietary habits and embracing a healthier lifestyle 55 – 57 . Such behaviors effectively promoted health self-management and enhanced overall self-management behaviors. This study further confirmed that the benefit finding of the patients with CKD played a fully mediating role between family care and self-management behaviors, that was to say, although family care could not be used as an independent variable to directly predict patients' self-management behaviors, it could indirectly and positively influence self-management behaviors through benefit finding. It is well known that CKD is a lifelong condition that requires long-term and stable treatment and care, and the economic burden on the family is relatively heavy 58 – 60 . In addition, family members often play an important role in the long-term care of patients with CKD 61 . The stronger care and support provided by family members, the more secure the patients would feel in the family, and then the patients could actively perceive the benefits from disease 45 , and establish motivation and confidence in disease self-management 62 , as a result of fostering self-management behaviors among patients with CKD 63 . Limitation Despite the many strengths of the current study, certain limitations should be considered. Firstly, Due to human resources and time constraints, all participants were recruited from a tertiary hospital in Chengdu. Thus, the findings of this study may not necessarily be applicable to infer the self-management behaviors of CKD patients in other locations or healthcare institutions. Secondly, the cross-sectional design of this study caused difficulty in making causal inferences. Finally, similar to other cross-sectional studies, a certain amount of recall bias may be present as the results of the study were all measured using self-report questionnaires rather than through objective records. Conclusion The results of this study provide support for the relationship between benefit finding, family care, and self-management behaviors in patients with CKD, and demonstrate a pathway mechanism by which family care influences self-management behaviors through benefit finding. In clinical practice, healthcare professionals should enhance the assessment of the self-management behaviors of CKD patients, focus on and formulate intervention strategies in family care and benefit finding, encourage patients to actively seek family support, and facilitate patients to perceive the positive experience of the disease, to promote the implementation of good self-management behaviors. In addition, by fostering a trusting relationship with patients and their families, empowering family members to act as peer mentors, improving patients' perceptions of family care, and arousing patients' positive emotions, they can strengthen patients' self-management behaviors and improve patients' quality of life. Declarations Competing interests The authors declare no competing interests. Author Contribution Conceptualization: W.W.Y., H.H.Y., X.H.Z.; Methodology: W.W.Y., H.H.Y., Software: W.W.Y.; Validation: C.X.F., X.H.Z.; Formal Analysis: W.W.Y., H.H.Y., X.H.Z.; Investigation: W.W.Y., C.X.F.; Writing-Original Draft Preparation: W.W.Y., Writing- Review & Editing: W.W.Y., H.H.Y., X.H.Z.; Supervision: H.H.Y. After reading the final manuscript, all members of the research agreed on the final version of the manuscript. Data Availability The datasets generated during and/or analyzed during the current study are not publicly available but are available from the corresponding author on reasonable request. References Evans, M. et al. A Narrative Review of Chronic Kidney Disease in Clinical Practice: Current Challenges and Future Perspectives. Adv. Ther. 39 , 33–43 (2022). Burnier, M. & Damianaki, A. Hypertension as Cardiovascular Risk Factor in Chronic Kidney Disease. Circ. Res. 132 , 1050–1063 (2023). Ribeiro, H. S. et al. 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Study on Status of Benefit Finding and its Influencing Factors Among Elderly Patients with Chronic Diseases. (Naval Medical University, 2018). Lassmann, I. et al. Benefit finding in long-term prostate cancer survivors. Support. Care Cancer Off. J. Multinatl. Assoc. Support. Care Cancer 29 , 4451–4460 (2021). Wang, Y. et al. What factors are predictive of benefit finding in women treated for non-metastatic breast cancer? A prospective study. Psychooncology. 24 , 533–539 (2015). Yang, J. et al. Benefit finding in individuals undergoing maintenance hemodialysis in Shanghai: a latent profile analysis. Front. Psychol. 15 , 1292175 (2024). Zhang, Y. et al. Effects of family function, depression, and self-perceived burden on loneliness in patients with type 2 diabetes mellitus: a serial multiple mediation model. BMC Psychiatry 23 , 636 (2023). Zhao, M. et al. The impact of social support on benefit finding among patients with advanced lung cancer and their caregivers: based on actor-partner interdependence mediation model. Support. Care Cancer Off. J. Multinatl. Assoc. Support. Care Cancer 32 , 287 (2024). Sun, L., Liu, K., Li, X., Zhang, Y. & Huang, Z. Benefit-finding experiences of cervical cancer survivors in rural Yunnan province, China: A qualitative study. Nurs. Open 9 , 2637–2645 (2022). Sheikh-Wu, S. F., Anglade, D., Gattamorta, K. & Downs, C. A. Relationships Between Colorectal Cancer Survivors’ Positive Psychology, Symptoms, and Quality of Life. Clin. Nurs. Res. 32 , 171–184 (2023). Gong, Y. et al. Benefit finding experience in maintenance hemodialysis patients：a qualitative research. Chin. J. Nurs. 59 , 164–169 (2024). Hajomer, H. A. et al. The burden of end-stage renal disease in Khartoum, Sudan: cost of illness study. J. Med. Econ. 27 , 455–462 (2024). Scholes-Robertson, N. et al. Financial toxicity experienced by rural Australian families with chronic kidney disease. Nephrol. Carlton Vic 28 , 456–466 (2023). Hong, Z. et al. Economic evaluation of three dialysis methods in patients with end-stage renal disease in China. Int. Urol. Nephrol. 55 , 1247–1254 (2023). Vovlianou, S. et al. Burden, depression and anxiety effects on family caregivers of patients with chronic kidney disease in Greece: a comparative study between dialysis modalities and kidney transplantation. Int. Urol. Nephrol. 55 , 1619–1628 (2023). Lipińska, W. R. & Nowicka-Sauer, K. Illness perception and perceived benefits of illness among persons with type 1 diabetes. Health Psychol. Rep. 11 , 200–212 (2023). Suarilah, I. & Lin, C.-C. Factors influencing self-management among Indonesian patients with early-stage chronic kidney disease: A cross-sectional study. J. Clin. Nurs. 31 , 703–715 (2022). Tables Table 1 . Sample characteristics (N = 529). Variables n (%) Gender Male 248 (46.9) Female 281 (53.1) Age 18 ~ <45 304 (57.5) 45 ~ <60 169 (31.9) ≥60 56 (10.6) Education level Primary school or below 61 (11.5) Junior high school 101 (19.1) High/vocational school 110 (20.8) College or above 257 (48.6) Marital status Unmarried 111 (21.0) Married 382 (72.2) Divorced or widowed 36 (6.8) Work status Employed 252 (47.6) Unemployed 220 (41.6) Retired 57 (10.8) Household income per capita (CNY/month) 5,000 232 (43.9) Duration of CKD (year) 5 174 (32.9) Stage of CKD Stage 1 144 (27.2) Stage 2 75 (14.2) Stage 3 86 (16.3) Stage 4 16 (3.0) Stage 5 208 (39.3) Current treatment options Conservative treatment without dialysis 316 (59.7) Peritoneal dialysis 26 (4.9) Hemodialysis 183 (34.6) Kidney transplantation 4 (0.8) Received health education Yes 311 (58.8) No 218 (41.2) Residence Rural 110 (20.8) Urban 419 (79.2) Medical coverage New rural cooperative medical care 110 (20.8) Resident health insurance 183 (34.6) Employee health insurance 203 (38.4) Self-financed 29 (5.5) Commercial health insurance 4 (0.7) Comorbidities or complications Yes 236 (44.6) No 293 (55.4) Table 2 . Means, SDs, and correlations of all variables. Variables Mean (SD) Range a Family care Benefit finding Family care 7.67 (2.39) 0-10 Benefit finding 46.90 (11.40) 19-76 0.342** Self-management behaviors 19.19 (7.54) 2-47 0.115** 0.459** Note: a The actual score range for each variable. ** p < 0.01. Table 3 . The path coefficients of the mediation model. Structural path Standardized estimate S.E. C.R. P Family care → Benefit finding 0.368 1.434 7.853 <0.001 Family care → Self-management behaviors -0.074 0.176 -1.169 0.242 Benefit finding → Self-management behaviors 0.701 0.012 5.406 <0.001 Table 4 . Mediating effect. Effect Estimate Lower Upper P Indirect effect 0.258 0.184 0.342 0.000 Direct effect -0.074 -0.207 0.073 0.317 Total effect 0.184 0.060 0.313 0.006 Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5267980","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":374976965,"identity":"2672e315-0900-4864-af3c-9a73502a5113","order_by":0,"name":"Weiwei Yang","email":"","orcid":"","institution":"West China Hospital of Sichuan University","correspondingAuthor":false,"prefix":"","firstName":"Weiwei","middleName":"","lastName":"Yang","suffix":""},{"id":374976966,"identity":"55e432aa-aa67-4e81-a62b-0a0867959d4b","order_by":1,"name":"Xuhua Zhou","email":"","orcid":"","institution":"West China Hospital of Sichuan University","correspondingAuthor":false,"prefix":"","firstName":"Xuhua","middleName":"","lastName":"Zhou","suffix":""},{"id":374976967,"identity":"215a1359-b775-4cbe-9b95-5aec0ddd1dc7","order_by":2,"name":"Chengxin Fu","email":"","orcid":"","institution":"West China Hospital of Sichuan University","correspondingAuthor":false,"prefix":"","firstName":"Chengxin","middleName":"","lastName":"Fu","suffix":""},{"id":374976968,"identity":"1544deb1-626c-476a-8697-5583fd82fa47","order_by":3,"name":"Huaihong Yuan","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA6klEQVRIiWNgGAWjYJACZiDmMQCxPjAwJJCmhXEGKVoYQFqYeYjRYnAj+dnjwjY7GXP23sOvbdvs8uTbzxgw/NyBT0uaufHMtmQey55zada5bcnFBmdyDBh7z+DTkmAmzdvGzGNwI8fMOHfbgcQNEjwGzIxt+LSkfwNqqYdosQRqmT+DoJYckC2HQVqMHzMCtTTcIKBF8sybMmmec8d5DM6cMWPs/ZecuOFMWsHBXjxa+I6nb5PmKau2NzjeY/zhxxm7xPnthzc++IlHi8IBBJtNAsY6gKkQAeQbEGzmD/hUjoJRMApGwcgFAINaUdbxO+D+AAAAAElFTkSuQmCC","orcid":"","institution":"West China Hospital of Sichuan University","correspondingAuthor":true,"prefix":"","firstName":"Huaihong","middleName":"","lastName":"Yuan","suffix":""}],"badges":[],"createdAt":"2024-10-15 10:38:13","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5267980/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5267980/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":69358573,"identity":"07033b06-1652-4b3c-92b2-14f99f79cfe4","added_by":"auto","created_at":"2024-11-19 14:06:55","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":78659,"visible":true,"origin":"","legend":"\u003cp\u003eHypothesized framework of the mediation analysis. c', direct effect of family care on self-management behaviors controlling for benefit finding.\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-5267980/v1/6cc4a9cd9418970367980fb0.jpeg"},{"id":69358574,"identity":"885da1fc-24d6-487b-ab1a-33b773896b20","added_by":"auto","created_at":"2024-11-19 14:06:55","extension":"jpeg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":263176,"visible":true,"origin":"","legend":"\u003cp\u003eModel of the mediating role of benefit finding between family care and self-management behaviors.\u003cstrong\u003e \u003c/strong\u003eX1: adaptation; X2: partnership; X3: growth; X4: affection; X5: Intimacy; Y1: exercise; Y2: cognitive symptom management practice; Y3: communication with doctors.\u003c/p\u003e","description":"","filename":"floatimage2.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-5267980/v1/9a9efaaa730fd14c4a32a8b5.jpeg"},{"id":77558691,"identity":"ffecad0f-8ded-4778-9dbb-87f3294b2c2e","added_by":"auto","created_at":"2025-03-03 06:16:58","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1498440,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5267980/v1/a959c3df-c2e0-42b1-b463-c575289e1e2d.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"The Mediating Role of Benefit Finding in the Relationship Between Family Care and Self-Management Behaviors in Patients with Chronic Kidney Disease","fulltext":[{"header":"Introduction","content":"\u003cp\u003eChronic kidney disease (CKD) is considered one of the most common chronic diseases and is associated with adverse health outcomes such as cardiovascular events, anemia, and death\u003csup\u003e\u003cspan additionalcitationids=\"CR2 CR3\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e. According to statistics, the global prevalence of CKD is approximately 14.3%, and the number of cases is growing year by year, which has become an ever-increasing global public health problem\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e,\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e. Therefore, the treatment, care, and complication prevention of CKD are exceptionally significant. However, as a complex chronic disease, the crucial factor in the prevention and treatment of CKD is the patient's self-management behaviors, in addition to long-term standardized therapy and nursing care\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e,\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eSelf-management behaviors refer to the processes and activities in which individuals engage positively in self-care to improve their health, which is an effective strategy for reducing negative events and achieving a better quality of life\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e,\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e. Self-management behaviors implemented by CKD patients usually include exercise, a healthy diet, symptom control, psychological recovery, and medication adherence\u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e. As an influential and modifiable factor in prolonged rehabilitation and caring, self-management behaviors play a crucial role in the health consequences of CKD patients\u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e,\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e. Numerous studies have revealed that good self-management behaviors can not only directly facilitate chronic CKD patients to learn about the disease and change their undesirable lifestyles, but also alleviate the burden of symptoms, slow down the disease process, reduce healthcare costs, and enhance the quality of life\u003csup\u003e\u003cspan additionalcitationids=\"CR15\" citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e. Thus, healthcare professionals should strengthen the identification of factors influencing CKD self-management behaviors and develop effective intervention strategies to improve the performance of CKD patients.\u003c/p\u003e \u003cp\u003eFamily care is generally defined as an individual's subjective satisfaction with family functioning\u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e,\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e. A study in Mexico found that family care was a vital factor in the maintenance and change of self-management behaviors\u003csup\u003e\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003e. Previous studies of patients with chronic diseases have also indicated that family care has a positive effect on self-management behaviors\u003csup\u003e\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e,\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e. In other words, patients with a high level of family care can better regulate their emotional state and lifestyle, contributing to medical compliance and thus enhancing disease self-management behaviors\u003csup\u003e\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e,\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u003c/sup\u003e. However, the mechanism of family care on self-management behaviors in CKD is still unknown. Therefore, understanding the relationship between family care and self-management behaviors in CKD patients can provide patients with personalized care and health advice to promote their self-care.\u003c/p\u003e \u003cp\u003eBenefit finding is a cognitive adaptation process that an individual undergoes when confronted with an external stressful event or situation, and is employed to describe the positive psychological changes that occur after a negative event\u003csup\u003e\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e,\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u003c/sup\u003e. As an intrinsic motivator, benefit finding has been demonstrated to improve medication adherence, disease self-monitoring, and health self-management\u003csup\u003e\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e,\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u003c/sup\u003e. In addition, earlier studies had proven the relationships between benefit finding and patient self-management behaviors and family care, respectively\u003csup\u003e\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e,\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e,\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u003c/sup\u003e. However, to our knowledge, the underlying mechanisms of the associations between benefit finding, family care, and self-management behaviors are still unclear.\u003c/p\u003e \u003cp\u003eBased on the above empirical research, the hypothesis framework of this study (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e) was developed. The aim of this research was to explore the links between family care, benefit finding and self-management behaviors, and the mediating role of benefit finding, in order to provide healthcare professionals with key information for designing effective care packages to reduce adverse health outcomes due to low levels of self-management in CKD.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e"},{"header":"Methods","content":"\u003ch2\u003eStudy design and sample population\u003c/h2\u003e\n\u003cp\u003eOur research was a cross-sectional survey and convenience sampling was employed to recruit CKD inpatients from the Department of Nephrology and maintenance hemodialysis outpatients at the Hemodialysis Center of a grade A tertiary hospital in Chengdu, Sichuan Province, China. This study was approved by the Biomedical Ethics Review Committee of the West China Hospital of Sichuan University (2023-2077).\u003c/p\u003e\n\u003cp\u003eThe inclusion criteria for patients were: (1) diagnosed with CKD by a physician; (2) able to communicate in Chinese or Sichuan dialect; (3) voluntary participation in this study. Patients were excluded for any of the following: (1) age \u0026lt; 18 years; (2) severe physical illness; (3) severe visual or hearing impairment; (4) cognitive disorders.\u003c/p\u003e\n\u003cp\u003eThe sample size is based on Barrett\u0026apos;s recommendations for sample sizes in the structural equation model (SEM). To obtain a stable SEM, a minimum sample size would be 200\u003csup\u003e30\u003c/sup\u003e. Thus, the final consideration of this study was 200 samples.\u003c/p\u003e\n\u003ch2\u003eResearch tools\u003c/h2\u003e\n\u003ch3\u003eDemographic characteristics\u003c/h3\u003e\n\u003cp\u003eThe demographic information included patients\u0026apos; age, gender, education level, marital status, place of residence, occupational status, current residence, and per capita household income. The following clinical characteristics were also assessed in this study: whether the patients were first diagnosed with CKD, whether the patients had complications or comorbidities, whether they had received any health education about CKD, whether they had been diagnosed with CKD for the first time in the current treatment, patient category (inpatient or outpatient), the clinical stage, duration of illness, and the current treatment.\u003c/p\u003e\n\u003ch3\u003eBenefit finding scale (BFS)\u003c/h3\u003e\n\u003cp\u003eThis study adopted the Chinese version of the Benefit Finding Scale (BFS) developed by Antoni MH. in 2001\u003csup\u003e31\u003c/sup\u003e, which has been widely employed to assess patients\u0026apos; degree of benefit finding. The BFS is a one-dimensional scale with a total of 19 items. Each item is rated on a 4-point Likert scale, with responses ranging from \u0026ldquo;not at all\u0026rdquo; (1 point) to \u0026ldquo;very much\u0026rdquo; (4 points). The total score is between 19 and 76, with higher scores suggesting that patients perceive more benefit from the disease. In this study, the Cronbach\u0026apos;s alpha coefficient was 0.942.\u003c/p\u003e\n\u003ch3\u003eThe family APGAR index (APGAR)\u003c/h3\u003e\n\u003cp\u003eThe APGAR, also known as the Family Functioning Assessment Scale, was used to gauge the individuals\u0026apos; subjective satisfaction with their family function. This scale was created by Smilkstein and later translated into a Mandarin version by Lv Fan\u003csup\u003e32,33\u003c/sup\u003e. The instrument comprises 5 items, categorized into 5 major domains: adaptation, partnership, growth, affection, and Intimacy. Responses to each item are evaluated on a 3-point scale from \u0026ldquo;almost rarely\u0026rdquo; (0 points) to \u0026ldquo;often\u0026rdquo; (2 points), with a total score of 0 to 10. Scores of 7-10 denote good family function (high family care) and high subjective satisfaction with family function. Moderate family dysfunction is shown by scores between 4 and 6, severe family dysfunction is represented by scores between 0 and 3, and both moderate and severe family dysfunction indicate low family care. The Cronbach\u0026apos;s alpha value for our research was 0.867.\u003c/p\u003e\n\u003ch3\u003eThe chronic disease self-management behavior measuring scale (CDSMBMS)\u003c/h3\u003e\n\u003cp\u003eThe present research utilized the Chronic Disease Self-Management Behavior Scale (CDSMBMS) compiled by Lorig to measure individuals\u0026apos; self-management behaviors for chronic diseases\u003csup\u003e34\u003c/sup\u003e. The scale consists of 15 items divided into three core components related to self-management behaviors: exercise (6 items), cognitive symptom management practices (6 items), and communication with healthcare providers (3 items). Items within the exercise dimension are scored on a 5-point scale ranging from 0 to 4, where 0 denotes \u0026quot;no exercise\u0026quot; and 4 indicates \u0026quot;3 hours per week\u0026quot;. The items related to cognitive symptom management practices and communication with healthcare providers are scored on a 6-point scale, ranging from 0 to 5, with 0 representing \u0026apos;never\u0026apos; and 5 equaling \u0026apos;very often\u0026apos;. The total score for the CDSMBMS varies from 0 to 69, with higher scores corresponding to better self-management behaviors. In the current survey, the Cronbach\u0026apos;s alpha coefficient was calculated to be 0.718.\u003c/p\u003e\n\u003ch2\u003eData collection\u003c/h2\u003e\n\u003cp\u003eData collection was carried out from November 2023 to February 2024. Two researchers underwent identical training to ensure the use of consistent terminology. They refrained from conducting surveys during mealtimes, treatment sessions, and lunch breaks. Before the examination, participants were thoroughly informed about the purpose, significance, procedures, and ethical implications of the study. After obtaining written informed consent, the uniformly trained investigators utilized a web-based questionnaire for data collection. Participants completed the electronic questionnaires on \u0026quot;Wenjuanxing\u0026quot; (www.wjx.cn), one of the largest online survey platforms in China, known for its user-friendly interface and its capability to customize questions to meet survey requirements. In cases where participants faced difficulties in completing the electronic questionnaire or lacked electronic devices, the researchers read the questions nonjudgmentally, allowing participants to respond verbally. Subsequently, the researchers assisted participants in completing the questionnaire accurately and truthfully. Each questionnaire was designed to take approximately 15 to 30 minutes; all collected data were anonymized and used exclusively by the research team. A total of 561 questionnaires were distributed for this study. The researchers excluded any returned questionnaires that were logically inconsistent, incomplete, or repetitive. Ultimately, 529 valid questionnaires were remained, yielding a validity rate of 94.30%.\u003c/p\u003e\n\u003ch2\u003eData analysis\u003c/h2\u003e\n\u003cp\u003eSPSS version 29.0 was utilized for data analysis. The demographic and clinical characteristics of the sample were described using frequency and percentage. To evaluate the normality of the data for three variables\u0026mdash;family care, benefit finding, and self-management behaviors\u0026mdash;charts (histograms and Q-Q plots) were employed. After conducting normality tests, all variables exhibited either normal or approximately normal distributions. Therefore, the three continuous variables were expressed as the mean \u0026plusmn; standard deviation (SD). Pearson correlation analysis was conducted to explore the relationships between family care, benefit finding, and self-management behaviors. AMOS Statistics 28.0 was employed to construct the SEM, and maximum likelihood estimation was implemented to fit the data. The bias-corrected bootstrap method was applied to test the mediating effect, setting the confidence interval at 95% with 5000 bootstrap multiple replicate samples, and statistical significance was established at a p-value of less than 0.05 (two-tailed). The goodness-of-fit of the SEM was assessed using indices including the chi-square to degree of freedom ratio (\u0026chi;\u0026sup2;/df \u0026lt; 3), root mean square error of approximation (RMSEA \u0026lt; 0.08), goodness-of-fit index (GFI \u0026gt; 0.90), adjusted goodness-of-fit index (AGFI \u0026gt; 0.90), Tucker-Lewis fit index (TLI \u0026gt; 0.90), and comparative fit index (CFI \u0026gt; 0.90).\u003c/p\u003e"},{"header":"Results","content":"\u003ch2\u003eSample characteristics\u003c/h2\u003e\n\u003cp\u003eA sum of 529 respondents participated in this study. Table 1 shows the general characteristics of the respondents. The proportion of males was 46.9%, 57.5% of the participants were under 45 years old and the average age was 41.78 years (SD = 13.69; range 18\u0026ndash;90). Nearly half of the subjects\u0026apos; educational level was college or above (48.6%). The questionnaire revealed that 72.2% of the patients were married, 79.2% lived in urban areas, 47.6% were employed, and 43.9% had a per capita monthly household income of more than 5,000 yuan (5,000 yuan is about USD 690), 44.6% of the patients had CKD for less than one year, 39.3% of the patients had stage 5 CKD, 58.8% had received health education about CKD, 44.6% had complications or comorbidities, 34.6% received hemodialysis treatment, and 94.5% of the patients had health insurance.\u003c/p\u003e\n\u003ch2\u003eCorrelation between self-management behaviors and family care and benefit finding\u003c/h2\u003e\n\u003cp\u003eThe mean total scores for family care, benefit finding, and self-management behaviors among the patients with CKD were 7.67 (SD = 2.39), 46.90 (SD = 11.40), and 19.19 (SD = 7.54), respectively. Table 2 shows significant correlations between family care, benefit finding, and self-management behaviors among the patients. The results indicated that family care was positively related to benefit finding (r = 0.342, \u003cem\u003ep\u003c/em\u003e \u0026lt; 0.01), and benefit finding was positively associated with self-management behaviors (r = 0.459, \u003cem\u003ep\u003c/em\u003e \u0026lt; 0.01). There was a positive correlation between family care and self-management behaviors (r = 0.115, \u003cem\u003ep\u003c/em\u003e \u0026lt; 0.01).\u003c/p\u003e\n\u003ch2\u003eMediation model construction\u003c/h2\u003e\n\u003cp\u003eThe analysis of the data revealed a significant correlation among family care, benefit finding, and self-management behaviors, thus warranting a mediation effect analysis. Following the validation procedure for the mediation effect, AMOS 28.0 software was selected to construct the model to investigate the direct and indirect impacts of family care, benefit finding, and self-management behaviors (Figure 2). Benefit finding was then directly used as a latent variable. The exogenous latent variable of family care was conceptualized using five dimensions: adaptation, partnership, growth, affection, and resolve. The latent variable of self-management behaviors was operationalized with three dimensions: exercise, cognitive symptom management practices, and communication with healthcare providers. The model fit indices showed that the proposed model was adequate, as evidenced by a CMIN/DF (Chi-square Degrees of Freedom Ratio) of 2.959, an RMSEA (Root Mean Square Error) of 0.061, a GFI (Goodness of Fit Index) of 0.970, an AGFI (Adjusted Goodness of Fit Index) of 0.946, a TLI (Tucker-Lewis Index) of 0.952, and a CFI (Comparative Fit Index) of 0.967. Figure 2 illustrated that benefit finding was the mediating variable between family care and self-management behaviors.\u003c/p\u003e\n\u003ch2\u003ePath testing for SEM\u003c/h2\u003e\n\u003cp\u003eIn the path analysis of SEM, family care could positively predict benefit finding (\u0026beta; =0.368, \u003cem\u003ep\u003c/em\u003e \u0026lt; 0.001), and benefit finding could positively predict self-management behaviors (\u0026beta; = 0.701, \u003cem\u003ep\u003c/em\u003e \u0026lt; 0.001). However, family care could not predict self-management behaviors (\u003cem\u003ep\u003c/em\u003e \u0026gt; 0.05). Table 3 and Figure 2 present the results.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003ch2\u003eThe mediating role of benefit finding on the relationship between family care and self-management behaviors\u003c/h2\u003e\n\u003cp\u003eThe mediating effect among family care, benefit finding, and self-management behaviors was examined using the bias-corrected percentile bootstrap method with 5,000 resamples and a 95% confidence interval. Table 4 showed that benefit finding was a significant mediating variable between family care and self-management behaviors, with an indirect effect size of 0.258 (95% CI: 0.184 to 0.342). Additionally, the direct effect of family care on self-management behaviors was not statistically significant (\u003cem\u003ep\u003c/em\u003e = 0.317). Thus, it was concluded that benefit finding played a fully mediating role in this indirect impact pathway between family care and self-management behaviors.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study verified that the level of family care in patients with CKD had an indirect positive effect on self-management behaviors through the mediating variable of benefit finding, and explained the psychosocial mechanism by which family care affected self-management behaviors through benefit finding so that healthcare professionals could improve self-management behaviors of the patients with CKD by enhancing the levels of family care and benefit finding.\u003c/p\u003e \u003cp\u003eIn this study, the average score of self-management behaviors in the patients with CKD was low, which was similar to the results of previous studies\u003csup\u003e\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e\u003c/sup\u003e. According to the self-management theory model, self-management behaviors are those in which patients fully mobilize their subjective initiative, utilize social resources, and participate in maintaining and promoting their health\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e,\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e,\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e\u003c/sup\u003e. Six essential skills in self-management are required: problem-solving, decision-making, resource utilization, forming patient-provider partnerships, action planning, and self-customization\u003csup\u003e\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e\u003c/sup\u003e. Patients with CKD should primarily focus on psychological adjustment, developing self-care skills, encouraging medical compliance behaviors, modifying unhealthy lifestyles, self-symptom management, proactive self-monitoring of medical conditions, and other self-management behaviors\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e,\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e,\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e\u003c/sup\u003e. This kind of management was extremely comprehensive and involved the intersection of multiple disciplines\u003csup\u003e\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e\u003c/sup\u003e, which made the implementation of self-management relatively difficult for patients, coupled with the fact that there were problems in the domestic healthcare system such as a lack of effective implementation of health education, irregularities in follow-up management, and system imperfections\u003csup\u003e\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e\u003c/sup\u003e. These challenges might contribute to low levels of self-management behaviors. Therefore, the level of self-management behaviors among people with CKD still deserves further attention and improvement.\u003c/p\u003e \u003cp\u003eThe APGAR scores demonstrated a high level of family care for the participants in our study, implying that the family function of patients with CKD was in good shape, consistent with a study of older adults in Zhejiang, China\u003csup\u003e\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e\u003c/sup\u003e. The high level of family care may be explained by the fact that traditional Chinese culture vigorously promotes the family values of respecting the elderly, cherishing the young, and helping and caring for each other\u003csup\u003e\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e,\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e\u003c/sup\u003e. Previous studies have pointed to a positive association between family functioning and family support and a negative correlation between family support and negative emotions such as illness distress in patients with type 2 diabetes\u003csup\u003e\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e,\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e\u003c/sup\u003e. When suffering from a severe blow of the illness, patients could get main social support from the family, as well as full understanding and assistance from their family members, so the patients with CKD had a high degree of satisfaction with their family function.\u003c/p\u003e \u003cp\u003eOur study revealed that the medium level of benefit finding among patients with CKD corresponded with the result of a study involving the patients receiving maintenance hemodialysis in Shanghai, China\u003csup\u003e\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e\u003c/sup\u003e, and was lower than that of older Chinese patients with chronic diseases\u003csup\u003e\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e\u003c/sup\u003e. The differing results may be attributed to the heterogeneity of the population, with the average age of patients included in this study being younger. Previous research has indicated that older patients tended to have a higher perception of benefit finding from their disease\u003csup\u003e\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e,\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e,\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e\u003c/sup\u003e. Compared with elderly patients, younger individuals tended to have less life experience, weaker mental toughness and resilience, and were more likely to exhibit negative attitudes in coping with illness. This, in turn, made it more challenging for them to perceive the benefits of disease for self-growth\u003csup\u003e\u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThe results of this study highlighted a positive predictive relationship between family care and benefit finding among the patients with CKD \u0026mdash; in other words, higher levels of family care were associated with higher levels of benefit finding. Family care is an individual's subjective satisfaction with family function, which often leads to positive coping with negative life events\u003csup\u003e\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e,\u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e\u003c/sup\u003e. In the patients with CKD, comprehensive care, strong financial support, and sincere emotional comfort provided by family members were beneficial in reducing patients' self-perceived burden of illness, alleviating negative emotions, and decreasing the sense of stigma\u003csup\u003e\u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e\u003c/sup\u003e, which ultimately contributed to perceived benefits from the disease experience.\u003c/p\u003e \u003cp\u003eOur findings provided initial evidence that benefit finding in patients with CKD positively predicted self-management behaviors. Specifically, higher levels of benefit finding were associated with improved self-management behaviors. This was in line with previous research on elderly patients with chronic liver disease\u003csup\u003e\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u003c/sup\u003e. Benefit finding, a subset of positive psychology, serves as an intrinsic motivational factor that can encourage patients to psychologically attune themselves and engage in various beneficial behaviors in the face of adversity\u003csup\u003e\u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e\u003c/sup\u003e. Related studies have illustrated that patients with higher levels of benefit finding were more likely to adopt active coping strategies in both cognition and behavior; these included maintaining a positive attitude, taking the initiative to learn about their condition, and being more willing to follow medical advice, as well as correcting harmful dietary habits and embracing a healthier lifestyle\u003csup\u003e\u003cspan additionalcitationids=\"CR56\" citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e\u003c/sup\u003e. Such behaviors effectively promoted health self-management and enhanced overall self-management behaviors.\u003c/p\u003e \u003cp\u003eThis study further confirmed that the benefit finding of the patients with CKD played a fully mediating role between family care and self-management behaviors, that was to say, although family care could not be used as an independent variable to directly predict patients' self-management behaviors, it could indirectly and positively influence self-management behaviors through benefit finding. It is well known that CKD is a lifelong condition that requires long-term and stable treatment and care, and the economic burden on the family is relatively heavy\u003csup\u003e\u003cspan additionalcitationids=\"CR59\" citationid=\"CR58\" class=\"CitationRef\"\u003e58\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e60\u003c/span\u003e\u003c/sup\u003e. In addition, family members often play an important role in the long-term care of patients with CKD\u003csup\u003e\u003cspan citationid=\"CR61\" class=\"CitationRef\"\u003e61\u003c/span\u003e\u003c/sup\u003e. The stronger care and support provided by family members, the more secure the patients would feel in the family, and then the patients could actively perceive the benefits from disease\u003csup\u003e\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e\u003c/sup\u003e, and establish motivation and confidence in disease self-management\u003csup\u003e\u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e62\u003c/span\u003e\u003c/sup\u003e, as a result of fostering self-management behaviors among patients with CKD\u003csup\u003e\u003cspan citationid=\"CR63\" class=\"CitationRef\"\u003e63\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003eLimitation\u003c/h2\u003e \u003cp\u003eDespite the many strengths of the current study, certain limitations should be considered. Firstly, Due to human resources and time constraints, all participants were recruited from a tertiary hospital in Chengdu. Thus, the findings of this study may not necessarily be applicable to infer the self-management behaviors of CKD patients in other locations or healthcare institutions. Secondly, the cross-sectional design of this study caused difficulty in making causal inferences. Finally, similar to other cross-sectional studies, a certain amount of recall bias may be present as the results of the study were all measured using self-report questionnaires rather than through objective records.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe results of this study provide support for the relationship between benefit finding, family care, and self-management behaviors in patients with CKD, and demonstrate a pathway mechanism by which family care influences self-management behaviors through benefit finding. In clinical practice, healthcare professionals should enhance the assessment of the self-management behaviors of CKD patients, focus on and formulate intervention strategies in family care and benefit finding, encourage patients to actively seek family support, and facilitate patients to perceive the positive experience of the disease, to promote the implementation of good self-management behaviors. In addition, by fostering a trusting relationship with patients and their families, empowering family members to act as peer mentors, improving patients' perceptions of family care, and arousing patients' positive emotions, they can strengthen patients' self-management behaviors and improve patients' quality of life.\u003c/p\u003e "},{"header":"Declarations","content":"\u003ch2\u003eCompeting interests\u003c/h2\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\n\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\n\u003cp\u003eConceptualization: W.W.Y., H.H.Y., X.H.Z.; Methodology: W.W.Y., H.H.Y., Software: W.W.Y.; Validation: C.X.F., X.H.Z.; Formal Analysis: W.W.Y., H.H.Y., X.H.Z.; Investigation: W.W.Y., C.X.F.; Writing-Original Draft Preparation: W.W.Y., Writing- Review \u0026amp; Editing: W.W.Y., H.H.Y., X.H.Z.; Supervision: H.H.Y. After reading the final manuscript, all members of the research agreed on the final version of the manuscript.\u003c/p\u003e\n\u003ch2\u003eData Availability\u003c/h2\u003e\n\u003cp\u003eThe datasets generated during and/or analyzed during the current study are not publicly available but are available from the corresponding author on reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eEvans, M. \u003cem\u003eet al.\u003c/em\u003e A Narrative Review of Chronic Kidney Disease in Clinical Practice: Current Challenges and Future Perspectives. \u003cem\u003eAdv. Ther.\u003c/em\u003e\u003cstrong\u003e39\u003c/strong\u003e, 33\u0026ndash;43 (2022).\u003c/li\u003e\n\u003cli\u003eBurnier, M. \u0026amp; Damianaki, A. Hypertension as Cardiovascular Risk Factor in Chronic Kidney Disease. \u003cem\u003eCirc. Res.\u003c/em\u003e\u003cstrong\u003e132\u003c/strong\u003e, 1050\u0026ndash;1063 (2023).\u003c/li\u003e\n\u003cli\u003eRibeiro, H. 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Nurs.\u003c/em\u003e\u003cstrong\u003e31\u003c/strong\u003e, 703\u0026ndash;715 (2022).\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e1\u003c/strong\u003e\u003cstrong\u003e.\u003c/strong\u003e Sample characteristics (N = 529).\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"99%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 78.7879%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21.2121%;\"\u003e\n \u003cp\u003e\u003cstrong\u003en (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 78.7879%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGender\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21.2121%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 78.7879%;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21.2121%;\"\u003e\n \u003cp\u003e248 (46.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 78.7879%;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21.2121%;\"\u003e\n \u003cp\u003e281 (53.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 78.7879%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21.2121%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 78.7879%;\"\u003e\n \u003cp\u003e18 ~ \u0026lt;45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21.2121%;\"\u003e\n \u003cp\u003e304 (57.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 78.7879%;\"\u003e\n \u003cp\u003e45 ~ \u0026lt;60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21.2121%;\"\u003e\n \u003cp\u003e169 (31.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 78.7879%;\"\u003e\n \u003cp\u003e\u0026ge;60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21.2121%;\"\u003e\n \u003cp\u003e56 (10.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 78.7879%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEducation level\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21.2121%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 78.7879%;\"\u003e\n \u003cp\u003ePrimary school or below\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21.2121%;\"\u003e\n \u003cp\u003e61 (11.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 78.7879%;\"\u003e\n \u003cp\u003eJunior high school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21.2121%;\"\u003e\n \u003cp\u003e101 (19.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 78.7879%;\"\u003e\n \u003cp\u003eHigh/vocational school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21.2121%;\"\u003e\n \u003cp\u003e110 (20.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 78.7879%;\"\u003e\n \u003cp\u003eCollege or above\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21.2121%;\"\u003e\n \u003cp\u003e257 (48.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 78.7879%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMarital status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21.2121%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 78.7879%;\"\u003e\n \u003cp\u003eUnmarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21.2121%;\"\u003e\n \u003cp\u003e111 (21.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 78.7879%;\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21.2121%;\"\u003e\n \u003cp\u003e382 (72.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 78.7879%;\"\u003e\n \u003cp\u003eDivorced or widowed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21.2121%;\"\u003e\n \u003cp\u003e36 (6.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 78.7879%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eWork status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21.2121%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 78.7879%;\"\u003e\n \u003cp\u003eEmployed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21.2121%;\"\u003e\n \u003cp\u003e252 (47.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 78.7879%;\"\u003e\n \u003cp\u003eUnemployed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21.2121%;\"\u003e\n \u003cp\u003e220 (41.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 78.7879%;\"\u003e\n \u003cp\u003eRetired\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21.2121%;\"\u003e\n \u003cp\u003e57 (10.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 78.7879%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHousehold income per capita (CNY/month)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21.2121%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 78.7879%;\"\u003e\n \u003cp\u003e\u0026lt;3,000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21.2121%;\"\u003e\n \u003cp\u003e144 (27.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 78.7879%;\"\u003e\n \u003cp\u003e3,000 ~ 5,000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21.2121%;\"\u003e\n \u003cp\u003e153 (28.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 78.7879%;\"\u003e\n \u003cp\u003e\u0026gt;5,000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21.2121%;\"\u003e\n \u003cp\u003e232 (43.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 78.7879%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDuration of CKD (year)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21.2121%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 78.7879%;\"\u003e\n \u003cp\u003e\u0026lt;1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21.2121%;\"\u003e\n \u003cp\u003e236 (44.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 78.7879%;\"\u003e\n \u003cp\u003e1 ~ 5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21.2121%;\"\u003e\n \u003cp\u003e119 (22.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 78.7879%;\"\u003e\n \u003cp\u003e\u0026gt;5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21.2121%;\"\u003e\n \u003cp\u003e174 (32.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 78.7879%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eStage of CKD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21.2121%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 78.7879%;\"\u003e\n \u003cp\u003eStage 1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21.2121%;\"\u003e\n \u003cp\u003e144 (27.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 78.7879%;\"\u003e\n \u003cp\u003eStage 2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21.2121%;\"\u003e\n \u003cp\u003e75 (14.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 78.7879%;\"\u003e\n \u003cp\u003eStage 3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21.2121%;\"\u003e\n \u003cp\u003e86 (16.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 78.7879%;\"\u003e\n \u003cp\u003eStage 4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21.2121%;\"\u003e\n \u003cp\u003e16 (3.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 78.7879%;\"\u003e\n \u003cp\u003eStage 5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21.2121%;\"\u003e\n \u003cp\u003e208 (39.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 78.7879%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCurrent treatment options\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21.2121%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 78.7879%;\"\u003e\n \u003cp\u003eConservative treatment without dialysis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21.2121%;\"\u003e\n \u003cp\u003e316 (59.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 78.7879%;\"\u003e\n \u003cp\u003ePeritoneal dialysis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21.2121%;\"\u003e\n \u003cp\u003e26 (4.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 78.7879%;\"\u003e\n \u003cp\u003eHemodialysis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21.2121%;\"\u003e\n \u003cp\u003e183 (34.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 78.7879%;\"\u003e\n \u003cp\u003eKidney transplantation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21.2121%;\"\u003e\n \u003cp\u003e4 (0.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 78.7879%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eReceived health education\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21.2121%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 78.7879%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21.2121%;\"\u003e\n \u003cp\u003e311 (58.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 78.7879%;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21.2121%;\"\u003e\n \u003cp\u003e218 (41.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 78.7879%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eResidence\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21.2121%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 78.7879%;\"\u003e\n \u003cp\u003eRural\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21.2121%;\"\u003e\n \u003cp\u003e110 (20.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 78.7879%;\"\u003e\n \u003cp\u003eUrban\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21.2121%;\"\u003e\n \u003cp\u003e419 (79.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 78.7879%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMedical coverage\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21.2121%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 78.7879%;\"\u003e\n \u003cp\u003eNew rural cooperative medical care\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21.2121%;\"\u003e\n \u003cp\u003e110 (20.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 78.7879%;\"\u003e\n \u003cp\u003eResident health insurance\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21.2121%;\"\u003e\n \u003cp\u003e183 (34.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 78.7879%;\"\u003e\n \u003cp\u003eEmployee health insurance\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21.2121%;\"\u003e\n \u003cp\u003e203 (38.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 78.7879%;\"\u003e\n \u003cp\u003eSelf-financed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21.2121%;\"\u003e\n \u003cp\u003e29 (5.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 78.7879%;\"\u003e\n \u003cp\u003eCommercial health insurance\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21.2121%;\"\u003e\n \u003cp\u003e4 (0.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 78.7879%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eComorbidities or complications\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21.2121%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 78.7879%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21.2121%;\"\u003e\n \u003cp\u003e236 (44.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 78.7879%;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21.2121%;\"\u003e\n \u003cp\u003e293 (55.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e2\u003c/strong\u003e\u003cstrong\u003e.\u003c/strong\u003e Means, SDs, and correlations of all variables.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 31.1958%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21.3172%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean (SD)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.1716%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRange\u003csup\u003ea\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.4645%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFamily care\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.851%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBenefit finding\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 31.1958%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFamily care\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21.3172%;\"\u003e\n \u003cp\u003e7.67 (2.39)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.1716%;\"\u003e\n \u003cp\u003e0-10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.4645%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.851%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 31.1958%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBenefit finding\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21.3172%;\"\u003e\n \u003cp\u003e46.90 (11.40)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.1716%;\"\u003e\n \u003cp\u003e19-76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.4645%;\"\u003e\n \u003cp\u003e0.342**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.851%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 31.1958%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSelf-management behaviors\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21.3172%;\"\u003e\n \u003cp\u003e19.19 (7.54)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.1716%;\"\u003e\n \u003cp\u003e2-47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.4645%;\"\u003e\n \u003cp\u003e0.115**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.851%;\"\u003e\n \u003cp\u003e0.459**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eNote:\u0026nbsp;\u003c/strong\u003e\u003csup\u003ea\u003c/sup\u003eThe actual score range for each variable. **\u003cem\u003ep\u003c/em\u003e \u0026lt; 0.01.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e3\u003c/strong\u003e\u003cstrong\u003e.\u003c/strong\u003e The path coefficients of the mediation model.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"97%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 48.4848%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eStructural path\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19.1919%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eStandardized estimate\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.101%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eS.E.\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.101%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eC.R.\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.1212%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 48.4848%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFamily care \u0026rarr; Benefit finding\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19.1919%;\"\u003e\n \u003cp\u003e0.368\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.101%;\"\u003e\n \u003cp\u003e1.434\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.101%;\"\u003e\n \u003cp\u003e7.853\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.1212%;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 48.4848%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFamily care \u0026rarr; Self-management behaviors\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19.1919%;\"\u003e\n \u003cp\u003e-0.074\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.101%;\"\u003e\n \u003cp\u003e0.176\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.101%;\"\u003e\n \u003cp\u003e-1.169\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.1212%;\"\u003e\n \u003cp\u003e0.242\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 48.4848%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBenefit finding \u0026rarr; Self-management behaviors\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19.1919%;\"\u003e\n \u003cp\u003e0.701\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.101%;\"\u003e\n \u003cp\u003e0.012\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.101%;\"\u003e\n \u003cp\u003e5.406\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.1212%;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e4\u003c/strong\u003e\u003cstrong\u003e.\u003c/strong\u003e Mediating effect.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 28.866%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEffect\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21.6495%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEstimate\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.5258%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLower\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.4948%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eUpper\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.4639%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 28.866%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eIndirect effect\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21.6495%;\"\u003e\n \u003cp\u003e0.258\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.5258%;\"\u003e\n \u003cp\u003e0.184\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.4948%;\"\u003e\n \u003cp\u003e0.342\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.4639%;\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 28.866%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDirect effect\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21.6495%;\"\u003e\n \u003cp\u003e-0.074\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.5258%;\"\u003e\n \u003cp\u003e-0.207\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.4948%;\"\u003e\n \u003cp\u003e0.073\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.4639%;\"\u003e\n \u003cp\u003e0.317\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 28.866%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal effect\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21.6495%;\"\u003e\n \u003cp\u003e0.184\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.5258%;\"\u003e\n \u003cp\u003e0.060\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.4948%;\"\u003e\n \u003cp\u003e0.313\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.4639%;\"\u003e\n \u003cp\u003e0.006\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Chronic kidney disease, Family care, Benefit finding, Self-management behaviors, Mediation analysis","lastPublishedDoi":"10.21203/rs.3.rs-5267980/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5267980/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eThis study aimed to investigate the mediating role of benefit finding on the relationship between family care and self-management behaviors in patients with chronic kidney disease (CKD) to inform improvements in patients' self-management behaviors. This survey was conducted from November 2023 to February 2024 with a cross-sectional design and convenience sampling among patients with chronic kidney disease in a tertiary care hospital in Chengdu City. Participants were prompted to complete a demographic questionnaire, the Family APGAR Index (APGAR), the Benefit Finding Scale (BFS), and the Chronic Disease Self-management Behavior Measuring Scale (CDSMBMS). The analysis of the data was carried out using SPSS 29.0 and AMOS Statistics 28.0. A total of 529 patients were enrolled in this research, with a majority of females (53.1%). The mean total score of CDSMBMS was 19.19\u0026thinsp;\u0026plusmn;\u0026thinsp;7.54. Family care and benefit finding were significantly positively associated with self-management behaviors (all \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01). In addition, benefit finding fully mediated the association between family care and self-management behaviors (β\u0026thinsp;=\u0026thinsp;0.258, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.000, 95% CI\u0026thinsp;=\u0026thinsp;0.184\u0026ndash;0.342). Our findings indicate that benefit finding plays a full mediator in the relationship between family care and self-management behaviors among patients with CKD. Thus, healthcare professionals should develop evidence-based interventions in future studies to enhance family care and benefit finding to promote self-management behaviors in people with CKD.\u003c/p\u003e","manuscriptTitle":"The Mediating Role of Benefit Finding in the Relationship Between Family Care and Self-Management Behaviors in Patients with Chronic Kidney Disease","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-11-19 14:06:49","doi":"10.21203/rs.3.rs-5267980/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"01b28d4b-4e5e-414b-b5f3-857354154c91","owner":[],"postedDate":"November 19th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":39916302,"name":"Health sciences/Nephrology/Kidney diseases/Chronic kidney disease"},{"id":39916303,"name":"Health sciences/Health care/Patient education"},{"id":39916304,"name":"Health sciences/Health care/Health services"}],"tags":[],"updatedAt":"2025-03-03T06:08:46+00:00","versionOfRecord":[],"versionCreatedAt":"2024-11-19 14:06:49","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5267980","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5267980","identity":"rs-5267980","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}