Exploring Factors Related to Self-Advocacy Among Patients Receiving Maintenance Hemodialysis in China: A Qualitative Study Based on the COM-B Model

Background: Patient-centered care requires patients receiving maintenance hemodialysis (MHD) to communicate their health needs and actively participate in disease management. Self-advocacy is a behavioral process through which patients seek health-related information, express individualized needs, and participate in disease management. Enhancing self-advocacy is essential for advancing patient-centered care in MHD. Objectives: This study sought to investigate the factors influencing self-advocacy among patients receiving MHD. Methods: From February to May 2026, we recruited 18 patients receiving MHD from the blood purification center of a tertiary hospital in Guangzhou, China, using purposive sampling. Guided by the Capability, Opportunity, Motivation–Behavior (COM-B) model, we conducted a descriptive qualitative study. We collected data through semi-structured interviews and analyzed them using inductive–deductive thematic analysis. Results: Guided by the COM-B model, the findings encompassed three dimensions: capability, opportunity, and motivation. Regarding capability, patients experienced cognitive overload and difficulty translating experiences into expression, while some acquired proactive coping strategies. Regarding opportunity, family relationships constrained patient voice, whereas ongoing patient–provider relationships fostered empowerment. Regarding motivation, patients showed sensitivity to relational costs and awareness of financial burden, while also demonstrating a sense of responsibility for their health. Conclusions: The findings revealed that multiple factors across the dimensions of capability, opportunity, and motivation influenced self-advocacy among patients receiving MHD. Promoting self-advocacy requires not only improving patients’ ability to understand health information and communicate effectively, but also strengthening family support, improving patient–provider interactions, and supporting patients’ sense of responsibility for their health. Future research could explore targeted support strategies based on these findings and evaluate their feasibility and effectiveness in dialysis care.