Influence of Social Support on Self-Management Behavior of Hemodialysis Patients: Focusing on the Mediating Effect of Self-Esteem

Background/Objectives: Patients undergoing hemodialysis experience psychosocial burdens that may hinder self-management. Guided by Bandura’s social cognitive theory, this study examined whether self-esteem statistically mediated the association between perceived social support and self-management behavior. Methods: A descriptive cross-sectional study was conducted with 145 patients receiving regular hemodialysis at three medical institutions in South Korea. The mediation model was tested using Hayes’ PROCESS macro Model 4 with 5000 bootstrap samples and 95% bias-corrected confidence intervals, adjusting for relevant covariates. Results: Self-management behavior was positively correlated with social support (r = 0.41, p < 0.001) and self-esteem (r = 0.52, p < 0.001). Social support was also positively correlated with self-esteem (r = 0.67, p < 0.001). Social support was associated with self-management both directly and indirectly through self-esteem. The bootstrap confidence interval for the indirect association excluded zero, consistent with partial statistical mediation. The indirect association accounted for approximately 45% of the total association. Conclusions: Higher perceived social support and self-esteem were associated with better self-management behavior among patients undergoing hemodialysis. Nursing interventions that strengthen supportive social resources and self-esteem may help promote sustained self-management in this population.