The Decision-Making Experience of Self-Management Behaviors in Home Peritoneal Dialysis for Patients with Diabetic Nephropathy: A Qualitative Study Using the Theory of Planned Behavior.

Purpose: Self-management among diabetic kidney disease(DKD) patients receiving home peritoneal dialysis(PD) remains a significant challenge, warranting further exploration. In this study, the Theory of Planned Behavior (TPB) was used to clarify patients' decision-making processes and understand the reasons for adhering to and changing behaviors.

Methods: Semi-structured interviews were conducted with 16 DKD patients who were undergoing follow-up and receiving home PD. The TPB was applied to formulate the interview themes and provide information for the Interpretative Phenomenological Analysis (IPA) method used.

Results: A total of 3 themes and 7 sub-themes were summarized, namely attitude towards behavior, where physical and mental perception affects the decision-making attitude (the positive feedback of improved physical function strengthens the decision-making attitude; the two-way influence of emotions catalyzes the decision-making attitude); subjective norm, where social factors drive the decision-making belief (the behavioral outcomes of peers transform the decision-making belief; the continuity of medical and nursing services consolidates the decision-making belief; the motivation of social feedback stimulates the decision-making belief); perceived behavioral control, where self-perception influences the decision-making intention (positive self-efficacy motivates the decision-making intention; the limitation of external resources restricts the decision-making intention).

Conclusion: For the management of home PD in patients with DKD, efforts can be made to improve patients' decision-making in self-management of home PD by strengthening the positive feedback of psychological experiences in behavioral decision-making, exploring digital peer support platforms and social support networks for such patients to improve the mechanism of patients' active participation in decision-making within social support networks, and improving the community support system from multiple dimensions such as incorporating relevant policies into assessment criteria, coordinating funds through multiple channels, enhancing the capabilities of community medical and nursing teams, and encouraging doctor-patient shared decision-making, thereby exploring and constructing a community assistance model for the management of home PD in patients with DKD.