A Pathway Analysis of Factors Affecting Quality of Life in Peritoneal Dialysis Patients: A Cross-Sectional Study Based on Individual and Family Self-Management Theory.

Purpose: This study aimed to explore factors affecting the quality of life in peritoneal dialysis (PD) patients. Furthermore, based on the Individual and Family Self-management Theory, this study constructed a path analysis to explore the relationship between psychological distress, social support, patient activation, and quality of life. Participants and Methods: This study was a cross-sectional study. It included 211 PD patients from a peritoneal dialysis center in China. The questionnaire survey employed convenience sampling, with data collection conducted between March and June 2025. The survey tools included a general information questionnaire, the perceived social support scale, the Kessler psychological distress scale, the patient activation measure-13 item and the short-form 12-item health survey. Correlation analysis and linear regression were used to explore the factors affecting the quality of life of PD patients. Path analysis was performed using structural equation modelling, and the bootstrap program was employed to further test the mediating effect. Results: In this study, quality of life was assessed in two dimensions, physical component summary (PCS) and mental component summary (MCS). MCS was positively correlated with social support (r = 0.55, P < 0.01) and patient activation (r = 0.51, P < 0.01), and negatively correlated with psychological distress (r = -0.65, P < 0.01). PCS was also positively related with social support (r = 0.23, P < 0.01) and patient activation (r = 0.21, P < 0.01), and negatively related with psychological distress (r = -0.25, P < 0.01). Complications, psychological distress, social support, and patient activation explained 48% of MCS. Age, monthly household income, psychological distress, social support, and patient activation explained 12% of PCS. The structural equation modelling exhibited a good fit (CMIN/df = 1.380, P = 0.252, GFI = 0.995, AGFI = 0.961, NFI = 0.993, IFI = 0.998, TLI = 0.990, CFI = 0.998, RMSEA=0.043). Path analysis revealed that social support (β = 0.17, P < 0.05), psychological distress (β = -0.47, P < 0.001), and patient activation (β = 0.18, P < 0.01) directly influenced MCS; only psychological distress (β = -0.29, P < 0.01) directly influenced PCS. Furthermore, patient activation mediated the relationship between social support and MCS (β = 0.10, 95% confidence interval [CI]: 0.02-0.18, P < 0.01), and also mediated the relationship between psychological distress and MCS (β = -0.04, 95% CI: -0.09 - -0.01, P < 0.01). Conclusion: The results indicated that psychological distress, social support, patient activation, and quality of life were closely related in PD patients. These findings emphasize the importance of implementing comprehensive care strategies for PD patients that address their physical, psychological, and social needs. Interventions should be implemented to alleviate psychological distress and strengthen social support. Concurrently, educational programs should be implemented to actively guide PD patients in participating in their own dialysis care, thereby enhancing engagement and improving their overall quality of life.