Low self-care and treatment adherence are found among hemodialysis patients. We aimed to identify the factors influencing self-care behavior and treatment adherence and examine the mediating effect of treatment adherence on self-care behavior. A questionnaire was administered through a social media community from 11 July to 13 August 2021. The data collected from 100 participants were analyzed using the independent t-test, one-way analysis of variance, Pearson’s correlation, multiple linear regression analysis, and hierarchical multiple regression analysis. The mean self-care behavior and treatment adherence scores were 3.52 ± 0.57 and 4.01 ± 0.48, respectively. The mean age and hemodialysis duration were 51.70 ± 9.40 and 7.57 ± 7.21 years, respectively. The common primary cause of end-stage renal disease was glomerulonephritis (n = 39, 39%). Self-care behavior varied with education, frequency of self-care behavior education, and social support and was positively correlated with treatment adherence and social support. Treatment adherence was positively correlated with social support. Treatment adherence, social support, and health status were influenced self-care behavior (54.5%. Self-care behavior and frequency of self-care behavior education influenced treatment adherence (61.3%). Treatment adherence partially mediated the relationship between social support and self-care behavior. Intervention strategies that increase both social support and treatment adherence can promote self-care behavior.

Herein, we performed a meta-analysis evaluating the effects of treatment adherence enhancement programs on treatment adherence and secondary outcomes for hemodialysis patients. Twenty-five Korean and international articles published prior to 31 March 2022 were selected following the PRISMA and Cochrane Systematic Review guidelines. We calculated summary effect sizes, conducted homogeneity and heterogeneity testing, constructed a funnel plot, and performed Egger’s regression test, Begg’s test, trim-and-fill method, subgroup analyses, and univariate meta-regression. The overall effect of treatment adherence enhancement programs for hemodialysis patients was statistically significant (Hedges’ g = 1.10, 95% CI: 0.77, 1.43). On performing subgroup analysis to determine the cause of effect size heterogeneity, statistically significant moderating effects were found for a range of input variables (Asian countries, study centers, sample size, study design, intervention types, number of sessions, quality assessment scores, funding, and evidence-based interventions). On univariate meta-regression, larger synthesized effect sizes were found for a range of study characteristics (Asian populations, single-center studies, studies with 12 sessions, studies with quality assessment scores above the mean, unfunded studies, and non-theory-based interventions). Our results provide evidence-based information for enhancing program efficacy when designing treatment adherence enhancement programs for hemodialysis patients.