Construction and Application of Maintenance Intervention Program for Autologous Arteriovenous Fistula in Elderly Hemodialysis Patients Based on IFSMT Theory

Ran Hao, Yufei Zhao, Meimei Rong, Wenxiu Liu, Meijie Zheng, Ziyu Gui, Zihan Hao, Xian Li

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¹ College of Nursing and Rehabilitation, North China University of Science and Technology, Tangshan 063210, Hebei, China,

² College of Nursing and Rehabilitation, North China University of Science and Technology, Tangshan 063210, Hebei, China,

³ College of Nursing and Rehabilitation, North China University of Science and Technology, Tangshan 063210, Hebei, China,

⁴ Nursing Department, Hebei General Hospital, Shijiazhuang 050000, Hebei, China,

⁵ Nursing Department, Hebei General Hospital, Shijiazhuang 050000, Hebei, China,

⁶ College of Nursing and Rehabilitation, North China University of Science and Technology, Tangshan 063210, Hebei, China,

⁷ College of Nursing and Rehabilitation, North China University of Science and Technology, Tangshan 063210, Hebei, China,

⁸ Department of Nursing and Medical Development, Hebei General Hospital, Shijiazhuang 050000, Hebei, China,

JCNR 2026 , 10(7), 252–267; https://doi.org/10.26689/jcnr.v10i7.15893

© 2026 by the Authors. Licensee Whioce Publishing, Singapore. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution 4.0 International License ( https://creativecommons.org/licenses/by/4.0/ )

Abstract

Objective: To analyze contextual factors influencing self-management of arteriovenous fistulas (AVFs) among elderly patients on maintenance hemodialysis based on the Individual and Family Self-Management Theory (IFSMT), to develop an intervention model centered on patient-family-healthcare collaboration for AVF maintenance, and to evaluate its effectiveness. Methods: This study consisted of two phases. The first phase was a cross-sectional survey involving 165 participants, with 157 valid questionnaires collected to identify contextual factors affecting AVF self-management in elderly maintenance hemodialysis (MHD) patients. The second phase was a randomized controlled trial designed to assess the effectiveness of the intervention model developed based on IFSMT. Elderly AVF patients admitted to the hemodialysis unit of a tertiary hospital in Hebei Province between September 2025 and March 2026 were randomly assigned to either a control group or an intervention group using a random number table, with 63 patients in each group; ultimately, 60 patients completed follow-up in each group. The control group received standard care, while the intervention group received the IFSMT-based intervention in addition to standard care over a three-month period. Results: The mean self-management score for elderly AVF patients was 45.662 ± 7.701, indicating a moderate overall level. Factors including dialysis duration, daily care, daily AVF exercise, daily AVF self-checking, history of AVF failure or complications, anxiety, depression, general self-efficacy, and family support were identified as significant contextual factors influencing AVF self-management. After the intervention, the incidence of AVF abnormalities and failure was significantly lower in the intervention group compared to the control group (p < 0.05). The total scores and subscale scores of the AVF self-management scale were higher in the intervention group than in the control group (p < 0.05). The self-efficacy scores and family support index scores were also significantly higher in the intervention group (p < 0.05). Additionally, quality-of-life scores were higher in the intervention group (p < 0.05). Conclusion: The self-management program based on IFSMT can improve AVF maintenance outcomes, reduce the occurrence of AVF complications and failure rates, enhance patients’ self-management capacity and general self-efficacy, and improve family support and quality of life.

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