The central role of habit in fluid management: a longitudinal study in patients on maintenance hemodialysis

Effective fluid management is essential for patients receiving maintenance hemodialysis; however, an “intention-behavior gap” is frequently observed in clinical practice. Temporal self-regulation theory provides an integrated framework for explaining this multifaceted behavior, yet its practical relevance and operative mechanisms in hemodialysis-related fluid management remain insufficiently understood.

A longitudinal design was employed with 184 patients receiving hemodialysis recruited through convenience sampling from two tertiary hospitals during November-December 2025. Baseline assessments (T1) captured demographic characteristics, behavioral intentions, self-regulatory capacity, and habitual patterns, with fluid management behaviors evaluated one week subsequently (T2). Hierarchical regression analysis examined variable relationships, while Johnson-Neyman techniques were used for exploratory analyses of interaction effects.

The hierarchical regression model explained 43.7% of the variance in behavior, with temporal self-regulation theory variables jointly accounting for 25% (p < .001). Habit was the strongest and most robust predictor of behavior (β = 0.416, p < .001). A negative interaction between intention and habit was observed but did not reach conventional statistical significance (β = -0.125, p = .058; adjusted p = .174 after Bonferroni correction). Exploratory Johnson‑Neyman analysis suggested that the positive association between intention and behavior was observed primarily among patients with lower habit scores, although the interaction did not reach statistical significance. Self-regulation capacity demonstrated neither a significant main effect nor a significant moderating effect.

A descriptive intention-behavior gap characterizes fluid management in patients receiving hemodialysis. Temporal Self-Regulation Theory offers a viable framework for explicating how social-cognitive factors influence fluid management behaviors in this population. It provides a reference for developing effective interventions aimed at enhancing fluid management practices among such patients.

Not applicable.