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Aim: To understand the real experiences of self-management in haemodialysis patients with self-regulatory fatigue, and to explore the influencing factors and coping strategies for patients with decreased self-management.Design: A qualitative study was carried out using the phenomenological analysis method.Methods: From 5 January to 25 February, 2022, semi-structured interviews were conducted with 18 haemodialysis patients in Lanzhou, China. Thematic analysis of the data was performed using the NVivo 12 software based on the 7 steps of Colaizzi's method. The study reporting followed the SRQR checklist.Results: Five themes and 13 sub-themes were identified. The main themes were difficulties in fluid restrictions and emotional management, hard to adhere to long-term self-management, uncertainty about self-management, influencing factors are complex and diverse and coping strategies should be further improved. Conclusion:This study revealed the difficulties, uncertainty, influencing facts and coping strategies of self-management among haemodialysis patients with self-regulatory fatigue.A targeted program should be developed and implemented according to the characteristics of patients to reduce the level of self-regulatory fatigue and improve self-management. Impact: Self-regulatory fatigue has a significant impact on the self-management behaviour of haemodialysis patients. Understanding the real experiences of selfmanagement in haemodialysis patients with self-regulatory fatigue enables medical staff to correctly identify the occurrence of self-regulatory fatigue in time and help patients adopt positive coping strategies to keep effective self-management behaviour. Patient or Public contribution:Haemodialysis patients who met the inclusion criteria were recruited to participate in the study from a blood purification centre in Lanzhou, China.

ObjectivesPatients’ and caregivers’ physical and mental health may interact. The theory of dyadic illness management holds that patients and caregivers should be regarded as a whole in health management. Previous studies have found that hemodialysis patients and their family caregivers experience poor sleep quality. Perceived stress and social support have effects on insomnia. However, the dyadic interaction between perceived stress, social support, and insomnia among hemodialysis patients and caregivers is unclear. This study aimed to explore the mediating role of social support in the association between perceived stress and insomnia in hemodialysis patient-caregiver dyads.MethodsA total of 259 hemodialysis patient-caregiver dyads completed the Chinese Perceived Stress Scales (CPSS), the Perceived Social Support Scale (PSSS), and the Athens Insomnia Scale (AIS) in Lanzhou, China, from May 2022 to July 2022. The actor-partner interdependence mediation model analysis was used for data analysis.ResultsIn the actor effect, there was a significant positive correlation between perceived stress and insomnia in hemodialysis patients (β = 0.091, p = 0.001) and their family caregivers (β = 0.588, p < 0.001). Patient’s and caregiver’s social support played partial mediating roles in the relationship between caregiver’s perceived stress and insomnia (β = 0.135, p < 0.001 and β = 0.111, p < 0.001). In the partner effect, caregiver’s perceived stress was positively connected with patient’s insomnia (β = 0.915, p < 0.001), and the mediating effect of patient’s social support on the relationship between caregiver’s perceived stress and patient’s insomnia was statistically significant (β = −0.040, p = 0.046).ConclusionThe perceived stress, social support and insomnia of hemodialysis patients and their family caregivers had interactive effects. Effective dyadic-based interventions should be developed to improve hemodialysis patients’ and caregivers’ sleep quality.