Objective <p>This study aimed to explore the facilitative and obstructive factors of self-management in patients undergoing maintenance hemodialysis to provide a reference for improving patient self-management in China.</p> Methods <p>Qualitative description was adopted as a suitable methodological. approach to characterize the phenomena of self-management experiences in patients undergoing maintenance hemodialysis. This qualitative study collected data via semi-structured interviews conducted with 18 maintenance hemodialysis patients in Henan Province, China, during the period from January 1 to February 28, 2025. Qualitative analysis of the recorded interviews was conducted to generate themes.</p> Results <p>Based on the Social Ecological Model, this study summarized the facilitators and barriers to self-management among patients receiving maintenance hemodialysis, and identified a total of 10 themes across five levels: individual, interpersonal, organizational, community, and social.</p> Conclusion <p>Maintenance hemodialysis patients' self-management is a systemic issue; single-level interventions fail to fundamentally improve outcomes. Based on the Social Ecological Model, it is imperative to establish a multidimensional collaborative intervention system covering individual, interpersonal, organizational, community, and social levels to comprehensively enhance their self-management capacity.</p>