Objective To explore the potential impact pathways of self?management behavior based on COM?B model， in maintenance hemodialysis （MHD） patients， and provide reference for the intervention of self?management behavior. Methods Judgment sampling was used to select 350 MHD patients undergoing dialysis at the hospital in a certain district of Guangzhou， and a questionnaire survey was conducted among them. Smart PLS software was used to construct a partial least squares structural equation model and perform path analysis. Results Self?management behavior score of MHD patients was （57.06 ± 13.28）. Univariate analysis showed that age， education background， employment status， occupational classification， per capita monthly income of families， and the number of comorbidities could directly affect self?management behavior of MHD patients （P < 0.05）. PLS?SEM model showed that self?efficacy （β = 0.246）， family care level （β = 0.124） and social support （β = 0.140） positively impacted patients′ self?management behavior， while disease perception negatively affected self?management behavior（β = -0.097）. Self?efficacy can mediate the impact of disease perception and social support on self?management behavior of MHD patients （P < 0.05）. Conclusions Self?management behavior of MHD patients is currently at a low level. Therefore， when devising intervention plans for these patients， it is crucial to consider the combined effects of disease knowledge education， disease perception reconstruction， opportunity provision， and motivation. The primary focus should be on enhancing patients' self?efficacy， which will ultimately elevate their overall level of self?management.