The construct of self-efficacy was grounded on the basis of challenges to diet and fluid restrictions and then the findings were used to develop a questionnaire to quantify patients’ perception of their ability to overcome each challenge. the sample of the qualitative study consisted of 16 haemodialysis patients. for the analysis of the data, template analysis was used. That of quantitative study consisted of 156 haemodialysis patients. the qualitative findings revealed that patients experienced a range of specific challenges to diet and fluid restrictions. Among these were practical constraints, being with others, view of haemodialysis as compensating for dietary non-compliance and emotional challenges including discomfort, distress, boredom with diet and fluid restrictions. the most common challenge to fluid restrictions was eating while not having any fluid allowance left. Boredom with diet was the commonest challenge to diet. Haemodialysis was a justification for a significant number of patients to neglect their diet and fluid restrictions. in the principal components analysis, 17 items of the Management of Diet and Fluid Restrictions Questionnaire for Haemodialysis Patients (MDFRQ-Haemodialysis) were loaded on one factor. the findings suggest that grounded self-efficacy is a unitary phenomenon but it incorporates a wide spectrum of specific challenges. the challenges to diet and fluid restrictions identified have provided an evidence base for educational interventions to improve compliance with these restrictions.