Psychological Well-being of Patients with End-Stage Renal Disease Undergoing Hemodialysis: Concurrent Mixed Methods Design

Abstract

BACKGROUND: Hemodialysis patients face a higher risk of mental health problems compared to the general population. Identifying factors influencing psychological well-being is essential for developing holistic care approaches.

OBJECTIVE: To examine factors affecting psychological well-being and psychological experiences of hemodialysis patients.

METHODS: A concurrent mixed-methods study was conducted with 100 participants for the quantitative component and 15 participants for the qualitative component. Instruments included a demographic and illness data form, the General Mental Well-Being Scale, the Resilience Scale, the Health Locus of Control Scale, and a semi-structured in-depth interview guide. Content validity indices ranged from 0.81 to 1.00, and Cronbach's alpha coefficients ranged from 0.76 to 0.97. Data were analyzed by descriptive statistics, Pearson's correlation, multiple regression analysis, and content analysis.

RESULTS: Resilience, hemoglobin levels, and health locus of control together accounted for 16.9% of the variance in psychological well-being, with resilience emerging as the strongest predictor (b=0.289, 95% CI [0.019, 0.559], p<0.05). Qualitative data synthesis yielded three overarching themes: emotional distress arising from functional limitations and role loss; the psychological transition process from resistance to acceptance; and the role of interpersonal relationships and social support systems.

CONCLUSION: The psychological experiences of patients undergoing hemodialysis are complex and dynamic in nature, evolving across the trajectory of treatment. These findings underscore the need to establish a systematic and continuous psychological well-being assessment framework, alongside effective anemia management strategies, while concurrently fostering resilience among patients throughout all phases of care.