Psychological Factors Associated with Treatment Adherence in Patients Undergoing Maintenance Hemodialysis: A Cross-Sectional Network Analysis.

Abstract

Background: Patients undergoing maintenance hemodialysis require long-term complex treatment and strict self-management, and nonadherence to treatment is relatively common. Meaning in life, social support, and loneliness may be jointly associated with treatment adherence; however, the complex network of associations among these factors remains unclear.

Methods: In this cross-sectional study, 481 patients with end-stage renal disease undergoing maintenance hemodialysis were recruited using convenience sampling from the hemodialysis centers of three hospitals in a city in China. Data were collected between December 2024 and February 2025 using the Treatment Adherence Scale for Patients with End-Stage Renal Disease Undergoing Maintenance Hemodialysis, the Meaning in Life Questionnaire, the Perceived Social Support Scale, and the Loneliness Scale. Network analysis was used to construct a partial correlation network comprising eight nodes. Strength centrality and expected influence were used to identify relatively central nodes, bridge expected influence was applied to analyze the strength of cross-community associations, and network accuracy and stability were examined.

Results: In the network, treatment adherence showed positive partial correlations with presence of meaning (edge weight = 0.213) and family support (0.103), and negative partial correlations with emotional loneliness (-0.099) and social loneliness (-0.093). Social loneliness and significant other support were among the nodes with the highest strength centrality, while support from friends had the highest expected influence. Presence of meaning had the highest positive bridge expected influence, while social loneliness had the highest negative bridge expected influence. Strength centrality and expected influence showed good stability, with correlation stability coefficients of 0.595 for both indices.

Conclusion: The findings suggest that social loneliness, support from friends and significant others, and presence of meaning may be important nodes in the psychological network related to treatment adherence. These findings may inform the selection of candidate targets for future nursing intervention research.