Exploring the association between perceived control, psychological flexibility, and hope among hemodialysis patients: a cross-sectional observational study.

BACKGROUND: Psychological resilience is critical for hemodialysis patients, although the associations among perceived control, psychological flexibility, and hope remain insufficiently understood. This study examined the relationships among these variables within a unified analytical framework. METHODS: Data were collected on 417 hemodialysis patients. This study employed a cross-sectional design and was conducted between January 2023 and May 2024 across four hospitals in China. Patients receiving maintenance hemodialysis were purposively sampled. Participants were included if they met the following criteria: (1) were diagnosed with kidney failure in accordance with the Kidney Disease Outcomes Quality Initiative (KDOQI) guidelines; (2) were 18 years of age or older; (3) had been receiving maintenance hemodialysis for at least three months, with regular sessions two to three times per week; (4) were clinically stable, without serious or acute complications; and (5) demonstrated adequate cognitive function and communication skills to understand the study and independently complete the questionnaire. Exclusion criteria included: (1) hemodialysis duration of less than three months; (2) presence of acute infection; (3) acute heart failure; or (4) being in the acute phase of a cerebrovascular event. Hope was assessed using the Herth Hope Index (HHI), developed by Kathryn Herth in 1991 to measure an individuals' positive outlook and sense of hope for the future. Perceived control was measured using selected subscales from the Revised Illness Perception Questionnaire (IPQ-R). Psychological flexibility was evaluated using the Acceptance and Action Questionnaire-II (AAQ-II). Linear regression analyses were conducted to examine associations among variables, and structural equation modeling was used to evaluate model-consistent relationships. RESULTS: Hope was associated with psychological flexibility scores and perceived control scores, indicating that higher levels of hope were related to greater psychological flexibility and perceived control. Psychological flexibility scores were positively associated with perceived control scores. Regression analyses showed that perceived control subdimensions (including consequence awareness, personal control, and treatment control) were associated with hope, with some associations remaining significant after adjustment for psychological flexibility. Structural equation modeling indicated that the observed associations among perceived control, psychological flexibility, and hope were consistent with the proposed model. CONCLUSIONS: The findings demonstrate close associations among perceived control, psychological flexibility, and hope in hemodialysis patients, consistent with the Stress and Coping Theory framework. The results may inform psychological support strategies.