The effect of spiritual orientation on illness perception and anxiety in hemodialysis patients

This descriptive and correlational study examined the effect of spiritual orientation on illness perception and anxiety in chronic renal failure patients receiving hemodialysis and the mediating role of illness perception. It included 121 adult patients treated for at least six months at the hemodialysis unit of Malatya Training and Research Hospital who met the inclusion criteria and agreed to participate. Data were collected through face-to-face interviews using a Personal Information Form, the Spiritual Orientation Scale, the Brief Illness Perception Questionnaire, and the State Anxiety Inventory (STAI-I), and analyzed using descriptive statistics, t-test, analysis of variance, Pearson correlation analysis, and bootstrap mediation analysis based on the Baron-Kenny and Hayes criteria. Patients' spiritual orientation was moderate-to-high (85.37±22.97), illness perception moderately threatening (39.59±12.55), and anxiety moderate (40.81±11.17). Spiritual orientation was significantly negatively related to illness perception (r=-0.483; p<0.01) and anxiety (r=-0.417; p<0.01), whereas illness perception and anxiety were strongly positively related (r=0.704; p<0.01). The direct effect of spiritual orientation on anxiety became non-significant when illness perception entered the model (p=0.181), while the indirect effect remained significant (β=-0.317; 95% CI [-0.417, -0.219]), demonstrating that illness perception fully mediated this relationship. The explained variance in anxiety increased from 17.4% to 50.4% with the mediator. In conclusion, spiritual orientation reduces anxiety indirectly through illness perception rather than directly: patients with high spiritual orientation perceive their illness as less threatening, more meaningful, and more manageable, which lowers anxiety. Holistic nursing care for hemodialysis patients should therefore incorporate spiritual assessment and psychosocial interventions that strengthen illness perception.