The relationship between illness perception and general self-efficacy in hemodialysis patients: A cross-sectional study in south-western Iran

The relationship between illness perception and general self-efficacy in hemodialysis patients: A cross-sectional study in south-western Iran | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article The relationship between illness perception and general self-efficacy in hemodialysis patients: A cross-sectional study in south-western Iran Masome jafarzadeh, Mohammad Adineh, Shahram Molavynejad, Saeed ghanbari This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6500811/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 28 Aug, 2025 Read the published version in BMC Nephrology → Version 1 posted 12 You are reading this latest preprint version Abstract Introduction: Illness perception may influence self-efficacy in chronic disease management. This study examined the relationship between illness perception and general self-efficacy in hemodialysis patients in Ahvaz, Iran." Materials and methods: This descriptive-analytical cross-sectional study included 266 hemodialysis patients who were selected using stratified sampling with proportional allocation from the hemodialysis units affiliated to Ahvaz Jundishapur University of Medical Sciences in 2023. Data were collected through interviews and medical records using the demographic information form, General Self-Efficacy (GSE) scale and the Brief Illness Perception Questionnaire (Brief-IPQ). Data were analyzed using SPSS version 22. Results: The mean age of the participants was 57.16 ± 12.38 years, and 57.1% of them were male. A direct and significant Correlation was observed between the total score of self-efficacy and illness perception (r = 0.56, P < 0.001). Also, there was a direct and significant Correlation between illness perception and the subscales of self-efficacy including independence (r = 0.201, P = 0.001), organization (r = 0.235, P < 0.001), and problem-solving (r = 0.126, P = 0.039), but no significant Correlation was observed between illness perception and social support (r=-0.041, P = 0.507). Self-efficacy had an inverse and significant relationship with age (r=-0.501, P < 0.001), while it had a direct and significant Correlation with dialysis history (r = 0.182, P = 0.003). Conclusion: The study revealed a significant positive relationship between illness perception and general self-efficacy in hemodialysis patients, particularly in the domains of independence, organization, and problem-solving. These findings underscore the need for targeted nursing interventions—such as patient education and empowerment programs—to enhance illness perception, thereby promoting self-efficacy and adaptive disease management. Chronic kidney disease Hemodialysis Self-efficacy Illness perception Quality of life Iran Figures Figure 1 Introduction Chronic kidney disease (CKD) is a growing global health concern, with mortality rates increasing by 82.3% in recent decades ( 1 , 2 ). In Iran, its prevalence ranges from 5–19%, imposing a substantial burden on healthcare systems ( 3 , 4 ). Patients with end-stage renal disease (ESRD) require lifelong hemodialysis, a process that demands strict adherence to treatment regimens, active patient participation and high level Self-efficacy ( 5 , 6 ). Self-efficacy is a concept introduced in 1977 by Dr. Albert Bandura, a psychologist at Stanford University ( 7 ). It refers to an individual's belief in their ability to successfully perform a specific behavior. Self-efficacy plays an important role in hemodialysis patients, as it can affect their quality of life, adherence to treatment, and clinical outcomes ( 8 ). Hemodialysis patients with higher self-efficacy have been reported to have better control over their diet and dialysis sessions, and thus experience fewer complications ( 9 ). Self-efficacy is influenced by various factors, notably an individual's illness perception ( 10 ). Illness cognition and perception describe the cognitive evaluation and emotional expression experienced when facing a disease state or health threat, subsequently initiating psychological coping responses ( 11 ). Illness perception can predict a wide range of psychosocial and clinical outcomes in patients with ESRD, including depression, non-adherence, and even survival ( 12 ). The findings of Shirazian et al.'s study showed that in chronic patients, such as hemodialysis patients, a higher perception of the chronic timeline of the disease was associated with better weight control between dialysis sessions and reduced depression ( 13 ). While studies in other chronic diseases confirm the correlation between illness perception and self-efficacy ( 14 , 15 ), limited evidence exists for hemodialysis populations, particularly in low-resource settings like Iran ( 16 ). This lack of investigation is noteworthy considering the potential influence of factors like educational attainment, socioeconomic status, and access to healthcare services on illness perception and self-efficacy in the Iranian context. Although CKD prevalence is high in Iran, little is known about the psychological and behavioral characteristics of hemodialysis patients in Ahvaz. As the largest medical referral center in southwestern Iran, Ahvaz hosts numerous hemodialysis patients, yet no studies have explored how illness perception influences their self-efficacy. Therefore, this study investigates this relationship, with findings intended to guide the development of patient-centered education programs in similar resource-limited settings. Materials and methods Study design This research is a descriptive-analytical cross-sectional study conducted to investigate the relationship between illness perception and general self-efficacy in hemodialysis patients referring to hospitals affiliated to Ahvaz Jundishapur University of Medical Sciences in 2023. A cross-sectional design was selected to efficiently examine the relationship between illness perception and self-efficacy at a single time point, given the time constraints and clinical setting. Study population and sampling method The statistical population included all hemodialysis patients referring to the hemodialysis units of hospitals affiliated to Ahvaz Jundishapur University of Medical Sciences in 2023. Using stratified sampling with proportional, 266 patients were selected from 4 hemodialysis centers in Ahvaz. To this aim, hospitals were considered as strata and then, proportional to the each center’s patient load, the sample size from that stratum was determined. Samples were randomly selected from the patient lists of that center and included in the study. Eventually of eligible patients across 4 hospitals, 266 were selected proportionally (80 from Golestan Hospital, 90 from Emam Hospital, 40 from Razi Hospital, 56 from Sina Hospital). Eligible participants were adults (≥ 18 years) with ≥ 6 months of hemodialysis, no cognitive impairment (per physician assessment), and willingness to consent. Patients with psychiatric disorders (ICD-10 criteria) were excluded." The sample size was determined using MedCalc statistical software (version 20.115) based on parameters derived from Hosseinizadeh et al.'s study ( 17 ). The calculation incorporated: 80% statistical power (β = 0.2), 5% type I error rate (α = 0.05) and an expected correlation coefficient (r) of 0.171 from previous findings. The formula applied was: n = [(Z_(1-α/2) + Z_(1-β)]² / [0.5 × ln((1 + r)/(1-r))]² + 3 Where: Z_ (1-α/2) = 1.96 (for α = 0.05), Z_ (1-β) = 0.84 (for 80% power), r = 0.171 (observed correlation coefficient) This calculation yielded a minimum required sample size of 266 participants to ensure adequate power for detecting statistically significant associations. Data collection tools and method In this study, data were collected from March to October 2023 through structured interviews with patients and the review of medical records. Demographic information included age, gender, marital status, education level, dialysis history, number of dialysis sessions per week, duration of each session, and Body Mass Index (BMI). The General Self-Efficacy Scale (GSE), which includes 10 questions scored based on a 4-point Likert scale (from 1 = not at all true to 4 = exactly true ), was used to assess general self-efficacy, with the total score ranging from 10 to 40 ( 18 ). Its validity and reliability have been confirmed in previous studies in Iran (Cronbach's alpha = 0.85) ( 19 ). Illness perception was measured using the Brief Illness Perception Questionnaire (Brief-IPQ), which includes 9 questions scored from 0 to 10 and assesses various dimensions of illness perception (such as consequences, treatment control, and identity) ( 20 ). This instrument has also been reported to have acceptable validity and reliability (Cronbach's alpha = 0.80) ( 21 ). The questionnaires were completed through interviews by the researcher to ensure the patients' correct understanding of the questions. Interviews were conducted in a private room during dialysis sessions to minimize patient burden. Each interview lasted ~ 20 minutes. Data analysis Data were analyzed using SPSS software (version 22; IBM Corp., Armonk, NY). Descriptive statistics (means ± standard deviations for continuous variables and frequencies [percentages] for categorical variables) were used to characterize the study population. Pearson's correlation coefficients were calculated to assess bivariate relationships between self-efficacy, illness perception, and continuous clinical variables (e.g., age, dialysis vintage, blood pressure). Group comparisons (by gender, marital status, and education level) were performed using independent t-tests or one-way ANOVA for normally distributed data, with post-hoc Tukey tests where appropriate. Multiple linear regression analyses were conducted to examine independent associations while controlling for potential confounders (including age and dialysis vintage). The Shapiro-Wilk test confirmed normal distribution of all analyzed variables (all p-values > 0.05). A two-tailed p-value < 0.05 was considered statistically significant, with Bonferroni adjustment applied for multiple comparisons to maintain the family-wise error rate at α = 0.05. All statistical tests were conducted using complete-case analysis. Ethical considerations This study was approved by the Ethics Committee of Ahvaz Jundishapur University of Medical Sciences (Code: IR.AJUMS.REC.1402.616). Written informed consent was obtained from all participants after explaining the study objectives and procedures. Data were anonymized for confidentiality, and participation was voluntary. For participants with limited literacy, verbal consent was obtained with a thumbprint signature. The study complied with Helsinki Declaration principles and national research regulations. Results Demographic Characteristics Table 1 presents the demographic and clinical characteristics of the study participants. The sample consisted of 57.1% males and 42.9% females, with 85.7% married and 14.3% single individuals. Educational distribution included 32.3% illiterate, 46.2% high school graduates, 21.4% bachelor's degree holders. The mean age was 57.16 ± 12.38 years, with a mean dialysis history of 2.5 ± 1.55 years. Clinical measurements showed mean BMI of 26.72 ± 3.02 kg/m², blood pressure of 146.45 ± 14.88/85.37 ± 10.98 mmHg (systolic/diastolic), and mean dialysis duration in each session of 3.44 ± 0.30 hours. Treatment frequency distribution was: twice weekly (12.8%), three times weekly (82.3%), and four times weekly (4.9%). Table 1 Demographic and background characteristics of study participants Variable Category Level of Education Illiterate n (%) 86 (32/3) Diploma n (%) 123 (46/2) Bachelor's Degree n (%) 57 (21/4) Gender Male n (%) 152 (57.1) Female n (%) 114 (42.91) Marital status Single n (%) 38 (14.31) Married n (%) 228 (85.72) Dialysis Sessions per Week 2 times n (%) 34 (12.82) 3 times n (%) 218 (82.32) 4 times n (%) 13 (4.94) Age Mean (SD) 57.16 (12.38) (Years) Dialysis History Mean (SD) 2.50 (1.55) (Years) Body Mass Index Mean (SD) 26.72 (3.02) Systolic Blood Pressure Mean (SD) 146.45 (14.88) Diastolic Blood Pressure Mean (SD) 85.37 (10.98) Dialysis Duration in each session Mean (SD) 3.44 (0.30) (Hours) Group Comparisons The findings presented in Table 2 demonstrate that independent t-test results showed no statistically significant differences between males and females regarding total self-efficacy scores, their subscales (independence, organization, problem-solving, social support), or total illness perception scores (P > 0.05), indicating that gender had no measurable influence on these variables. Similarly, no significant differences were observed in total self-efficacy scores or subscales between single and married participants (P > 0.05). However, a statistically significant difference emerged in total illness perception scores between marital status groups (P = 0.003), with married individuals displaying lower mean scores (54.87 ± 3.90) compared to single participants (56.94 ± 4.51), suggesting married patients had a comparatively better understanding of their illness. ANOVA results revealed significant differences in both total self-efficacy and illness perception scores across educational attainment levels (P < 0.001). Notably, bachelor’s degree holders achieved higher mean scores in total self-efficacy (205.15 ± 13.09), illness perception (57.98 ± 3.62), and the subscales of independence (65.70 ± 4.96), organization (57.40 ± 5.41), and problem-solving (50.28 ± 3.23), though no significant difference was detected for the social support subscale (P = 0.54). Furthermore, while no significant associations were found between dialysis frequency (per week) and total self-efficacy, its subscales (independence, organization, social support), or illness perception scores (P > 0.05), a significant difference was identified for problem-solving scores (P = 0.03), where patients receiving dialysis three times weekly exhibited higher mean scores (49.28 ± 2.83). Table 2 Comparative Analysis of Self-Efficacy, Its Subscales, and Illness Perception across Demographic and Treatment Variables Variable Group Mean ( SD) df t/F P-value Total Self-Efficacy Score Gender Male 197.10 (12.78) 264 0.898 0.37 Female 195.50 (16.21) Marital Status Single 197.55 ( 18.14) 264 0.524 0.60 Married 196.23 ( 13.65) Education Illiterate 189.40 ( 13.40) 3 17.24 < 0.001 Diploma 197.27 ( 13.11) Bachelor's 205.15 (13.09) frequency of dialysis (per week) 2 191.94(15.41) 2 2.10 0.13 3 197.14(14.18) 4 197.14(10.20) Independence Gender Male 61.95 ( 5.49) 264 0.384 0.70 Female 61.67 ( 6.29) Marital Status Single 62.34 ( 7.17) 264 0.578 0.56 Married 61.75 (5.59) Education Illiterate 58.54 ( 5.31) 3 22.30 < 0.001 Diploma 62.34 (5.30) Bachelor's 65.70 ( 4.96) frequency of dialysis (per week) 2 60.91(6.55) 2 0.28 0.76 3 61.91(5.76) 4 62.71(4.23) Organization Gender Male 54.14 ( 5.25) 264 0.228 0.82 Female 53.99 ( 5.64) Marital Status Single 55.13 ( 6.16) 264 1.295 0.19 Married 53.90 ( 5.27) Education Illiterate 51.70 ( 4.47) 3 15.96 < 0.001 Diploma 54.19 ( 5.21) Bachelor's 57.40 ( 5.41) frequency of dialysis (per week) 2 52.48(5.19) 2 2.50 0.09 3 54.30(5.46) 4 53.85(3.71) Problem Solving Gender Male 49.21 ( 3.38) 264 0.867 0.38 Female 48.78 ( 4.70) Marital Status Single 48.39 ( 5.60) 264 1.052 0.29 Married 49.13 ( 3.670 Education Illiterate 47.77 ( 4.05) 3 5.134 0.001 Diploma 49.31 (4.07) Bachelor's 50.28 (3.23) frequency of dialysis (per week) 2 47.59(4.91) 2 3.70 0.03 3 49.28(3.83) 4 48.28(2.13) Social Support Gender Male 31.78 (2.22) 264 1.548 0.12 Female 31.32 ( 2.66) Marital Status Single 31.68 (2.99) 264 0.257 0.79 Married 31.57 ( 2.32) Education Illiterate 31.36 (2.63) 3 0.728 0.54 Diploma 31.66 ( 2.23) Bachelor's 31.77 ( 2.52) frequency of dialysis (per week) 2 30.94(3.02) 2 0.85 0.43 3 31.67(2.32) 4 32.28(1.97) Total Illness Perception Score Gender Male 54.98 ( 3.85) 264 0847 0.39 Female 55.41 ( 4.30) Marital Status Single 56.94 ( 4.51) 264 2.964 0.003 Married 54.87 ( 3.90) Education Illiterate 53.02 ( 4.03) 3 24.37 < 0.001 Diploma 55.36 ( 3.35) Bachelor's 57.98 (3.62) frequency of dialysis (per week) 2 54.94(4.08) 2 0.90 0.41 3 55.25(4.05) 4 53.71(4.19) Correlation Analyses The correlation analysis revealed several significant relationships (Table 3 ). Age demonstrated statistically significant inverse correlations with: total self-efficacy score (r = -0.501, p < 0.001), problem-solving (r = -0.138, p = 0.024), organization (r = -0.327, p < 0.001), independence (r = -0.335, p < 0.001), and total illness perception score (r = -0.459, p < 0.001). No significant correlation emerged between age and social support (r = -0.098, p = 0.112). Table 3 Correlational Analysis of Psychosocial Measures with Continuous Variables Total Score of Self-Efficacy Problem Solving Organization Independence Social Support Total Score of Illness Perception Age Pearson Correlation Coefficient − .501** − .138* − .327** − .355** 0.098 − .459** Significance Level < 0.001 0.024 < 0.001 < 0.001 0.112 < 0.001 Dialysis History Pearson Correlation Coefficient .182** . 0.089 .179** .220** - 0.041 0.099 Significance Level 0.003 0.149 0.003 < 0.001 0.509 0.109 Body Mass Index Pearson Correlation Coefficient 0.039 0.039 0.029 -0.038 0.097 -0.027 Significance Level 0.528 0.525 0.643 0.542 0.116 0.666 duration of dialysis in each session (hours) Pearson Correlation Coefficient 0.009 0.054 0.021 − .001 0.083 -0.048 Significance Level 0.879 0.384 0.736 0.991 0.179 0.439 Dialysis history showed significant positive correlations with: total self-efficacy (r = 0.182, p = 0.003), organization (r = 0.179, p = 0.003), and independence (r = 0.220, p = 0.001). However, no significant relationships were found between dialysis history and problem-solving (r = 0.089, p = 0.149), social support (r = 0.041, p = 0.509), or illness perception (r = 0.099, p = 0.109). Body mass index showed no significant correlations with any study variables (all p > 0.05). In addition, no significant relationships were found between dialysis duration in each season with total self-efficacy score, its subscales, and total illness perception score (all p > 0.05). As presented in Table 4 , strong positive correlations were observed between total self-efficacy and its subscales: independence (r = 0.87, p < 0.001), organization (r = 0.86, p < 0.001), problem-solving (r = 0.78, p < 0.001), and social support (r = 0.47, p < 0.001). A moderately strong positive correlation was found between illness perception and self-efficacy (r = 0.561, p < 0.001, 95% CI [0.45, 0.62]) (Fig. 1 ). Among subscales, organization showed the strongest association with illness perception (r = 0.235, p < 0.001), while social support demonstrated no significant relationship (r = -0.041, p = 0.507). Table 4 Correlational Relationships between Self-Efficacy, Its Subscales, and Illness Perception Total Score of Self-Efficacy Total Score of Illness Perception Total score of self-efficacy Pearson Correlation Coefficient 1 0.54** Significance Level - 0.002 Independence Pearson Correlation Coefficient .870** 0.201** Significance Level < 0.001 < 0.001 Organization Pearson Correlation Coefficient 0.869** 0.235** Significance Level < 0.001 < 0.001 Problem solving Pearson Correlation Coefficient .789** *0.126 Significance Level < 0.001 0.039 Social support Pearson Correlation Coefficient .479** -0.041 Significance Level < 0.001 0.507 Total score of illness perception Pearson Correlation Coefficient 0.561** 1 Significance Level < 0.001 - The multiple regression analysis (Table 5 ) showed that about 40% of the variance in total self-efficacy was explained by the included variables (Adjusted R² = 0.404). Higher illness perception (B = 0.754, p < 0.001) and longer dialysis history (B = 0.611, p = 0.022) were significant positive predictors, while older age (B = -0.155, p = 0.001) and illiteracy (B = -3.293, p = 0.036) were associated with lower self-efficacy. Other variables, such as gender, marital status, dialysis frequency, and session duration, were not significantly related to self-efficacy (p > 0.05). Table 5 Multiple Regression Analysis of Factors Associated with Total Self-Efficacy Parameter B Std. Error t Sig. 95% Confidence Interval Lower Bound Upper Bound Intercept 159.804 9.458 16.896 .000 141.178 178.430 Frequency of dialysis (per week) 2 3.109 2.633 1.181 .239 -2.077 8.295 3 2.888 2.474 1.168 .244 -1.983 7.760 4 0 a . . . . . Education level Illiterate -3.293 1.564 -2.106 .036 -6.374 − .213 Diploma − .710 1.129 − .629 .530 -2.933 1.513 Bachelor's 0 a . . . . . Gender male .199 .816 .244 .807 -1.408 1.807 female 0 a . . . . . Marital status Single -0.225 1.236 -0.182 0.856 -2.660 2.210 Married 0 a . . . . . Age − .155 .048 -3.234 .001 − .250 − .061 Dialysis history .611 .264 2.310 .022 .090 1.131 BMI − .049 .121 − .403 .688 − .287 .189 Total score of illness perception .754 .113 6.700 .000 .532 .975 Duration of dialysis in each session .584 1.298 .450 .653 -1.973 3.141 R Squared = .427 (Adjusted R Squared = .404) Discussion This study examined the factors influencing self-efficacy (an individual's belief in their ability to manage illness) and illness perception (organized beliefs about symptoms, consequences, and disease control) in dialysis patients. According to Bandura's theory, self-efficacy is considered a key factor in health-oriented behaviors ( 22 ). Illness perception has been shown to predict various psychosocial and clinical outcomes in ESRD patients ( 23 ). Here, the discussion of findings will address several key domains. Relationship between illness perception and self-efficacy with demographic characteristics of patients The findings showed that age has an inverse relationship with self-efficacy and illness perception scores. This inverse relationship (consistent with Tsay & Healstead ( 24 )) likely reflects the cumulative burden of aging on physical capacity and cognitive flexibility in ESRD patients. Older patients may struggle with complex treatment regimens due to comorbid conditions and sensory impairments, reducing their perceived control. This finding emphasizes the need for age-adapted educational interventions. The results of this study showed no statistically significant gender-based differences in overall self-efficacy, its subcomponents, or overall illness perception. This lack of gender variation (consistent with the findings of Musa et al. ( 25 ) and Rakhshan et al. ( 27 ), but inconsistent with Tsay ( 26 )) suggests that, within our cultural framework, dialysis treatment places comparable psychological burdens on both male and female patients. The discrepancy with Tsay's results ( 26 ) could potentially be attributed to enhanced gender equality in healthcare accessibility or variations in assessment methodologies. From a clinical perspective, these findings suggest that generalized psychosocial support strategies may prove equally beneficial for patients of both sexes. The study found that marital status significantly affected illness perception but not self-efficacy. Married patients demonstrated higher illness perception than singles, likely due to greater social support (partially consistent with Wilde et al. ( 28 )). However, unlike studies such as Smith et al. ( 29 ) which reported positive associations between marriage and self-efficacy, our results showed no differences in self-efficacy scores or its subscales (independence, organization, problem-solving, social support) between married and single patients. This discrepancy may stem from; cultural differences (In Iran, despite strong family support, this doesn't necessarily translate to increased individual self-efficacy), variations in measurement tools, unique sample characteristics Furthermore, the study demonstrated a significant association between patients' education levels and their total self-efficacy scores and its subscales, as well as their total illness perception scores. However, this difference was not significant for the social support subscale. The observed positive association between educational attainment and self-efficacy/illness perception scores (consistent with Pakaya et al. ( 30 ) and Wilde et al. ( 28 )) likely stems from higher-educated patients' superior health literacy and cognitive capacity to process complex medical information. However, the non-significant finding for the social support subscale reveals a critical nuance: while education enhances individual competencies in illness management, it does not inherently strengthen social support networks. This distinction carries important clinical implications, suggesting that less-educated patients—who may depend more heavily on community-based resources than individual capabilities—require specifically tailored support programs that leverage existing communal structures rather than assuming education-dependent self-management skills. Relationship between illness perception and self-efficacy with dialysis characteristics. Results showed no significant effect of weekly dialysis frequency (2, 3, or 4 times) on illness perception or overall self-efficacy and most subscales, except for problem-solving, where a notable difference was found. This contrasts with Tsay’s study ( 26 ), which correlationed higher frequency to better self-efficacy. While prior research, such as Musa et al. ( 25 ), emphasized treatment team interactions, the limited impact on overall outcomes may stem from patient adaptation. The problem-solving improvement at three sessions weekly could reflect balanced engagement with healthcare providers without excessive fatigue. Discrepancies with other studies might relate to session duration or illness severity, indicating that dialysis frequency should be analyzed alongside other factors. The study found no significant correlation between BMI and self-efficacy or illness perception, suggesting that body weight and nutritional status did not directly influence these psychological factors. This aligns with Kim et al. ( 31 ), who associated BMI with physical rather than psychological outcomes in dialysis patients. While some studies (e.g., Tsay & Healstead, 24) suggest malnutrition (low BMI) may indirectly reduce self-efficacy by lowering energy, our sample's average BMI (26.72 ± 3.02) fell within normal/overweight ranges, with no severe malnutrition cases, possibly explaining the absence of association. The study found that longer history of dialysis significantly increased overall self-efficacy, particularly in independence, organization, and social support, but not in problem-solving. These results support Wild et al.'s ( 28 ) findings on treatment mastery, but contrast with Rakhshan et al.'s ( 27 ) report of decreasing self-efficacy due to fatigue. The improved self-efficacy likely stems from patients' growing treatment experience and healthcare team interactions. These conflicting findings suggest the need for further research examining additional variables like treatment quality and support systems. No significant association was found between history of dialysis and illness perception. Consistent with this, Kim et al. ( 31 ) showed illness perception depends more on psychological factors (e.g., anxiety/depression) than treatment duration, while Musa et al. ( 25 ) emphasized educational/psychological support. However, Tsay & Healstead ( 24 ) and Johnson et al. ( 32 ) reported contradictory findings, possibly due to differences in assessment tools, cultural factors, or educational interventions. These discrepancies suggest illness perception is influenced more by cognitive/educational factors than history of dialysis alone. In addition to dialysis history, the duration of each dialysis session was also examined. However, the findings indicated no significant relationship between session duration and total self-efficacy, its subscales (independence, organization, problem-solving, and social support), or illness perception. This result aligns with previous studies such as those by Kim et al. ( 31 ) and Musa et al. ( 25 ), which suggest that psychological and educational factors play a more critical role in shaping illness perception and self-efficacy than merely the quantitative aspects of treatment like session duration. Furthermore, the relatively uniform session times across participants (mean = 3.44 hours) may have limited the variability needed to detect statistically meaningful associations. These findings highlight that the quality of patient-provider interactions and the nature of educational support provided may exert a greater influence on psychological outcomes than the sheer length of dialysis treatment. Relationship of illness perception and self-efficacy The findings of this study demonstrated that higher illness perception is significantly associated with greater self-efficacy in hemodialysis patients, particularly in the subscales of independence, organization, and problem-solving. These results are consistent with the studies by Petrie et al. ( 32 ) in diabetic patients, as well as Kim et al. ( 31 ) and Rakhshan et al. ( 27 ) in hemodialysis patients. Moreover, the multiple regression analysis revealed that illness perception was the strongest predictor of self-efficacy, even after adjusting for variables such as age, education, and dialysis history. This highlights the pivotal role of cognitive understanding of illness in effective disease management. In contrast, the study by Hanania et al. ( 33 ) on patients with COPD reported different results, which may be attributed to the unique nature of the disease and the specific psychological and physical conditions of those patients. Additionally, unlike the findings of Bilel et al. ( 34 ), who suggested that reducing negative perceptions of illness outcomes leads to higher self-efficacy, the present study showed that a more comprehensive and realistic understanding of the disease plays a more effective role in enhancing self-efficacy among hemodialysis patients. This may be due to the complex and treatment-dependent nature of hemodialysis. The present study also found no significant relationship between the social support subscale and illness perception, which could be explained by cultural characteristics of Iranian society, where strong familial support is prevalent. This finding is in line with the study by Hosseini et al. ( 35 ), which confirmed only certain aspects of the relationship between self-efficacy and illness perception. Overall, the findings of this section, consistent with those of Nouhjah et al. ( 36 ), emphasize the importance of designing and implementing educational interventions aimed at improving illness perception and enhancing self-efficacy in hemodialysis patients. Conclusion This study demonstrates that comprehensive illness understanding (including symptoms, consequences, and control methods) plays a pivotal role in enhancing self-efficacy among hemodialysis patients, particularly in the domains of Independence, organization, and problem-solving. While demographic factors such as age and education level significantly influence outcomes, cultural-specific support systems appear to moderate these relationships. The findings underscore the importance of tailored educational interventions that address both cognitive (illness perception) and behavioral (self-management) aspects to improve treatment adherence and overall patient outcomes. These results highlight the need for integrated care approaches combining medical management with psychosocial support in hemodialysis treatment protocols. Future research should further explore cultural variations and develop targeted strategies for vulnerable patient subgroups. Limitations & Future Directions: This study has several limitations that should be considered when interpreting the results. First, the cross-sectional design precludes establishing causal relationships between illness perception and self-efficacy. Second, the reliance on self-reported measures may introduce response bias, particularly in assessing subjective constructs. Third, the sample was drawn from a single dialysis center in Iran, which may limit generalizability to other cultural contexts or healthcare settings. Fourth, potential confounding variables such as depression levels or cognitive function were not systematically assessed. Fifth, the study did not evaluate the long-term stability of the observed relationships. Finally, while validated instruments were used, cultural adaptation of some measures may have affected their psychometric properties. These limitations highlight the need for longitudinal, multi-center studies with comprehensive psychological assessments to confirm and extend these findings. Declarations ACKNOWLEDGMENTS The present study was part of a Master's degree dissertation in nursing approved and funded by Ahvaz Jundishapur University of Medical Sciences. We hereby thank all patients, the nurses, and all individuals who cooperated in implementing this project in one way or another AUTHOR CONTRIBUTIONS Study conception and design: "M A, M J, SH M"- Data collection: "M A, M J” - Data analysis and interpretation: "MA, S GH"- Drafting of the manuscript: "All authors"- Critical revision of the manuscript: "M A, MJ, SH M, S Gh” FUNDING The author(s) disclosed receipt of the following financial support for the research, authorship, and publication of this article: This work was supported by the Research Deputy of Ahvaz Jundishapur University of Medical Sciences (grant number NCRCCD-0219). Availability of data and materials Data may be available by request submitted to the corresponding author Consent for publication Not applicable. Competing interests All authors report no conflicts of interest. The authors alone are responsible for the content and writing of this article. References Levey AS, Atkins R, Coresh J, Cohen EP, Collins AJ, Eckardt KU, et al. Chronic kidney disease as a global public health problem: approaches and initiatives - a position statement from Kidney Disease Improving Global Outcomes. Kidney Int. 2007;72(3):247-59. doi:10.1038/sj.ki.5002273 Dehghani A, Alishavandi S, Nourimajalan N, Fallahzadeh H, Rahmanian V. Prevalence of chronic kidney diseases and its determinants among Iranian adults: results of the first phase of Shahedieh cohort study. BMC Nephrol. 2022;23(1):203. doi:10.1186/s12882-022-02828-1 Hosseinpanah F, Kasraei F, Nassiri AA, Azizi F. High prevalence of chronic kidney disease in Iran: a large population-based study. BMC Public Health. 2009;9(1):44. doi:10.1186/1471-2458-9-44 Najafi I, Shakeri R, Islami F, Malekzadeh F, Salahi R, Yapan-Gharavi M, et al. Prevalence of chronic kidney disease and its associated risk factors: the first report from Iran using both microalbuminuria and urine sediment. Arch Iran Med. 2012;15(2):70-5. PMID: 22292579 Murdeshwar HN, Anjum F. Hemodialysis. In: StatPearls . Treasure Island (FL): StatPearls Publishing; 2025. Available from: https://www.ncbi.nlm.nih.gov/books/NBK563296/ Yasin F, Khraim F, Santos M, Forgrave D, Hamad A. Factors influencing self-care management in adult hemodialysis patients: An integrative review. Qatar Med J. 2024;2024(1):12. doi:10.5339/qmj.2024.12 Pekmezi D, Jennings E, Marcus BH. Evaluating and enhancing self-efficacy for physical activity. ACSM’s Health Fit J. 2009;13(2):16-21. doi:10.1249/FIT.0b013e31819969c1 Almutary H, Tayyib N. Evaluating self-efficacy among patients undergoing dialysis therapy. Nurs Rep. 2021;11(1):195-201. doi:10.3390/nursrep11010019 Clark-Cutaia MN, Ren D, Hoffman LA, Burke LE, Sevick MA. Adherence to hemodialysis dietary sodium recommendations: influence of patient characteristics, self-efficacy, and perceived barriers. J Ren Nutr. 2014;24(2):92-9. doi:10.1053/j.jrn.2013.11.007 Adadıoğlu Ö, Oğuz S. Factors associated with self-efficacy among patients with epilepsy in Turkey. Epilepsy Behav. 2021;117:107802. doi:10.1016/j.yebeh.2021.107802 Huang L, Yang L, Ouyang R, Ren S. Illness cognition, illness perception and related factors in patients with lymphangioleiomyomatosis. Orphanet J Rare Dis. 2025;20(1):78. doi:10.1186/s13023-025-01678-4 Chilcot J. The importance of illness perception in end-stage renal disease: associations with psychosocial and clinical outcomes. Semin Dial. 2012;25(1):59-64. doi:10.1111/j.1525-139X.2011.01004.x Shirazian S, Grant CD, Aina O, Mattana J, Khorassani F, Ricardo AC. Depression in Chronic Kidney Disease and End-Stage Renal Disease: Similarities and Differences in Diagnosis, Epidemiology, and Management. Kidney Int Rep. 2017;2(1):94-107. doi:10.1016/j.ekir.2016.09.005 Alhofaian A, Alaamri MM, Abdalmajeed MA, Wadaah LS, Aljuhani LA, Amin MA, et al. The Role of Illness Perception and Self-Efficacy in Determining Quality of Life among Cancer Patients. Clin Pract. 2024;14(2):498-507. doi:10.3390/clinpract14020038 Luo Z-n, Li K, Chen A-q, Qiu Y-c, Yang X-x, Lin Z-w, et al. The influence of family health on self-efficacy in patients with chronic diseases: the mediating role of perceived social support and the moderating role of health literacy. BMC Public Health. 2024;24(1):3398. doi:10.1186/s12889-024-17894-3 Rambod M, Peyravi H, Sarban MT, Rafii F, Hosseini F. Self-efficacy in hemodialysis patients and its related factors. Adv Nurs Midwifery. 2009;18(62):29-36. Hoseinzadeh T, Paryad E, Asiri S, Kazem Nezhad Leili E. Relationship between perception of illness and general self-efficacy in coronary artery disease patients. J Holist Nurs Midwifery. 2012;22(1):1-8. Lin C-C, Wu C-C, Anderson R, Chang C-S, Chang S-C, Hwang S-J, Chen H-C. The chronic kidney disease self-efficacy (CKD-SE) instrument: development and psychometric evaluation. Nephrol Dial Transplant. 2012;27(9):3288-94. doi:10.1093/ndt/gfr815 Baghaie-lakeh M, Bozorgzade M, Paryad E, Ehsan Kazemnejad L, Sefati A. Predictive Factors of Self-Efficacy in Patients Receiving Hemodialysis. J Health Care. 2016;18(2):101-10. Schwartz MN, Rimland CA, Quinn KA, Ferrada MA, Gribbons KB, Rosenblum JS, et al. Utility of the Brief Illness Perception Questionnaire to Monitor Patient Beliefs in Systemic Vasculitis. J Rheumatol. 2020;47(12):1785-92. doi:10.3899/jrheum.190983 Kalantari H, Bagherian Sararoodi R, Afshar H, Khoramian N, Forouzandeh N, Daghagh Zadeh H, et al. Relationship between Illness Perceptions and Quality of Life in Patients with Irritable Bowel Syndrome. J Mazandaran Univ Med Sci. 2012;22(90):33-41. Abusubhiah M, Walshe N, Creedon R, Noonan B, Hegarty J. Self-efficacy in the context of nursing education and transition to practice as a registered practitioner: A systematic review. Nurs Open. 2023;10(10):6650-67. doi:10.1002/nop2.1937 Lew SQ, Centron P. Psychiatric challenges in patients treated with peritoneal dialysis. In: Cukor D, Cohen SD, Kimmel PL, editors. Psychosocial Aspects of Chronic Kidney Disease . Academic Press; 2021. p. 311-33. doi:10.1016/B978-0-12-817080-9.00015-1 Tsay S-L, Healstead M. Self-care self-efficacy, depression, and quality of life among patients receiving hemodialysis in Taiwan. Int J Nurs Stud. 2002;39(3):245-51. doi:10.1016/S0020-7489(01)00030-0 Mousa I, Ataba R, Al-ali K, Alkaiyat A, Zyoud SeH. Dialysis-related factors affecting self-efficacy and quality of life in patients on haemodialysis: a cross-sectional study from Palestine. Ren Replace Ther. 2018;4(1):21. doi:10.1186/s41100-018-0160-0 Tsay SL. Self-efficacy training for patients with end-stage renal disease. J Adv Nurs. 2003;43(4):370-5. doi:10.1046/j.1365-2648.2003.02725.x Rakhshan M, Mirshekari F, Dehghanrad F. The relationship between illness perception and self-care behaviors among hemodialysis patients. Iran J Psychiatry. 2020;15(2):150. doi:10.18502/ijps.v15i2.2696 Wild MG, Wallston KA, Green JA, Beach LB, Umeukeje E, Wright Nunes JA, et al. The Perceived Medical Condition Self-Management Scale can be applied to patients with chronic kidney disease. Kidney Int. 2017;92(4):972-8. doi:10.1016/j.kint.2017.04.020 Smith A, Johnson B, Williams C. The impact of marital status on self-efficacy in chronic disease management: a longitudinal study. J Health Psychol. 2020;25(3):456-468. doi:10.1177/1359105319876543 Pakaya RE, Syam Y, Syahrul S. Correlation of self-efficacy and self-care of patients undergoing hemodialysis with their quality of life. Enferm Clin. 2021;31:S797-S801. doi:10.1016/j.enfcli.2020.09.024 Kim S, Kim E, Ryu E. Illness Perceptions, Self-Care Management, and Clinical Outcomes According to Age-Group in Korean Hemodialysis Patients. Int J Environ Res Public Health. 2019;16(22). doi:10.3390/ijerph16224459 Petrie KJ, Jago LA, Devcich DA. The role of illness perceptions in patients with medical conditions. Curr Opin Psychiatry. 2007;20(2):163-7. doi:10.1097/YCO.0b013e3280147738 Hanania NA, Bunner SH, Bengtson LGS, Ismaila AS, Bogart M. COPD Exacerbations, Costs, and Health Care Resource Utilization Before and After Initiation of Fluticasone Furoate/Umeclidinium/Vilanterol in Routine Care in the USA. Int J Chron Obstruct Pulmon Dis. 2023;18:407-18. doi:10.2147/COPD.S391989 Ebrahimi Belil F, Alhani F, Ebadi A, Kazemnejad A. Self-Efficacy of People with Chronic Conditions: A Qualitative Directed Content Analysis. J Clin Med. 2018;7(11). doi:10.3390/jcm7110411 Hosseini M, Rahimi N, Alavi NM. The relationship between illness perception and self-efficacy in heart failure patients. J Health Psychol. 2020 Mar;25(3):412-20. doi: 10.1177/1359105319826354. PubMed PMID: 30791732. Nouhjah S, Jahanfar S, Shahbazian H. The need for continuous self-management education programs in hemodialysis patients: A qualitative study. J Renal Inj Prev. 2018;7(3):175-81. doi:10.15171/jrip.2018.42. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 28 Aug, 2025 Read the published version in BMC Nephrology → Version 1 posted Editorial decision: Revision requested 07 Jul, 2025 Reviews received at journal 13 Jun, 2025 Reviewers agreed at journal 09 Jun, 2025 Reviews received at journal 09 Jun, 2025 Reviewers agreed at journal 07 Jun, 2025 Reviewers agreed at journal 05 Jun, 2025 Reviewers agreed at journal 28 May, 2025 Reviewers invited by journal 21 May, 2025 Editor invited by journal 02 May, 2025 Editor assigned by journal 29 Apr, 2025 Submission checks completed at journal 29 Apr, 2025 First submitted to journal 22 Apr, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6500811","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":460364537,"identity":"077f8d85-305c-4651-944d-fbda0c25106a","order_by":0,"name":"Masome jafarzadeh","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Masome","middleName":"","lastName":"jafarzadeh","suffix":""},{"id":460364538,"identity":"e4086742-fb5c-423c-9762-38be423e4aff","order_by":1,"name":"Mohammad Adineh","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA0ElEQVRIiWNgGAWjYFACHiAyYGAwYG8AcgwsSNHCcwCkRYJYLWDFCSAeEVp023sPfnhTcEfOXPL51Q0/CiQY+Nu7E/BqMTtzLllyjsEzY8vZOWU3e4AOkzhzdgN+LTdyDKR5DA4nbridk3aDB6jFQCKXoBbj30At9Rtunkm7+YdILWYgWxIMbrAfu02cLWfOmFnOMThsuOFMDtttGQMJHsJ+Od5jfOPNn8PyBsePP7v55o+NHH97L34tSAAUoZA4IhqwPyBF9SgYBaNgFIwgAACsGEqFZUQatQAAAABJRU5ErkJggg==","orcid":"","institution":"","correspondingAuthor":true,"prefix":"","firstName":"Mohammad","middleName":"","lastName":"Adineh","suffix":""},{"id":460364539,"identity":"299a07ed-65d8-4906-95cc-e3f158509c42","order_by":2,"name":"Shahram Molavynejad","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Shahram","middleName":"","lastName":"Molavynejad","suffix":""},{"id":460364542,"identity":"ba06cda5-0708-4597-9783-2f74a29f3b6d","order_by":3,"name":"Saeed ghanbari","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Saeed","middleName":"","lastName":"ghanbari","suffix":""}],"badges":[],"createdAt":"2025-04-22 06:23:09","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6500811/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6500811/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12882-025-04426-3","type":"published","date":"2025-08-28T15:58:19+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":83436405,"identity":"f5ef9bc0-4633-48ac-86cc-f760cc37206c","added_by":"auto","created_at":"2025-05-26 08:35:59","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":11997,"visible":true,"origin":"","legend":"\u003cp\u003eSimple Scatter with Fit Line of Self-Efficacy by Illness Perception\u003c/p\u003e","description":"","filename":"Onlinefloatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-6500811/v1/6d76fd89d045fcd61212e7dc.png"},{"id":90345017,"identity":"549b2dc3-2b70-4305-9e50-65c573894b41","added_by":"auto","created_at":"2025-09-01 16:09:18","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1176845,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6500811/v1/a98d2918-549c-446d-b1ee-984ba9f9b27f.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"The relationship between illness perception and general self-efficacy in hemodialysis patients: A cross-sectional study in south-western Iran","fulltext":[{"header":"Introduction","content":"\u003cp\u003eChronic kidney disease (CKD) is a growing global health concern, with mortality rates increasing by 82.3% in recent decades (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). In Iran, its prevalence ranges from 5\u0026ndash;19%, imposing a substantial burden on healthcare systems (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). Patients with end-stage renal disease (ESRD) require lifelong hemodialysis, a process that demands strict adherence to treatment regimens, active patient participation and high level Self-efficacy (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eSelf-efficacy is a concept introduced in 1977 by Dr. Albert Bandura, a psychologist at Stanford University (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). It refers to an individual's belief in their ability to successfully perform a specific behavior. Self-efficacy plays an important role in hemodialysis patients, as it can affect their quality of life, adherence to treatment, and clinical outcomes (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). Hemodialysis patients with higher self-efficacy have been reported to have better control over their diet and dialysis sessions, and thus experience fewer complications (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eSelf-efficacy is influenced by various factors, notably an individual's illness perception (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). Illness cognition and perception describe the cognitive evaluation and emotional expression experienced when facing a disease state or health threat, subsequently initiating psychological coping responses (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). Illness perception can predict a wide range of psychosocial and clinical outcomes in patients with ESRD, including depression, non-adherence, and even survival (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). The findings of Shirazian et al.'s study showed that in chronic patients, such as hemodialysis patients, a higher perception of the chronic timeline of the disease was associated with better weight control between dialysis sessions and reduced depression (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eWhile studies in other chronic diseases confirm the correlation between illness perception and self-efficacy (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e), limited evidence exists for hemodialysis populations, particularly in low-resource settings like Iran (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). This lack of investigation is noteworthy considering the potential influence of factors like educational attainment, socioeconomic status, and access to healthcare services on illness perception and self-efficacy in the Iranian context.\u003c/p\u003e \u003cp\u003eAlthough CKD prevalence is high in Iran, little is known about the psychological and behavioral characteristics of hemodialysis patients in Ahvaz. As the largest medical referral center in southwestern Iran, Ahvaz hosts numerous hemodialysis patients, yet no studies have explored how illness perception influences their self-efficacy. Therefore, this study investigates this relationship, with findings intended to guide the development of patient-centered education programs in similar resource-limited settings.\u003c/p\u003e"},{"header":"Materials and methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy design\u003c/h2\u003e \u003cp\u003eThis research is a descriptive-analytical cross-sectional study conducted to investigate the relationship between illness perception and general self-efficacy in hemodialysis patients referring to hospitals affiliated to Ahvaz Jundishapur University of Medical Sciences in 2023. A cross-sectional design was selected to efficiently examine the relationship between illness perception and self-efficacy at a single time point, given the time constraints and clinical setting.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eStudy population and sampling method\u003c/h3\u003e\n\u003cp\u003eThe statistical population included all hemodialysis patients referring to the hemodialysis units of hospitals affiliated to Ahvaz Jundishapur University of Medical Sciences in 2023. Using stratified sampling with proportional, 266 patients were selected from 4 hemodialysis centers in Ahvaz. To this aim, hospitals were considered as strata and then, proportional to the each center\u0026rsquo;s patient load, the sample size from that stratum was determined. Samples were randomly selected from the patient lists of that center and included in the study. Eventually of eligible patients across 4 hospitals, 266 were selected proportionally (80 from Golestan Hospital, 90 from Emam Hospital, 40 from Razi Hospital, 56 from Sina Hospital). Eligible participants were adults (\u0026ge;\u0026thinsp;18 years) with \u0026ge;\u0026thinsp;6 months of hemodialysis, no cognitive impairment (per physician assessment), and willingness to consent. Patients with psychiatric disorders (ICD-10 criteria) were excluded.\"\u003c/p\u003e \u003cp\u003eThe sample size was determined using MedCalc statistical software (version 20.115) based on parameters derived from Hosseinizadeh et al.'s study (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). The calculation incorporated: 80% statistical power (β\u0026thinsp;=\u0026thinsp;0.2), 5% type I error rate (α\u0026thinsp;=\u0026thinsp;0.05) and an expected correlation coefficient (r) of 0.171 from previous findings. The formula applied was:\u003c/p\u003e \u003cp\u003en = [(Z_(1-α/2)\u0026thinsp;+\u0026thinsp;Z_(1-β)]\u0026sup2; / [0.5 \u0026times; ln((1\u0026thinsp;+\u0026thinsp;r)/(1-r))]\u0026sup2; + 3\u003c/p\u003e \u003cp\u003eWhere: Z_ (1-α/2)\u0026thinsp;=\u0026thinsp;1.96 (for α\u0026thinsp;=\u0026thinsp;0.05), Z_ (1-β)\u0026thinsp;=\u0026thinsp;0.84 (for 80% power), r\u0026thinsp;=\u0026thinsp;0.171 (observed correlation coefficient)\u003c/p\u003e \u003cp\u003eThis calculation yielded a minimum required sample size of 266 participants to ensure adequate power for detecting statistically significant associations.\u003c/p\u003e\n\u003ch3\u003eData collection tools and method\u003c/h3\u003e\n\u003cp\u003eIn this study, data were collected from March to October 2023 through structured interviews with patients and the review of medical records. Demographic information included age, gender, marital status, education level, dialysis history, number of dialysis sessions per week, duration of each session, and Body Mass Index (BMI). The General Self-Efficacy Scale (GSE), which includes 10 questions scored based on a 4-point Likert scale (from 1\u0026thinsp;=\u0026thinsp;\u003cem\u003enot at all true\u003c/em\u003e to 4\u0026thinsp;=\u0026thinsp;\u003cem\u003eexactly true\u003c/em\u003e), was used to assess general self-efficacy, with the total score ranging from 10 to 40 (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). Its validity and reliability have been confirmed in previous studies in Iran (Cronbach's alpha\u0026thinsp;=\u0026thinsp;0.85) (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). Illness perception was measured using the Brief Illness Perception Questionnaire (Brief-IPQ), which includes 9 questions scored from 0 to 10 and assesses various dimensions of illness perception (such as consequences, treatment control, and identity) (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). This instrument has also been reported to have acceptable validity and reliability (Cronbach's alpha\u0026thinsp;=\u0026thinsp;0.80) (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). The questionnaires were completed through interviews by the researcher to ensure the patients' correct understanding of the questions. Interviews were conducted in a private room during dialysis sessions to minimize patient burden. Each interview lasted\u0026thinsp;~\u0026thinsp;20 minutes.\u003c/p\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eData analysis\u003c/h2\u003e \u003cp\u003eData were analyzed using SPSS software (version 22; IBM Corp., Armonk, NY). Descriptive statistics (means\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviations for continuous variables and frequencies [percentages] for categorical variables) were used to characterize the study population. Pearson's correlation coefficients were calculated to assess bivariate relationships between self-efficacy, illness perception, and continuous clinical variables (e.g., age, dialysis vintage, blood pressure). Group comparisons (by gender, marital status, and education level) were performed using independent t-tests or one-way ANOVA for normally distributed data, with post-hoc Tukey tests where appropriate. Multiple linear regression analyses were conducted to examine independent associations while controlling for potential confounders (including age and dialysis vintage). The Shapiro-Wilk test confirmed normal distribution of all analyzed variables (all p-values\u0026thinsp;\u0026gt;\u0026thinsp;0.05). A two-tailed p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant, with Bonferroni adjustment applied for multiple comparisons to maintain the family-wise error rate at α\u0026thinsp;=\u0026thinsp;0.05. All statistical tests were conducted using complete-case analysis.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eEthical considerations\u003c/h3\u003e\n\u003cp\u003e This study was approved by the Ethics Committee of Ahvaz Jundishapur University of Medical Sciences (Code: IR.AJUMS.REC.1402.616). Written informed consent was obtained from all participants after explaining the study objectives and procedures. Data were anonymized for confidentiality, and participation was voluntary. For participants with limited literacy, verbal consent was obtained with a thumbprint signature. The study complied with Helsinki Declaration principles and national research regulations.\u003c/p\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eDemographic Characteristics\u003c/h2\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e presents the demographic and clinical characteristics of the study participants. The sample consisted of 57.1% males and 42.9% females, with 85.7% married and 14.3% single individuals. Educational distribution included 32.3% illiterate, 46.2% high school graduates, 21.4% bachelor's degree holders. The mean age was 57.16\u0026thinsp;\u0026plusmn;\u0026thinsp;12.38 years, with a mean dialysis history of 2.5\u0026thinsp;\u0026plusmn;\u0026thinsp;1.55 years. Clinical measurements showed mean BMI of 26.72\u0026thinsp;\u0026plusmn;\u0026thinsp;3.02 kg/m\u0026sup2;, blood pressure of 146.45\u0026thinsp;\u0026plusmn;\u0026thinsp;14.88/85.37\u0026thinsp;\u0026plusmn;\u0026thinsp;10.98 mmHg (systolic/diastolic), and mean dialysis duration in each session of 3.44\u0026thinsp;\u0026plusmn;\u0026thinsp;0.30 hours. Treatment frequency distribution was: twice weekly (12.8%), three times weekly (82.3%), and four times weekly (4.9%).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDemographic and background characteristics of study participants\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCategory\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"1\" nameend=\"c4\" namest=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eLevel of Education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIlliterate n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e86 (32/3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c4\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDiploma n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e123 (46/2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c4\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBachelor's Degree n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e57 (21/4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c4\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e152 (57.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c4\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e114 (42.91)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c4\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eMarital status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSingle n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e38 (14.31)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c4\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMarried n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e228 (85.72)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c4\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eDialysis Sessions per Week\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 times n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e34 (12.82)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c4\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 times n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e218 (82.32)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c4\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 times n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13 (4.94)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c4\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge Mean (SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e57.16 (12.38) (Years)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDialysis History Mean (SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e2.50 (1.55) (Years)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBody Mass Index Mean (SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e26.72 (3.02)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSystolic Blood Pressure Mean (SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e146.45 (14.88)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiastolic Blood Pressure Mean (SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e85.37 (10.98)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDialysis Duration in each session Mean (SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e3.44 (0.30) (Hours)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eGroup Comparisons\u003c/h3\u003e\n\u003cp\u003eThe findings presented in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e demonstrate that independent t-test results showed no statistically significant differences between males and females regarding total self-efficacy scores, their subscales (independence, organization, problem-solving, social support), or total illness perception scores (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05), indicating that gender had no measurable influence on these variables. Similarly, no significant differences were observed in total self-efficacy scores or subscales between single and married participants (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05). However, a statistically significant difference emerged in total illness perception scores between marital status groups (P\u0026thinsp;=\u0026thinsp;0.003), with married individuals displaying lower mean scores (54.87\u0026thinsp;\u0026plusmn;\u0026thinsp;3.90) compared to single participants (56.94\u0026thinsp;\u0026plusmn;\u0026thinsp;4.51), suggesting married patients had a comparatively better understanding of their illness. ANOVA results revealed significant differences in both total self-efficacy and illness perception scores across educational attainment levels (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Notably, bachelor\u0026rsquo;s degree holders achieved higher mean scores in total self-efficacy (205.15\u0026thinsp;\u0026plusmn;\u0026thinsp;13.09), illness perception (57.98\u0026thinsp;\u0026plusmn;\u0026thinsp;3.62), and the subscales of independence (65.70\u0026thinsp;\u0026plusmn;\u0026thinsp;4.96), organization (57.40\u0026thinsp;\u0026plusmn;\u0026thinsp;5.41), and problem-solving (50.28\u0026thinsp;\u0026plusmn;\u0026thinsp;3.23), though no significant difference was detected for the social support subscale (P\u0026thinsp;=\u0026thinsp;0.54). Furthermore, while no significant associations were found between dialysis frequency (per week) and total self-efficacy, its subscales (independence, organization, social support), or illness perception scores (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05), a significant difference was identified for problem-solving scores (P\u0026thinsp;=\u0026thinsp;0.03), where patients receiving dialysis three times weekly exhibited higher mean scores (49.28\u0026thinsp;\u0026plusmn;\u0026thinsp;2.83).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparative Analysis of Self-Efficacy, Its Subscales, and Illness Perception across Demographic and Treatment Variables\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eGroup\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMean ( SD)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003edf\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003et/F\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"9\" rowspan=\"10\"\u003e \u003cp\u003eTotal Self-Efficacy Score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e197.10 (12.78)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e264\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.898\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.37\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e195.50 (16.21)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eMarital Status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSingle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e197.55 ( 18.14)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e264\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.524\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.60\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e196.23 ( 13.65)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eEducation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIlliterate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e189.40 ( 13.40)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e17.24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDiploma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e197.27 ( 13.11)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eBachelor's\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e205.15 (13.09)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003efrequency of dialysis (per week)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e191.94(15.41)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e2.10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.13\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e197.14(14.18)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e197.14(10.20)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"9\" rowspan=\"10\"\u003e \u003cp\u003eIndependence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e61.95 ( 5.49)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e264\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.384\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.70\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e61.67 ( 6.29)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eMarital Status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSingle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e62.34 ( 7.17)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e264\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.578\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.56\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e61.75 (5.59)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eEducation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIlliterate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e58.54 ( 5.31)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e22.30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDiploma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e62.34 (5.30)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eBachelor's\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e65.70 ( 4.96)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003efrequency of dialysis (per week)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e60.91(6.55)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.76\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e61.91(5.76)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e62.71(4.23)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"9\" rowspan=\"10\"\u003e \u003cp\u003eOrganization\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e54.14 ( 5.25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e264\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.228\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.82\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e53.99 ( 5.64)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eMarital Status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSingle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e55.13 ( 6.16)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e264\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e1.295\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.19\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e53.90 ( 5.27)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eEducation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIlliterate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e51.70 ( 4.47)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e15.96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDiploma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e54.19 ( 5.21)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eBachelor's\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e57.40 ( 5.41)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003efrequency of dialysis (per week)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e52.48(5.19)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e2.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.09\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e54.30(5.46)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e53.85(3.71)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"9\" rowspan=\"10\"\u003e \u003cp\u003eProblem Solving\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e49.21 ( 3.38)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e264\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.867\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.38\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e48.78 ( 4.70)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eMarital Status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSingle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e48.39 ( 5.60)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e264\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e1.052\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.29\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e49.13 ( 3.670\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eEducation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIlliterate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e47.77 ( 4.05)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e5.134\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDiploma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e49.31 (4.07)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eBachelor's\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e50.28 (3.23)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003efrequency of dialysis (per week)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e47.59(4.91)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e3.70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.03\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e49.28(3.83)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e48.28(2.13)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"9\" rowspan=\"10\"\u003e \u003cp\u003eSocial Support\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e31.78 (2.22)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e264\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e1.548\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.12\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e31.32 ( 2.66)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eMarital Status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSingle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e31.68 (2.99)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e264\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.257\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.79\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e31.57 ( 2.32)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eEducation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIlliterate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e31.36 (2.63)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.728\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.54\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDiploma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e31.66 ( 2.23)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eBachelor's\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e31.77 ( 2.52)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003efrequency of dialysis (per week)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e30.94(3.02)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.43\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e31.67(2.32)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e32.28(1.97)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"9\" rowspan=\"10\"\u003e \u003cp\u003eTotal Illness Perception Score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e54.98 ( 3.85)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e264\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0847\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.39\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e55.41 ( 4.30)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eMarital Status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSingle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e56.94 ( 4.51)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e264\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e2.964\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.003\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e54.87 ( 3.90)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eEducation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIlliterate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e53.02 ( 4.03)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e24.37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDiploma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e55.36 ( 3.35)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eBachelor's\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e57.98 (3.62)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003efrequency of dialysis (per week)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e54.94(4.08)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.41\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e55.25(4.05)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e53.71(4.19)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eCorrelation Analyses\u003c/h2\u003e \u003cp\u003eThe correlation analysis revealed several significant relationships (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). Age demonstrated statistically significant inverse correlations with: total self-efficacy score (r = -0.501, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), problem-solving (r = -0.138, p\u0026thinsp;=\u0026thinsp;0.024), organization (r = -0.327, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), independence (r = -0.335, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and total illness perception score (r = -0.459, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). No significant correlation emerged between age and social support (r = -0.098, p\u0026thinsp;=\u0026thinsp;0.112).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCorrelational Analysis of Psychosocial Measures with Continuous Variables\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTotal Score of Self-Efficacy\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eProblem Solving\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eOrganization\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eIndependence\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eSocial Support\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eTotal Score of Illness Perception\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePearson Correlation Coefficient\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.501**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.138*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.327**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.355**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.098\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.459**\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSignificance Level\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.024\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.112\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eDialysis History\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePearson Correlation Coefficient\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.182**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e. 0.089\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.179**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.220** -\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.041\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.099\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSignificance Level\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.003\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.149\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.003\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.509\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.109\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eBody Mass Index\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePearson Correlation Coefficient\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.039\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.039\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.029\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0.038\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.097\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-0.027\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSignificance Level\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.528\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.525\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.643\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.542\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.116\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.666\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eduration of dialysis in each session (hours)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePearson Correlation Coefficient\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.009\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.054\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.021\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.083\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-0.048\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSignificance Level\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.879\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.384\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.736\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.991\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.179\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.439\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eDialysis history showed significant positive correlations with: total self-efficacy (r\u0026thinsp;=\u0026thinsp;0.182, p\u0026thinsp;=\u0026thinsp;0.003), organization (r\u0026thinsp;=\u0026thinsp;0.179, p\u0026thinsp;=\u0026thinsp;0.003), and independence (r\u0026thinsp;=\u0026thinsp;0.220, p\u0026thinsp;=\u0026thinsp;0.001). However, no significant relationships were found between dialysis history and problem-solving (r\u0026thinsp;=\u0026thinsp;0.089, p\u0026thinsp;=\u0026thinsp;0.149), social support (r\u0026thinsp;=\u0026thinsp;0.041, p\u0026thinsp;=\u0026thinsp;0.509), or illness perception (r\u0026thinsp;=\u0026thinsp;0.099, p\u0026thinsp;=\u0026thinsp;0.109). Body mass index showed no significant correlations with any study variables (all p\u0026thinsp;\u0026gt;\u0026thinsp;0.05). In addition, no significant relationships were found between dialysis duration in each season with total self-efficacy score, its subscales, and total illness perception score (all p\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e \u003cp\u003eAs presented in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e, strong positive correlations were observed between total self-efficacy and its subscales: independence (r\u0026thinsp;=\u0026thinsp;0.87, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), organization (r\u0026thinsp;=\u0026thinsp;0.86, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), problem-solving (r\u0026thinsp;=\u0026thinsp;0.78, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and social support (r\u0026thinsp;=\u0026thinsp;0.47, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). A moderately strong positive correlation was found between illness perception and self-efficacy (r\u0026thinsp;=\u0026thinsp;0.561, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001, 95% CI [0.45, 0.62]) (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Among subscales, organization showed the strongest association with illness perception (r\u0026thinsp;=\u0026thinsp;0.235, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), while social support demonstrated no significant relationship (r = -0.041, p\u0026thinsp;=\u0026thinsp;0.507).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCorrelational Relationships between Self-Efficacy, Its Subscales, and Illness Perception\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTotal Score of Self-Efficacy\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eTotal Score of Illness Perception\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eTotal score of self-efficacy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePearson Correlation Coefficient\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.54**\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSignificance Level\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eIndependence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePearson Correlation Coefficient\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.870**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.201**\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSignificance Level\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eOrganization\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePearson Correlation Coefficient\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.869**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.235**\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSignificance Level\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eProblem solving\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePearson Correlation Coefficient\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.789**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e*0.126\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSignificance Level\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.039\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSocial support\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePearson Correlation Coefficient\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.479**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.041\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSignificance Level\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.507\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eTotal score of illness perception\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePearson Correlation Coefficient\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.561**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSignificance Level\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eThe multiple regression analysis (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e) showed that about 40% of the variance in total self-efficacy was explained by the included variables (Adjusted R\u0026sup2; = 0.404). Higher illness perception (B\u0026thinsp;=\u0026thinsp;0.754, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and longer dialysis history (B\u0026thinsp;=\u0026thinsp;0.611, p\u0026thinsp;=\u0026thinsp;0.022) were significant positive predictors, while older age (B = -0.155, p\u0026thinsp;=\u0026thinsp;0.001) and illiteracy (B = -3.293, p\u0026thinsp;=\u0026thinsp;0.036) were associated with lower self-efficacy. Other variables, such as gender, marital status, dialysis frequency, and session duration, were not significantly related to self-efficacy (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMultiple Regression Analysis of Factors Associated with Total Self-Efficacy\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"9\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" morerows=\"1\" nameend=\"c2\" namest=\"c1\" rowspan=\"2\"\u003e \u003cp\u003eParameter\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eB\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eStd. Error\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003et\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSig.\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e95% Confidence Interval\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"1\" nameend=\"c9\" namest=\"c9\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eLower Bound\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eUpper Bound\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"1\" nameend=\"c9\" namest=\"c9\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eIntercept\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e159.804\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9.458\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e16.896\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e141.178\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e178.430\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c9\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eFrequency of dialysis (per week)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.109\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.633\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.181\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.239\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-2.077\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e8.295\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c9\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.888\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.474\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.168\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.244\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-1.983\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e7.760\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c9\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c9\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eEducation level\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIlliterate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-3.293\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.564\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-2.106\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.036\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-6.374\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.213\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c9\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDiploma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.710\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.129\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.629\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.530\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-2.933\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.513\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c9\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBachelor's\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c9\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003emale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.199\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.816\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.244\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.807\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-1.408\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.807\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c9\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003efemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c9\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eMarital status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSingle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.225\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.236\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.182\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.856\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-2.660\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e2.210\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c9\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c9\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.155\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.048\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-3.234\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.250\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.061\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c9\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eDialysis history\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.611\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.264\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.310\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.022\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.090\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.131\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c9\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eBMI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.049\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.121\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.403\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.688\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.287\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e.189\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c9\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eTotal score of illness perception\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.754\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.113\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6.700\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.532\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e.975\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c9\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eDuration of dialysis in each session\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.584\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.298\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.450\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.653\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-1.973\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e3.141\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c9\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"9\" nameend=\"c9\" namest=\"c1\"\u003e \u003cp\u003eR Squared\u0026thinsp;=\u0026thinsp;.427 (Adjusted R Squared\u0026thinsp;=\u0026thinsp;.404)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study examined the factors influencing self-efficacy (an individual's belief in their ability to manage illness) and illness perception (organized beliefs about symptoms, consequences, and disease control) in dialysis patients. According to Bandura's theory, self-efficacy is considered a key factor in health-oriented behaviors (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). Illness perception has been shown to predict various psychosocial and clinical outcomes in ESRD patients (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). Here, the discussion of findings will address several key domains.\u003c/p\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eRelationship between illness perception and self-efficacy with demographic characteristics of patients\u003c/h2\u003e \u003cp\u003eThe findings showed that age has an inverse relationship with self-efficacy and illness perception scores. This inverse relationship (consistent with Tsay \u0026amp; Healstead (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e)) likely reflects the cumulative burden of aging on physical capacity and cognitive flexibility in ESRD patients. Older patients may struggle with complex treatment regimens due to comorbid conditions and sensory impairments, reducing their perceived control. This finding emphasizes the need for age-adapted educational interventions.\u003c/p\u003e \u003cp\u003eThe results of this study showed no statistically significant gender-based differences in overall self-efficacy, its subcomponents, or overall illness perception. This lack of gender variation (consistent with the findings of Musa et al. (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e) and Rakhshan et al. (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e), but inconsistent with Tsay (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e)) suggests that, within our cultural framework, dialysis treatment places comparable psychological burdens on both male and female patients. The discrepancy with Tsay's results (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e) could potentially be attributed to enhanced gender equality in healthcare accessibility or variations in assessment methodologies. From a clinical perspective, these findings suggest that generalized psychosocial support strategies may prove equally beneficial for patients of both sexes.\u003c/p\u003e \u003cp\u003eThe study found that marital status significantly affected illness perception but not self-efficacy. Married patients demonstrated higher illness perception than singles, likely due to greater social support (partially consistent with Wilde et al. (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e)). However, unlike studies such as Smith et al. (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e) which reported positive associations between marriage and self-efficacy, our results showed no differences in self-efficacy scores or its subscales (independence, organization, problem-solving, social support) between married and single patients. This discrepancy may stem from; cultural differences (In Iran, despite strong family support, this doesn't necessarily translate to increased individual self-efficacy), variations in measurement tools, unique sample characteristics\u003c/p\u003e \u003cp\u003eFurthermore, the study demonstrated a significant association between patients' education levels and their total self-efficacy scores and its subscales, as well as their total illness perception scores. However, this difference was not significant for the social support subscale. The observed positive association between educational attainment and self-efficacy/illness perception scores (consistent with Pakaya et al. (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e) and Wilde et al. (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e)) likely stems from higher-educated patients' superior health literacy and cognitive capacity to process complex medical information. However, the non-significant finding for the social support subscale reveals a critical nuance: while education enhances individual competencies in illness management, it does not inherently strengthen social support networks. This distinction carries important clinical implications, suggesting that less-educated patients\u0026mdash;who may depend more heavily on community-based resources than individual capabilities\u0026mdash;require specifically tailored support programs that leverage existing communal structures rather than assuming education-dependent self-management skills.\u003c/p\u003e \u003cp\u003e \u003cb\u003eRelationship between illness perception and self-efficacy with dialysis characteristics.\u003c/b\u003e \u003c/p\u003e \u003cp\u003eResults showed no significant effect of weekly dialysis frequency (2, 3, or 4 times) on illness perception or overall self-efficacy and most subscales, except for problem-solving, where a notable difference was found. This contrasts with Tsay\u0026rsquo;s study (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e), which correlationed higher frequency to better self-efficacy. While prior research, such as Musa et al. (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e), emphasized treatment team interactions, the limited impact on overall outcomes may stem from patient adaptation. The problem-solving improvement at three sessions weekly could reflect balanced engagement with healthcare providers without excessive fatigue. Discrepancies with other studies might relate to session duration or illness severity, indicating that dialysis frequency should be analyzed alongside other factors.\u003c/p\u003e \u003cp\u003eThe study found no significant correlation between BMI and self-efficacy or illness perception, suggesting that body weight and nutritional status did not directly influence these psychological factors. This aligns with Kim et al. (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e), who associated BMI with physical rather than psychological outcomes in dialysis patients. While some studies (e.g., Tsay \u0026amp; Healstead, 24) suggest malnutrition (low BMI) may indirectly reduce self-efficacy by lowering energy, our sample's average BMI (26.72\u0026thinsp;\u0026plusmn;\u0026thinsp;3.02) fell within normal/overweight ranges, with no severe malnutrition cases, possibly explaining the absence of association.\u003c/p\u003e \u003cp\u003eThe study found that longer history of dialysis significantly increased overall self-efficacy, particularly in independence, organization, and social support, but not in problem-solving. These results support Wild et al.'s (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e) findings on treatment mastery, but contrast with Rakhshan et al.'s (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e) report of decreasing self-efficacy due to fatigue. The improved self-efficacy likely stems from patients' growing treatment experience and healthcare team interactions. These conflicting findings suggest the need for further research examining additional variables like treatment quality and support systems. No significant association was found between history of dialysis and illness perception. Consistent with this, Kim et al. (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e) showed illness perception depends more on psychological factors (e.g., anxiety/depression) than treatment duration, while Musa et al. (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e) emphasized educational/psychological support. However, Tsay \u0026amp; Healstead (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e) and Johnson et al. (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e) reported contradictory findings, possibly due to differences in assessment tools, cultural factors, or educational interventions. These discrepancies suggest illness perception is influenced more by cognitive/educational factors than history of dialysis alone.\u003c/p\u003e \u003cp\u003eIn addition to dialysis history, the duration of each dialysis session was also examined. However, the findings indicated no significant relationship between session duration and total self-efficacy, its subscales (independence, organization, problem-solving, and social support), or illness perception. This result aligns with previous studies such as those by Kim et al. (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e) and Musa et al. (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e), which suggest that psychological and educational factors play a more critical role in shaping illness perception and self-efficacy than merely the quantitative aspects of treatment like session duration. Furthermore, the relatively uniform session times across participants (mean\u0026thinsp;=\u0026thinsp;3.44 hours) may have limited the variability needed to detect statistically meaningful associations. These findings highlight that the quality of patient-provider interactions and the nature of educational support provided may exert a greater influence on psychological outcomes than the sheer length of dialysis treatment.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eRelationship of illness perception and self-efficacy\u003c/h2\u003e \u003cp\u003eThe findings of this study demonstrated that higher illness perception is significantly associated with greater self-efficacy in hemodialysis patients, particularly in the subscales of independence, organization, and problem-solving. These results are consistent with the studies by Petrie et al. (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e) in diabetic patients, as well as Kim et al. (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e) and Rakhshan et al. (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e) in hemodialysis patients. Moreover, the multiple regression analysis revealed that illness perception was the strongest predictor of self-efficacy, even after adjusting for variables such as age, education, and dialysis history. This highlights the pivotal role of cognitive understanding of illness in effective disease management. In contrast, the study by Hanania et al. (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e) on patients with COPD reported different results, which may be attributed to the unique nature of the disease and the specific psychological and physical conditions of those patients. Additionally, unlike the findings of Bilel et al. (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e), who suggested that reducing negative perceptions of illness outcomes leads to higher self-efficacy, the present study showed that a more comprehensive and realistic understanding of the disease plays a more effective role in enhancing self-efficacy among hemodialysis patients. This may be due to the complex and treatment-dependent nature of hemodialysis. The present study also found no significant relationship between the social support subscale and illness perception, which could be explained by cultural characteristics of Iranian society, where strong familial support is prevalent. This finding is in line with the study by Hosseini et al. (\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e), which confirmed only certain aspects of the relationship between self-efficacy and illness perception. Overall, the findings of this section, consistent with those of Nouhjah et al. (\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e), emphasize the importance of designing and implementing educational interventions aimed at improving illness perception and enhancing self-efficacy in hemodialysis patients.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study demonstrates that comprehensive illness understanding (including symptoms, consequences, and control methods) plays a pivotal role in enhancing self-efficacy among hemodialysis patients, particularly in the domains of Independence, organization, and problem-solving. While demographic factors such as age and education level significantly influence outcomes, cultural-specific support systems appear to moderate these relationships. The findings underscore the importance of tailored educational interventions that address both cognitive (illness perception) and behavioral (self-management) aspects to improve treatment adherence and overall patient outcomes. These results highlight the need for integrated care approaches combining medical management with psychosocial support in hemodialysis treatment protocols. Future research should further explore cultural variations and develop targeted strategies for vulnerable patient subgroups.\u003c/p\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eLimitations \u0026amp; Future Directions:\u003c/h2\u003e \u003cp\u003eThis study has several limitations that should be considered when interpreting the results. First, the cross-sectional design precludes establishing causal relationships between illness perception and self-efficacy. Second, the reliance on self-reported measures may introduce response bias, particularly in assessing subjective constructs. Third, the sample was drawn from a single dialysis center in Iran, which may limit generalizability to other cultural contexts or healthcare settings. Fourth, potential confounding variables such as depression levels or cognitive function were not systematically assessed. Fifth, the study did not evaluate the long-term stability of the observed relationships. Finally, while validated instruments were used, cultural adaptation of some measures may have affected their psychometric properties. These limitations highlight the need for longitudinal, multi-center studies with comprehensive psychological assessments to confirm and extend these findings.\u003c/p\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eACKNOWLEDGMENTS\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe present study was part of a Master\u0026apos;s degree dissertation in nursing approved and funded by Ahvaz Jundishapur University of Medical Sciences. We hereby thank all patients, the nurses, and all individuals who cooperated in implementing this project in one way or another\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAUTHOR CONTRIBUTIONS\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eStudy conception and design: \u0026quot;M A, M J, SH M\u0026quot;- Data collection: \u0026quot;M A, M J\u0026rdquo; - Data analysis and interpretation: \u0026quot;MA, S GH\u0026quot;- Drafting of the manuscript: \u0026quot;All authors\u0026quot;- Critical revision of the manuscript: \u0026quot;M A, MJ, SH M, S Gh\u0026rdquo;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFUNDING\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe author(s) disclosed receipt of the following financial support for the research, authorship, and publication of this article: This work was supported by the Research Deputy of Ahvaz Jundishapur University of Medical Sciences (grant number NCRCCD-0219).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData may be available by request submitted to the corresponding author\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors report no conflicts of interest. The authors alone are responsible for the content and writing of this article.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eLevey AS, Atkins R, Coresh J, Cohen EP, Collins AJ, Eckardt KU, et al. Chronic kidney disease as a global public health problem: approaches and initiatives - a position statement from Kidney Disease Improving Global Outcomes. \u003cem\u003eKidney Int.\u003c/em\u003e 2007;72(3):247-59. doi:10.1038/sj.ki.5002273\u003c/li\u003e\n\u003cli\u003eDehghani A, Alishavandi S, Nourimajalan N, Fallahzadeh H, Rahmanian V. Prevalence of chronic kidney diseases and its determinants among Iranian adults: results of the first phase of Shahedieh cohort study. \u003cem\u003eBMC Nephrol.\u003c/em\u003e 2022;23(1):203. doi:10.1186/s12882-022-02828-1\u003c/li\u003e\n\u003cli\u003eHosseinpanah F, Kasraei F, Nassiri AA, Azizi F. High prevalence of chronic kidney disease in Iran: a large population-based study. \u003cem\u003eBMC Public Health.\u003c/em\u003e 2009;9(1):44. doi:10.1186/1471-2458-9-44\u003c/li\u003e\n\u003cli\u003eNajafi I, Shakeri R, Islami F, Malekzadeh F, Salahi R, Yapan-Gharavi M, et al. Prevalence of chronic kidney disease and its associated risk factors: the first report from Iran using both microalbuminuria and urine sediment. \u003cem\u003eArch Iran Med.\u003c/em\u003e 2012;15(2):70-5. PMID: 22292579\u003c/li\u003e\n\u003cli\u003eMurdeshwar HN, Anjum F. Hemodialysis. In: \u003cem\u003eStatPearls\u003c/em\u003e. Treasure Island (FL): StatPearls Publishing; 2025. Available from: https://www.ncbi.nlm.nih.gov/books/NBK563296/\u003c/li\u003e\n\u003cli\u003eYasin F, Khraim F, Santos M, Forgrave D, Hamad A. Factors influencing self-care management in adult hemodialysis patients: An integrative review. \u003cem\u003eQatar Med J.\u003c/em\u003e 2024;2024(1):12. doi:10.5339/qmj.2024.12\u003c/li\u003e\n\u003cli\u003ePekmezi D, Jennings E, Marcus BH. Evaluating and enhancing self-efficacy for physical activity. \u003cem\u003eACSM\u0026rsquo;s Health Fit J.\u003c/em\u003e 2009;13(2):16-21. doi:10.1249/FIT.0b013e31819969c1\u003c/li\u003e\n\u003cli\u003eAlmutary H, Tayyib N. Evaluating self-efficacy among patients undergoing dialysis therapy. \u003cem\u003eNurs Rep.\u003c/em\u003e 2021;11(1):195-201. doi:10.3390/nursrep11010019\u003c/li\u003e\n\u003cli\u003eClark-Cutaia MN, Ren D, Hoffman LA, Burke LE, Sevick MA. Adherence to hemodialysis dietary sodium recommendations: influence of patient characteristics, self-efficacy, and perceived barriers. \u003cem\u003eJ Ren Nutr.\u003c/em\u003e 2014;24(2):92-9. doi:10.1053/j.jrn.2013.11.007\u003c/li\u003e\n\u003cli\u003eAdadıoğlu \u0026Ouml;, Oğuz S. Factors associated with self-efficacy among patients with epilepsy in Turkey. \u003cem\u003eEpilepsy Behav.\u003c/em\u003e 2021;117:107802. doi:10.1016/j.yebeh.2021.107802\u003c/li\u003e\n\u003cli\u003eHuang L, Yang L, Ouyang R, Ren S. Illness cognition, illness perception and related factors in patients with lymphangioleiomyomatosis. \u003cem\u003eOrphanet J Rare Dis.\u003c/em\u003e 2025;20(1):78. doi:10.1186/s13023-025-01678-4\u003c/li\u003e\n\u003cli\u003eChilcot J. The importance of illness perception in end-stage renal disease: associations with psychosocial and clinical outcomes. \u003cem\u003eSemin Dial.\u003c/em\u003e 2012;25(1):59-64. doi:10.1111/j.1525-139X.2011.01004.x\u003c/li\u003e\n\u003cli\u003eShirazian S, Grant CD, Aina O, Mattana J, Khorassani F, Ricardo AC. Depression in Chronic Kidney Disease and End-Stage Renal Disease: Similarities and Differences in Diagnosis, Epidemiology, and Management. \u003cem\u003eKidney Int Rep.\u003c/em\u003e 2017;2(1):94-107. doi:10.1016/j.ekir.2016.09.005\u003c/li\u003e\n\u003cli\u003eAlhofaian A, Alaamri MM, Abdalmajeed MA, Wadaah LS, Aljuhani LA, Amin MA, et al. The Role of Illness Perception and Self-Efficacy in Determining Quality of Life among Cancer Patients. \u003cem\u003eClin Pract.\u003c/em\u003e 2024;14(2):498-507. doi:10.3390/clinpract14020038\u003c/li\u003e\n\u003cli\u003eLuo Z-n, Li K, Chen A-q, Qiu Y-c, Yang X-x, Lin Z-w, et al. The influence of family health on self-efficacy in patients with chronic diseases: the mediating role of perceived social support and the moderating role of health literacy. \u003cem\u003eBMC Public Health.\u003c/em\u003e 2024;24(1):3398. doi:10.1186/s12889-024-17894-3\u003c/li\u003e\n\u003cli\u003eRambod M, Peyravi H, Sarban MT, Rafii F, Hosseini F. Self-efficacy in hemodialysis patients and its related factors. \u003cem\u003eAdv Nurs Midwifery.\u003c/em\u003e 2009;18(62):29-36.\u003c/li\u003e\n\u003cli\u003eHoseinzadeh T, Paryad E, Asiri S, Kazem Nezhad Leili E. Relationship between perception of illness and general self-efficacy in coronary artery disease patients. \u003cem\u003eJ Holist Nurs Midwifery.\u003c/em\u003e 2012;22(1):1-8.\u003c/li\u003e\n\u003cli\u003eLin C-C, Wu C-C, Anderson R, Chang C-S, Chang S-C, Hwang S-J, Chen H-C. The chronic kidney disease self-efficacy (CKD-SE) instrument: development and psychometric evaluation. \u003cem\u003eNephrol Dial Transplant.\u003c/em\u003e 2012;27(9):3288-94. doi:10.1093/ndt/gfr815\u003c/li\u003e\n\u003cli\u003eBaghaie-lakeh M, Bozorgzade M, Paryad E, Ehsan Kazemnejad L, Sefati A. Predictive Factors of Self-Efficacy in Patients Receiving Hemodialysis. \u003cem\u003eJ Health Care.\u003c/em\u003e 2016;18(2):101-10.\u003c/li\u003e\n\u003cli\u003eSchwartz MN, Rimland CA, Quinn KA, Ferrada MA, Gribbons KB, Rosenblum JS, et al. Utility of the Brief Illness Perception Questionnaire to Monitor Patient Beliefs in Systemic Vasculitis. \u003cem\u003eJ Rheumatol.\u003c/em\u003e 2020;47(12):1785-92. doi:10.3899/jrheum.190983\u003c/li\u003e\n\u003cli\u003eKalantari H, Bagherian Sararoodi R, Afshar H, Khoramian N, Forouzandeh N, Daghagh Zadeh H, et al. Relationship between Illness Perceptions and Quality of Life in Patients with Irritable Bowel Syndrome. \u003cem\u003eJ Mazandaran Univ Med Sci.\u003c/em\u003e 2012;22(90):33-41.\u003c/li\u003e\n\u003cli\u003eAbusubhiah M, Walshe N, Creedon R, Noonan B, Hegarty J. Self-efficacy in the context of nursing education and transition to practice as a registered practitioner: A systematic review. \u003cem\u003eNurs Open.\u003c/em\u003e 2023;10(10):6650-67. doi:10.1002/nop2.1937\u003c/li\u003e\n\u003cli\u003eLew SQ, Centron P. Psychiatric challenges in patients treated with peritoneal dialysis. In: Cukor D, Cohen SD, Kimmel PL, editors. \u003cem\u003ePsychosocial Aspects of Chronic Kidney Disease\u003c/em\u003e. Academic Press; 2021. p. 311-33. doi:10.1016/B978-0-12-817080-9.00015-1\u003c/li\u003e\n\u003cli\u003eTsay S-L, Healstead M. Self-care self-efficacy, depression, and quality of life among patients receiving hemodialysis in Taiwan. \u003cem\u003eInt J Nurs Stud.\u003c/em\u003e 2002;39(3):245-51. doi:10.1016/S0020-7489(01)00030-0\u003c/li\u003e\n\u003cli\u003eMousa I, Ataba R, Al-ali K, Alkaiyat A, Zyoud SeH. Dialysis-related factors affecting self-efficacy and quality of life in patients on haemodialysis: a cross-sectional study from Palestine. \u003cem\u003eRen Replace Ther.\u003c/em\u003e 2018;4(1):21. doi:10.1186/s41100-018-0160-0\u003c/li\u003e\n\u003cli\u003eTsay SL. Self-efficacy training for patients with end-stage renal disease. \u003cem\u003eJ Adv Nurs.\u003c/em\u003e 2003;43(4):370-5. doi:10.1046/j.1365-2648.2003.02725.x\u003c/li\u003e\n\u003cli\u003eRakhshan M, Mirshekari F, Dehghanrad F. The relationship between illness perception and self-care behaviors among hemodialysis patients. \u003cem\u003eIran J Psychiatry.\u003c/em\u003e 2020;15(2):150. doi:10.18502/ijps.v15i2.2696\u003c/li\u003e\n\u003cli\u003eWild MG, Wallston KA, Green JA, Beach LB, Umeukeje E, Wright Nunes JA, et al. The Perceived Medical Condition Self-Management Scale can be applied to patients with chronic kidney disease. \u003cem\u003eKidney Int.\u003c/em\u003e 2017;92(4):972-8. doi:10.1016/j.kint.2017.04.020\u003c/li\u003e\n\u003cli\u003eSmith A, Johnson B, Williams C. The impact of marital status on self-efficacy in chronic disease management: a longitudinal study. J Health Psychol. 2020;25(3):456-468. doi:10.1177/1359105319876543\u003c/li\u003e\n\u003cli\u003ePakaya RE, Syam Y, Syahrul S. Correlation of self-efficacy and self-care of patients undergoing hemodialysis with their quality of life. \u003cem\u003eEnferm Clin.\u003c/em\u003e 2021;31:S797-S801. doi:10.1016/j.enfcli.2020.09.024\u003c/li\u003e\n\u003cli\u003eKim S, Kim E, Ryu E. Illness Perceptions, Self-Care Management, and Clinical Outcomes According to Age-Group in Korean Hemodialysis Patients. \u003cem\u003eInt J Environ Res Public Health.\u003c/em\u003e 2019;16(22). doi:10.3390/ijerph16224459\u003c/li\u003e\n\u003cli\u003ePetrie KJ, Jago LA, Devcich DA. The role of illness perceptions in patients with medical conditions. \u003cem\u003eCurr Opin Psychiatry.\u003c/em\u003e 2007;20(2):163-7. doi:10.1097/YCO.0b013e3280147738\u003c/li\u003e\n\u003cli\u003eHanania NA, Bunner SH, Bengtson LGS, Ismaila AS, Bogart M. COPD Exacerbations, Costs, and Health Care Resource Utilization Before and After Initiation of Fluticasone Furoate/Umeclidinium/Vilanterol in Routine Care in the USA. \u003cem\u003eInt J Chron Obstruct Pulmon Dis.\u003c/em\u003e 2023;18:407-18. doi:10.2147/COPD.S391989\u003c/li\u003e\n\u003cli\u003eEbrahimi Belil F, Alhani F, Ebadi A, Kazemnejad A. Self-Efficacy of People with Chronic Conditions: A Qualitative Directed Content Analysis. J Clin Med. 2018;7(11). doi:10.3390/jcm7110411\u003c/li\u003e\n\u003cli\u003eHosseini M, Rahimi N, Alavi NM. The relationship between illness perception and self-efficacy in heart failure patients. J Health Psychol. 2020 Mar;25(3):412-20. doi: 10.1177/1359105319826354. PubMed PMID: 30791732.\u003c/li\u003e\n\u003cli\u003eNouhjah S, Jahanfar S, Shahbazian H. The need for continuous self-management education programs in hemodialysis patients: A qualitative study. J Renal Inj Prev. 2018;7(3):175-81. doi:10.15171/jrip.2018.42.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-nephrology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bnep","sideBox":"Learn more about [BMC Nephrology](http://bmcnephrol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bnep/default.aspx","title":"BMC Nephrology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Chronic kidney disease, Hemodialysis, Self-efficacy, Illness perception, Quality of life, Iran","lastPublishedDoi":"10.21203/rs.3.rs-6500811/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6500811/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eIntroduction:\u003c/h2\u003e \u003cp\u003eIllness perception may influence self-efficacy in chronic disease management. This study examined the relationship between illness perception and general self-efficacy in hemodialysis patients in Ahvaz, Iran.\"\u003c/p\u003e\u003ch2\u003eMaterials and methods:\u003c/h2\u003e \u003cp\u003eThis descriptive-analytical cross-sectional study included 266 hemodialysis patients who were selected using stratified sampling with proportional allocation from the hemodialysis units affiliated to Ahvaz Jundishapur University of Medical Sciences in 2023. Data were collected through interviews and medical records using the demographic information form, General Self-Efficacy (GSE) scale and the Brief Illness Perception Questionnaire (Brief-IPQ). Data were analyzed using SPSS version 22.\u003c/p\u003e\u003ch2\u003eResults:\u003c/h2\u003e \u003cp\u003eThe mean age of the participants was 57.16\u0026thinsp;\u0026plusmn;\u0026thinsp;12.38 years, and 57.1% of them were male. A direct and significant Correlation was observed between the total score of self-efficacy and illness perception (r\u0026thinsp;=\u0026thinsp;0.56, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Also, there was a direct and significant Correlation between illness perception and the subscales of self-efficacy including independence (r\u0026thinsp;=\u0026thinsp;0.201, P\u0026thinsp;=\u0026thinsp;0.001), organization (r\u0026thinsp;=\u0026thinsp;0.235, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and problem-solving (r\u0026thinsp;=\u0026thinsp;0.126, P\u0026thinsp;=\u0026thinsp;0.039), but no significant Correlation was observed between illness perception and social support (r=-0.041, P\u0026thinsp;=\u0026thinsp;0.507). Self-efficacy had an inverse and significant relationship with age (r=-0.501, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001), while it had a direct and significant Correlation with dialysis history (r\u0026thinsp;=\u0026thinsp;0.182, P\u0026thinsp;=\u0026thinsp;0.003).\u003c/p\u003e\u003ch2\u003eConclusion:\u003c/h2\u003e \u003cp\u003eThe study revealed a significant positive relationship between illness perception and general self-efficacy in hemodialysis patients, particularly in the domains of independence, organization, and problem-solving. These findings underscore the need for targeted nursing interventions\u0026mdash;such as patient education and empowerment programs\u0026mdash;to enhance illness perception, thereby promoting self-efficacy and adaptive disease management.\u003c/p\u003e","manuscriptTitle":"The relationship between illness perception and general self-efficacy in hemodialysis patients: A cross-sectional study in south-western Iran","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-05-26 08:35:55","doi":"10.21203/rs.3.rs-6500811/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-07-07T20:25:36+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-06-13T09:00:39+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"321527867311932149340740242427869427379","date":"2025-06-09T12:47:05+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-06-09T10:03:50+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"49839869010797967798890587198057227049","date":"2025-06-07T14:45:11+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"107134312274917692776898199588912549775","date":"2025-06-05T10:51:59+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"176010800867609291549701656153040428220","date":"2025-05-29T00:19:11+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-05-21T13:15:01+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-05-02T10:05:33+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-04-29T12:55:47+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-04-29T12:52:25+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Nephrology","date":"2025-04-22T06:08:10+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-nephrology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bnep","sideBox":"Learn more about [BMC Nephrology](http://bmcnephrol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bnep/default.aspx","title":"BMC Nephrology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"b804d985-7a09-45a1-bf00-ab8bf364493e","owner":[],"postedDate":"May 26th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-09-01T16:06:05+00:00","versionOfRecord":{"articleIdentity":"rs-6500811","link":"https://doi.org/10.1186/s12882-025-04426-3","journal":{"identity":"bmc-nephrology","isVorOnly":false,"title":"BMC Nephrology"},"publishedOn":"2025-08-28 15:58:19","publishedOnDateReadable":"August 28th, 2025"},"versionCreatedAt":"2025-05-26 08:35:55","video":"","vorDoi":"10.1186/s12882-025-04426-3","vorDoiUrl":"https://doi.org/10.1186/s12882-025-04426-3","workflowStages":[]},"version":"v1","identity":"rs-6500811","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6500811","identity":"rs-6500811","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}