Patient health engagement as a moderator between perceived stress and treatment adherence among kidney failure patients undergoing hemodialysis: a cross-sectional analysis

The present research examined the moderating effect of patient health engagement on the relationship between perceived stress and treatment adherence among patients with kidney failure undergoing hemodialysis. In this cross-sectional study, 184 patients from three hemodialysis outpatient clinics in Türkiye completed the Perceived Stress Scale, Patient Health Engagement Scale, and End-stage Renal Disease Adherence Questionnaire. Descriptive and inferential analyses preceded a moderation test using Hayes’ PROCESS macro (Model 1) with age and weekly dialysis frequency as covariates. Results supported H1, showing that higher perceived stress was associated with lower adherence (b =− 25.90, SE = 6.38, p < 0.001), and in line with H2, the stress × engagement interaction was significant (b = 4.29, SE = 1.24, p = 0.001, ΔR2 = 0.034), suggesting that engagement buffers the adverse impact of stress on adherence. Simple-slope analyses revealed that stress negatively predicted adherence at low (b = − 12.98, p = 0.001) and average engagement (b = − 7.09, p = 0.011), but not at high engagement (b = − 1.20, p = 0.697). These findings highlight patient health engagement as a protective resource that buffers stress-related non-adherence, suggesting that interventions to strengthen engagement may enhance adherence in hemodialysis care.