Spiritual Well-Being, Treatment Adherence, and Self-Management in Hemodialysis Care: A Cross-Sectional Study

Background/Objectives: Hemodialysis requires sustained patient participation in demanding treatment and self-management routines. Spiritual well-being may be a patient-centered psychosocial resource relevant to adherence and self-management, but its independent associations with these patient-reported outcomes remain uncertain. This study examined the associations of spiritual well-being with treatment adherence and self-management among adults undergoing hemodialysis. Methods: This single-center cross-sectional study included 72 adults receiving maintenance hemodialysis at a public hospital in Türkiye between March and May 2025. Spiritual well-being, treatment adherence, and self-management were assessed using the Spiritual Well-Being Scale, End-Stage Renal Disease Adherence Questionnaire, and Chronic Disease Self-Management Scale, respectively. Pearson correlations and two multivariable linear regression models with HC3 robust standard errors were used. Models were adjusted for age, sex, dialysis duration, and number of comorbidities. Rank-based, influence-restricted, and nonlinear sensitivity analyses were performed. Results: Spiritual well-being was positively correlated with treatment adherence (r = 0.822, p < 0.001) and self-management (r = 0.891, p < 0.001). In adjusted linear models, higher spiritual well-being was associated with greater treatment adherence (B = 4.338, 95% CI 3.550–5.126; p < 0.001; adjusted R2 = 0.655) and better self-management (B = 0.494, 95% CI 0.418–0.569; p < 0.001; adjusted R2 = 0.787). Sensitivity analyses confirmed the direction and statistical significance of both associations, while nonlinear models suggested attenuation at higher spiritual well-being scores. Conclusions: Spiritual well-being was associated with two patient-reported outcomes relevant to long-term hemodialysis care after adjustment for the measured demographic and clinical covariates. Person-centered nephrology assessment may consider spiritual well-being alongside health literacy, psychological distress, social support, and practical treatment barriers. Longitudinal multicenter studies should determine the temporal direction and clinical implications of these relationships.