What Are the Hemodialysis Patients’ Style in Coping with Stress? A Directed Content Analysis

Document Type: Original Article


1 Department of Health Education and Promotion, School of Public Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran

2 Environmental and Occupational Hazards Control Research Center, Tehran, Iran;

3 Department of Aging Health, School of Public Health, Yazd Shahid Sadoughi University of Medical Sciences, Yazd, Iran;

4 Department of Epidemiology, School of health, Shahid Beheshti University of Medical Sciences, Tehran, Iran

5 Department of Medical, School of Urology. Shahid Sadoughi University of Medical Sciences, Yazd, Iran

6 Department of Medical, School of Psychology, Shahid Sadoughi University of Medical Sciences, Yazd, Iran

7 Department of Health Education and Promotion, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran


Background: Nowadays, the prevalence of chronic diseases, such as chronic renal failure, is rising.
These patients need hemodialysis to continue their treatment, which is a stressful process. This research was conducted with the purpose of explaining coping styles in hemodialysis patients regarding stress factors based on the Lazarus and Folkman’s transactional model.
Methods: This qualitative study was conducted as a content analysis. The data collection method was
semi-structured interview with 22 patients from dialysis centers in Tehran. The data were collected
from October to January 2017. Sampling was purposive and continued until data saturation. Data were analyzed using the directed content analysis method. The process of data analysis proposed by Hsieh and Shannon’s was followed.
Results: 106 codes and 24 sub subcategories were obtained through this research and classified into 8 sub-categories of transactional stress model including: problem management, emotional regulation, social support, dispositional coping styles, positive reappraisal, revised goals, spiritual beliefs and positive events; and 3 categories of coping structures that included coping efforts, meaning-based coping and moderators.
Conclusion: Dialysis patients are making efforts to cope with their stress in order to reduce their
stress; in some cases, these efforts lead to reduction in stress, and in some cases, due to using unsound coping style, they are ineffective or even harmful. Therefore, the necessity of planning and proper interventions is felt by health care providers to control stress in dialysis patients.


  1. Ahmad MM, Al Nazly EK. Hemodialysis: stressors and coping strategies. Psychology, Health & Medicine. 2015;20:477-87.
  2. Subramanian L, Quinn M, Zhao J, et al. Coping with kidney disease – qualitative findings from the Empowering Patients on Choices for Renal Replacement Therapy (EPOCH-RRT) study. BMC Nephrology. 2017;18:119.
  3. Clarke AL, Yates T, Smith AC, Chilcot J. Patient’s perceptions of chronic kidney disease and their association with psychosocial and clinical outcomes: a narrative review. Clinical Kidney Journal. 2016;9:494-502.
  4. Reid C, Seymour J, Jones C. A Thematic Synthesis of the Experiences of Adults Living with Hemodialysis. Clinical Journal of the American Society of Nephrology. 2016;11:1206-18.
  5. Kahn LS, Vest BM, Madurai N, et al. Chronic kidney disease (CKD) treatment burden among low-income primary care patients. Chronic Illness. 2015;11:171-83.
  6. Glanz K, Rimer BK, Viswanath K. Health behavior and health education: theory, research, and practice. 4th ed. California: Jossey-Bass; 2008.
  7. Lazarus RS. Progress on a cognitive-motivational-relational theory of emotion. The American Psychologist. 1991;46:819-34.
  8. Saini HK, Sumeriya NK. Depression & Coping strategies among Chronic Kidney Disease Patients undergoing Hemodialysis in Punjab. Journal of Advanced Medical and Dental Sciences Research. 2017;5:93-5.
  9. Niihata K, Fukuma S, Akizawa T, Fukuhara S. Association of coping strategies with mortality and health-related quality of life in hemodialysis patients: The Japan Dialysis Outcomes and Practice Patterns Study. PLoS One. 2017;12:e0180498.
  10. Avvenuti G, Baiardini I, Giardini A. Optimism’s explicative role for chronic diseases. Frontiers in Psychology. 2016;2:295.
  11. Gurkan A, Pakyuz SC, Demir T. Stress Coping Strategies in Hemodialysis and Kidney Transplant Patients. Transplantation Proceedings. 2015;47:1392-7.
  12. Hsieh HF, Shannon SE. Three approaches to qualitative content analysis. Qualitative Health Research. 2005;15:1277-88.
  13. Guba EG, Lincoln YS. Competing paradigms in qualitative research. In: Denzin Nk, Lincoln YS  Handbook of Qualitative Research. California: Sage Publications; 1994.
  14. Etemedi*Nia M, Mahmood*Aliloo M, Ansarian K. The role of stress and coping strategies in the emergence of asthma, and the moderating effects of gender in this illness. Procedia Social and Behavioral Sciences. 2010;5:910-14.
  15. Morowatisharifabad MA, Miri MR, Javadi A, et al. Lived experiences of stress in patients with coronary artery bypass grafting: A Qualitative Study. Bali Medical Journal. 2017;6:649-54.
  16. Yeh SC, Chou HC. Coping Strategies and Stressors in Patients With Hemodialysis. Psychosomatic Medicine. 2007;69:182-90.
  17. Ghasemi M, Kordi M, Asgharipour N, et al. The effect of a positive reappraisal coping intervention and problem-solving skills training on coping strategies during waiting period of IUI treatment: An RCT. International Journal of Reproductive Biomedicine. 2017;15:687-96.
  18. Narimani M. A survey of relationship between coping styles and mental health in patients undergoing hemodialytic treatment. Journal of Fundamentals of Mental Health. 2008;10:117-22. [In Persion]
  19. Pogrebtsova E, Craig J, Chris A, et al. Exploring daily affective changes in university students with a mindful positive reappraisal intervention: A daily diary randomized controlled trial. Stress and Health. 2018;34:46-58.
  20. Nowlan JS, Wuthrich VM, Rapee RM. The impact of positive reappraisal on positive (and negative) emotion among older adults. International Psychogeriatrics. 2016;28:681-93.
  21. Faryabi R, Mirzayi R, Salari E, Javadi A. Investigating the effect of Education based on Lazarus and Folkman’s Transactional Stress Model on Coping Skills of Jieroft University of Medical Sciences Health care workers. Journal of Jiroft University of Medical Sciences. 2016;2:120-9. [In Persian]
  22. Gustavsson-Lilius M, Julkunen J, Keskivaara P, Hietanen P. Sense of Coherence and Distress in Cancer Patients and Their Partners. Psycho-oncology. 2007;16:1100-10.
  23. Biniaz V, Karimi*Moonaghi H, Froutan R, Ebadi A. Subjective adequacy of dialysis; a neglected concept in hemodialysis adequacy. Journal of Renal Injury Prevention. 2018;7:164-70.
  24. Ahangarezaiezadeh S, Oladrostam N, Nemotplahi A. The effect of positive thinking training on stress, anxiety and depression in coronary heart disease. Journal of Urmia Nursing and Midwifery Faculty. 2017;15:339-48. [In Persian]
  25. Dehbashi F, Sabzevari S, Tirgari B. The relationship between spiritual well-being and hope in Hemodialysis patients referring to the Khatam Anbiya hospital in Zahedan 2013-2014. Medical Ethics Journal. 2015;8:77-96. [In Persian]
  26. Yodchai K, Dunning T, Savage S, Hutchinson AM. The role of religion and spirituality in coping with kidney disease and haemodialysis in Thailand. Scandinavian Journal of Caring Sciences. 2017;31:359-67.
  27. Ibrahim N, Desa A, Chiew-Tong NK. Religious coping as mediator between illness perception and health-related quality of life among chronic kidney disease patients. Asian Social Science. 2012;8:23-31.
  28. Novalany J. The Role of Hope and Optimism in Breast Cancer Patients: A Systematic Review. [thesis]. Minnesota: Catherine University; 2017.
  29. Ghadimi M, Latif ABA, Ninggal MT, Amin NFM. A Review of the Relationship Between Dispositional Coping Styles and Situational Coping Strategies. Advanced Science Letters. 2018;24:4202-5.
  30. Newton-John TR, Mason C, Hunter M. The role of resilience in adjustment and coping with chronic pain. Rehabilitation Psychology. 2014;59:360-5.
  31. Tanyi RA, Werner JS. Women experiences of spirituality whitin end-stage renal disease and hemodialysis. Clin Nurs Res . 2008;17:32-49.
  32. Roudi O, Tirgari B, Cheraghi MA, et al. “Tender Care”: Iranian Women’s Needs to Cope with Hysterectomy and Oophorectomy- A Qualitative Content Analysis Study. International Journal of Community Based Nursing and Midwifery. 2019;7:63-74.
  33. Malek*khahi A, Jadid*Milani M, Amiri P. The Effects of Peer Support Groups on Mental Health of Hemodialysis Patients. Iran Journal of Nursing. 2015;28:40-9. [In Persian]