A Mobile-Based Mindfulness Intervention for Reducing Demoralization in Patients on Maintenance Hemodialysis:
Xingxing Shen1,2, Huanhuan Li1,3, Fang Sun4
1Department of Psychology, Renmin University of China, Floor 10, Suite D, Huixian Building, 59 Zhongguancun Street, Haidian District, Beijing, 100872, China, 86 13439892584.
Journal of Medical Internet Research
|August 7, 2026
Summary
A mobile-based mindfulness intervention effectively reduced demoralization and symptom burden in patients with end-stage renal disease undergoing hemodialysis, highlighting the potential of digital mental health tools.
Area of Science:
- Psychology
- Nephrology
- Digital Health
Background:
- Patients with end-stage renal disease (ESRD) on maintenance hemodialysis face significant symptom burden and high rates of demoralization syndrome, impacting quality of life.
- The psychological mechanisms linking symptom burden to demoralization are not well understood, and effective interventions are limited.
Purpose of the Study:
- To investigate how coping strategies and trait mindfulness mediate the relationship between symptom burden and demoralization in hemodialysis patients.
- To evaluate the effectiveness of a mobile-based mindfulness intervention (MMI) for reducing demoralization in this population.
Main Methods:
- An explanatory sequential mixed-methods design was employed, including a cross-sectional survey and interviews (Study 1) followed by a randomized controlled trial (Study 2).
- Study 2 randomized 72 patients with moderate-to-severe demoralization to a 6-week WeChat-delivered MMI or usual care, analyzing outcomes using moderated mediation and ANOVA.
Main Results:
- Trait mindfulness moderated the association between symptom burden and demoralization, as well as avoidance coping and demoralization.
- Qualitative findings revealed themes on the experience of demoralization, barriers and facilitators to its alleviation, and a preference for flexible, dialysis-adapted support.
- The MMI group demonstrated significant reductions in demoralization and symptom burden, alongside increased trait mindfulness compared to the usual care group.
Conclusions:
- Avoidance coping is a key pathway to demoralization in ESRD patients, while trait mindfulness acts as a protective factor.
- A tailored mobile-based mindfulness intervention shows promise for improving psychological outcomes in patients undergoing hemodialysis.
- Scalable digital mindfulness interventions can potentially enhance psychological care within routine hemodialysis management.
