{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T22:07:10Z","timestamp":1790374030884,"version":"4.1.0"},"reference-count":57,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2025,12,14]],"date-time":"2025-12-14T00:00:00Z","timestamp":1765670400000},"content-version":"vor","delay-in-days":13,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,12,1]],"date-time":"2025-12-01T00:00:00Z","timestamp":1764547200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Health Science Reports"],"published-print":{"date-parts":[[2025,12]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background and Aims<\/jats:title>\n                    <jats:p>Declining sleep quality is common among hemodialysis patients, adversely affecting their quality of life and treatment adherence. Improving sleep is a nursing priority, and targeted interventions might be beneficial. This study aimed to evaluate the effect of a spiritual care program on treatment adherence and sleep quality in hemodialysis patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      This study was a parallel, two\u2010group, cluster\u2010randomized clinical trial with a pretest\u2013posttest design. In 2023, 80 hemodialysis patients from two teaching hospitals in Urmia, Iran, were enrolled via convenience sampling and cluster\u2010randomized by hospital unit to intervention (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200939) or control (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200937 completers) groups. The intervention involved four 1\u2009h spiritual care sessions twice weekly post\u2010dialysis. Outcomes were measured using the End\u2010Stage Renal Disease Adherence Questionnaire (ESRD\u2010AQ) and Pittsburgh Sleep Quality Index (PSQI) at baseline and 1 month post\u2010intervention. Data were analyzed in SPSS v26.0. Normality was checked with Kolmogorov\u2212Smirnov, between\u2010group differences with independent\n                      <jats:italic>t<\/jats:italic>\n                      \u2010tests, and within\u2010group changes with paired\n                      <jats:italic>t<\/jats:italic>\n                      \u2010tests.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The mean age of the 76 participants was 52.09 years (range: 20\u201384 years); 65 participants (85.5%) were male, and 11 (14.5%) were female. Baseline scores showed no significant between\u2010group differences (adherence:\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.848; sleep quality:\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.891). Post\u2010intervention, the intervention group had significantly higher adherence (mean difference: 219.60 [95% CI: 159.51\u2013279.69];\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001; Cohen's\n                      <jats:italic>d<\/jats:italic>\n                      \u2009=\u20091.92) and better sleep quality (mean difference: \u22122.67 [95% CI: \u22121.46 to \u22123.88];\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.006; Cohen's\n                      <jats:italic>d<\/jats:italic>\n                      \u2009=\u20090.68) compared to the control group. Within the intervention group, adherence improved (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001; Cohen's\n                      <jats:italic>d<\/jats:italic>\n                      \u2009=\u20092.15) and sleep quality enhanced (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001; Cohen's\n                      <jats:italic>d<\/jats:italic>\n                      \u2009=\u20090.79); no changes were observed in the control group (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&gt;\u20090.05).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>A spiritual care program improves treatment adherence and sleep quality in hemodialysis patients. Hospital administrators should integrate spiritual interventions like meditation and counseling, considering barriers such as staffing. Future studies should include diverse populations and longer follow\u2010ups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Reporting Tool<\/jats:title>\n                    <jats:p>The CONSORT 2010 checklist was used.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/hsr2.71627","type":"journal-article","created":{"date-parts":[[2025,12,15]],"date-time":"2025-12-15T07:36:19Z","timestamp":1765784179000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Effect of a Spiritual Care Program on Treatment Adherence and Sleep Quality in Hemodialysis Patients: A Cluster\u2010Randomized Clinical Trial"],"prefix":"10.1002","volume":"8","author":[{"given":"Naser","family":"Parizad","sequence":"first","affiliation":[{"name":"Patient Safety Research Center Clinical Research Institute Urmia University of Medical Sciences Urmia 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