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In this cross-sectional study, 184 patients from three hemodialysis outpatient clinics in T\u00fcrkiye 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\u2019 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 =\u2212\u200925.90, SE\u2009=\u20096.38, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001), and in line with H2, the stress \u00d7 engagement interaction was significant (b\u2009=\u20094.29, SE\u2009=\u20091.24, <jats:italic>p<\/jats:italic>\u2009=\u20090.001, \u0394R<jats:sup>2<\/jats:sup> = 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 = \u2212 12.98, <jats:italic>p<\/jats:italic>\u2009=\u20090.001) and average engagement (b = \u2212 7.09, <jats:italic>p<\/jats:italic>\u2009=\u20090.011), but not at high engagement (b = \u2212 1.20, <jats:italic>p<\/jats:italic>\u2009=\u20090.697). 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.<\/jats:p>","DOI":"10.1007\/s10865-025-00591-w","type":"journal-article","created":{"date-parts":[[2025,7,23]],"date-time":"2025-07-23T18:36:07Z","timestamp":1753295767000},"page":"848-859","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Patient health engagement as a moderator between perceived stress and treatment adherence among kidney failure patients undergoing hemodialysis: a cross-sectional analysis"],"prefix":"10.1007","volume":"48","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1300-0678","authenticated-orcid":false,"given":"Dilara","family":"Usta","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4836-6103","authenticated-orcid":false,"given":"Marta","family":"Acampora","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4378-7467","authenticated-orcid":false,"given":"Guendalina","family":"Graffigna","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2025,7,23]]},"reference":[{"issue":"1","key":"591_CR1","doi-asserted-by":"publisher","first-page":"13","DOI":"10.14744\/scie.2021.24993","volume":"32","author":"O Aky\u00fcz","year":"2021","unstructured":"Aky\u00fcz, O., Parmaks\u0131z, E., & Ardahanl\u0131, \u0130. 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