{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T18:30:04Z","timestamp":1785868204506,"version":"3.56.0"},"reference-count":18,"publisher":"Public Library of Science (PLoS)","issue":"8","license":[{"start":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T00:00:00Z","timestamp":1785801600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"\n Introduction<\/jats:title>\n Chronic kidney disease (CKD) is a growing global health issue that significantly impairs quality of life (QoL), particularly among patients undergoing dialysis. This study examines the relationships between e-health literacy, self-efficacy, and QoL in this vulnerable population.<\/jats:p>\n <\/jats:sec>\n \n Objectives<\/jats:title>\n To examine associations among e-health literacy, self-efficacy, and health-related quality of life (HRQoL) among patients receiving hemodialysis in Northern Jordan.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n A cross-sectional study was conducted among 184 adult HD patients recruited from four hospitals in Northern Jordan. Data were collected using validated Arabic versions of the eHealth Literacy Scale (eHEALS), the Self-Efficacy for Managing Chronic Disease Scale (SEMCD-6), and the Kidney Disease Quality of Life-36 (KDQOL-36). Spearman correlation was used to examine associations between variables. Multiple linear regression was performed to identify independent predictors of KDQOL-36 total scores.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Among 184 participants (mean age 49.9 years, 65% male), the mean self-efficacy score was 25.52 (SD\u2009=\u20091.8) and the mean e-health literacy score was 3.62 (SD\u2009=\u20090.58). The mean KDQOL\u201136 total score was 105\u2009\u00b1\u200917, with domain scores of 39\u2009\u00b1\u20097 for Symptoms\/Problems, 25\u2009\u00b1\u20096 for Effects of Kidney Disease, 11\u2009\u00b1\u20093 for Burden of Kidney Disease, 29\u2009\u00b1\u20095 for Social Function, 12\u2009\u00b1\u20093 for the Physical Component Summary, and 21\u2009\u00b1\u20094 for the Mental Component Summary. Multivariable regression identified independent predictors of higher quality of life: graduate-level education (B\u2009=\u20098.06, 95% CI: 2.32\u201313.80, p\u2009=\u20090.006) and employment (B\u2009=\u20097.14, 95% CI: 2.10\u201312.20, p\u2009=\u20090.006). Diabetes was independently associated with lower quality of life (B\u2009=\u2009\u22125.92, 95% CI: \u221210.90 to \u22120.95, p\u2009=\u20090.020). Although significant in unadjusted analyses, e-health literacy and self-efficacy were not independent predictors after adjustment for socioeconomic and clinical factors.<\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n Health-related quality of life among HD patients appears to be influenced primarily by socioeconomic and clinical factors, particularly educational attainment, employment status, and diabetes mellitus. Although e-health literacy and self-efficacy were associated with HRQoL in unadjusted analyses, these associations were attenuated after adjusting for socioeconomic and clinical characteristics. Interventions that address educational disparities, support patient engagement, and optimize comorbidity management may improve health outcomes among patients receiving hemodialysis.<\/jats:p>\n <\/jats:sec>","DOI":"10.1371\/journal.pone.0354170","type":"journal-article","created":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T17:31:37Z","timestamp":1785864697000},"page":"e0354170","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Associations between e-Health literacy, self-efficacy, and quality of life among hemodialysis patients: A cross-sectional study from Northern Jordan"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4583-2727","authenticated-orcid":true,"given":"Rawand A.","family":"Khasawneh","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Khalid","family":"Kheirallah","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rawan","family":"Ahmad Al-Laheem","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samah","family":"Al-Shatnawi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammad","family":"Nusair","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,8,4]]},"reference":[{"key":"pone.0354170.ref001","unstructured":"Jordan. The Hashemite kingdom of jordan ministry of health non-communicable diseases directorate national registry of end stage renal disease (ESRD) 12 th annual report. 2019."},{"issue":"1","key":"pone.0354170.ref002","doi-asserted-by":"crossref","first-page":"285","DOI":"10.1186\/s12882-025-04229-6","article-title":"Self-management interventions for adult haemodialysis patients: a scoping review of randomized controlled trials","volume":"26","author":"NK Friedrich","year":"2025","journal-title":"BMC Nephrol"},{"issue":"4","key":"pone.0354170.ref003","article-title":"Analysis of influencing factors on quality of life in patients with chronic kidney disease undergoing maintenance haemodialysis","volume":"10","author":"J Hao","year":"2024","journal-title":"Heliyon"},{"issue":"4","key":"pone.0354170.ref004","doi-asserted-by":"crossref","DOI":"10.2196\/jmir.8.4.e27","article-title":"eHEALS: the eHealth literacy scale","volume":"8","author":"CD Norman","year":"2006","journal-title":"J Med Internet Res"},{"issue":"2","key":"pone.0354170.ref005","doi-asserted-by":"crossref","first-page":"191","DOI":"10.1037\/0033-295X.84.2.191","article-title":"Self-efficacy: toward a unifying theory of behavioral change","volume":"84","author":"A Bandura","year":"1977","journal-title":"Psychol Rev"},{"issue":"8","key":"pone.0354170.ref006","doi-asserted-by":"crossref","first-page":"659","DOI":"10.1177\/03913988221108754","article-title":"Evaluation of the relationship between health literacy and self-efficacy: a sample of hemodialysis patients","volume":"45","author":"A Kazak","year":"2022","journal-title":"Int J Artif Organs"},{"issue":"3","key":"pone.0354170.ref007","doi-asserted-by":"crossref","DOI":"10.2196\/24466","article-title":"Arabic version of the electronic health literacy scale in arabic-speaking individuals in Sweden: prospective psychometric evaluation study","volume":"23","author":"J W\u00e5ngdahl","year":"2021","journal-title":"J Med Internet 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Illn"},{"issue":"2","key":"pone.0354170.ref011","doi-asserted-by":"crossref","first-page":"381","DOI":"10.1086\/209405","article-title":"A meta-analysis of cronbach\u2019s coefficient alpha","volume":"21","author":"RA Peterson","year":"1994","journal-title":"J Consum Res"},{"key":"pone.0354170.ref012","doi-asserted-by":"crossref","first-page":"105124","DOI":"10.1016\/j.ijmedinf.2023.105124","article-title":"Sociodemographic determinants of digital health literacy: a systematic review and meta-analysis","volume":"177","author":"M Estrela","year":"2023","journal-title":"Int J Med Inform"},{"issue":"3","key":"pone.0354170.ref013","doi-asserted-by":"crossref","first-page":"507","DOI":"10.1177\/1461444813487959","article-title":"The digital divide shifts to differences in usage","volume":"16","author":"AJ van Deursen","year":"2013","journal-title":"New Media 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Int"},{"issue":"3","key":"pone.0354170.ref017","doi-asserted-by":"crossref","first-page":"387","DOI":"10.1111\/j.1542-4758.2012.00688.x","article-title":"Depression and nonadherence predict mortality in hemodialysis treated end-stage renal disease patients","volume":"16","author":"D Rosenthal Asher","year":"2012","journal-title":"Hemodial Int"},{"key":"pone.0354170.ref018","doi-asserted-by":"crossref","DOI":"10.1093\/geroni\/igaf122.3215","article-title":"eHealth literacy is associated with self-efficacy in adult patients with chronic disease","volume":"9","author":"O Osokpo","year":"2025","journal-title":"Innovation in Aging"}],"container-title":["PLOS 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