Mental health literacy in maintenance hemodialysis: a qualitative study on recognition, knowledge fragmentation, and stigma-related help-seeking barriers.
Xiao W, Xue C, et al. • Frontiers in public health • 2026
Mental health literacy among maintenance hemodialysis patients is characterized by insufficient illness recognition, fragmented knowledge, and pronounced stigma-related help-seeking barriers, indicating an urgent need for targeted, tiered psychoeducation and culturally adapted assessment tools.
Key Findings
Results
MHD patients demonstrated heterogeneous and inconsistent recognition of mental illness, constituting the first core theme identified in the analysis.
Semi-structured in-depth interviews were conducted with 11 MHD patients at the Hemodialysis Center of a Grade III-A hospital in Ningxia from December 2023 to February 2024
Purposive sampling with the principle of maximum diversity was applied to ensure sample diversity
Data saturation determined the final sample size of 11 participants
Theme 1 was labeled 'Heterogeneity Recognizing of Mental Illness,' indicating variability across the patient group rather than a uniform level of awareness
Results
MHD patients exhibited fragmented mental health knowledge characterized by polarized information-seeking behaviors, superficial attribution patterns, polarized self-regulation strategies, and uneven awareness of mental health resources.
Theme 2 ('Fragmented Mental Health Knowledge') contained four subthemes: 2a Polarized Approaches to Health Information, 2b Superficial Attribution Patterns, 2c Polarization of Self-Regulation Strategies, and 2d Uneven Awareness of Mental Health Resources
Polarized approaches to health information suggest patients either over-relied on or entirely avoided health information sources
Superficial attribution patterns indicate patients tended to attribute mental health problems at a surface level rather than with deeper causal understanding
Uneven awareness of mental health resources suggests significant disparities in knowledge about available psychological services within this population
Results
MHD patients held ambivalent attitudes toward mental illness and help-seeking, with stigma and normalization coexisting cognitively and a gap between intention and action behaviorally.
Theme 3 was labeled 'Ambivalent Attitudes toward Mental Illness and Seeking Help' and contained two subthemes: 3a Cognitive Attitudes (Coexistence of Stigma and Normalization) and 3b Behavioral Attitudes (The Gap between Intention and Action)
Subtheme 3a indicates that stigmatizing views and normalized perceptions of mental illness existed simultaneously within the same patient population
Subtheme 3b indicates that patients who expressed willingness to seek help did not necessarily follow through with actual help-seeking behavior
Stigma-related barriers were identified as 'pronounced' in this population, representing a significant obstacle to accessing psychological services
Methods
A total of 3 core themes and 6 subthemes were identified through thematic analysis of interview data from MHD patients.
Data were managed using NVivo 14.0 software
Braun and Clarke's thematic analysis method was applied
The three core themes collectively addressed illness recognition, knowledge fragmentation, and help-seeking attitudes
The qualitative design was chosen because qualitative evidence on mental health literacy in MHD patients was described as 'scarce'
Background
Psychological distress is described as highly prevalent among MHD patients, yet mental health literacy in this population remains understudied.
The paper states that 'psychological distress is highly prevalent among patients undergoing maintenance hemodialysis'
Qualitative evidence on mental health literacy specifically in MHD patients is characterized as 'scarce'
The study aimed to identify constituent dimensions of MHL in this population to inform development of 'a localized, specialized mental health literacy scale' for MHD patients
The study setting was a Grade III-A hospital in Ningxia, China, conducted between December 2023 and February 2024
Conclusions
The authors concluded that targeted, tiered psychoeducation and a culturally adapted mental health literacy assessment tool are urgently needed for the MHD population.
The study identified insufficient illness recognition, fragmented knowledge, and pronounced stigma-related help-seeking barriers as the defining characteristics of MHL in MHD patients
The authors called for 'targeted, tiered psychoeducation' suggesting a one-size-fits-all approach is insufficient given the heterogeneity observed
A 'culturally adapted MHL assessment tool' was recommended, acknowledging that existing instruments may not be appropriate for this specific cultural and clinical context
The findings were positioned as providing 'qualitative evidence for developing a localized, specialized mental health literacy scale' and for 'implementing targeted psychological interventions'
What This Means
This research suggests that people receiving regular kidney dialysis (maintenance hemodialysis) have significant gaps in their understanding of mental health. Researchers in China interviewed 11 dialysis patients in depth and found three major problem areas: patients varied widely in their ability to recognize mental illness symptoms, their knowledge about mental health was incomplete and inconsistent, and they held conflicting attitudes about mental illness that made them reluctant to actually seek help even when they acknowledged they might need it. Stigma — the social shame associated with mental illness — was a particularly strong barrier, coexisting with more accepting views within the same individuals.
This research suggests that dialysis patients are a uniquely vulnerable group because they already face enormous physical and emotional burdens from their condition, yet the mental health support systems around them are not well matched to their needs. Patients showed 'polarized' behaviors around health information (either seeking too much or too little), tended to explain their mental health problems in overly simplistic ways, and were often unaware of what psychological resources were even available to them. The gap between wanting help and actually getting it was a consistent finding.
The practical implication of this research is that standard mental health education and screening tools may not work well for dialysis patients, particularly in Chinese cultural contexts where stigma around mental illness can be especially strong. The authors argue that psychoeducation programs need to be specifically designed for this population and delivered in layers suited to different levels of existing knowledge, and that new culturally appropriate tools are needed to properly measure and address mental health literacy in this group.
Xiao W, Xue C, Che Y, Ma L, Yao H, Li H. (2026). Mental health literacy in maintenance hemodialysis: a qualitative study on recognition, knowledge fragmentation, and stigma-related help-seeking barriers.. Frontiers in public health. https://doi.org/10.3389/fpubh.2026.1951731