Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Jan 11, 2026
Date Accepted: Jul 15, 2026
A Mobile-Based Mindfulness Intervention for Reducing Demoralization in Patients Receiving Hemodialysis: Randomized Controlled Trial
ABSTRACT
Background:
Patients with chronic kidney disease undergoing hemodialysis experience substantial symptom burden, and demoralization syndrome—characterized by helplessness, hopelessness, and loss of meaning—is highly prevalent and strongly associated with impaired quality of life. However, the psychological mechanisms linking symptom burden to demoralization remain poorly understood, and scalable, evidence-based interventions targeting demoralization in this population are limited.
Objective:
This study aimed to examine the pathway linking symptom burden to demoralization via coping strategies, to test the moderating role of trait mindfulness, and to evaluate the effectiveness of a mobile-based mindfulness intervention (MMI) in reducing demoralization.
Methods:
In a randomized controlled trial (n = 72), a 6-week MMI intervention delivered via the WeChat E-Check-in Mini Program, featuring mindfulness audio practices and group peer support. The control group received routine medical care and health education. The intervention content was delivered automatically, with optional peer support and basic guidance from the research team within the group. Participants were recruited offline at hemodialysis centers; all assessments were online, and the intervention was delivered by mobile. Effectiveness was tested using repeated-measures ANOVA. To explore mechanisms and inform needs, we conducted moderated mediation analyses on questionnaire data (n = 305) and semi-structured interviews (n = 14).
Results:
Among 72 randomized participants (36 per group), the intervention dropout rate was 11.1%. Avoidance coping significantly mediated the association between the symptom burden and demoralization [β = 0.20; 95% confidence interval (CI): 0.15, 0.26]. Trait mindfulness negatively moderated the paths from the symptom burden to demoralization (β = -0.11; 95%CI: -0.17, -0.05) and from avoidance coping to demoralization (β = -0.07; 95%CI: -0.12, -0.01). Relative to the control group, the MMI group had higher trait mindfulness scores (t = 5.06, p < 0.001), as well as lower demoralization (t = -5.09, p < 0.001) and symptom burden (t = -17.26, p = 0.004) scores.
Conclusions:
The symptom burden and avoidance coping are related closely to demoralization in patients receiving hemodialysis. Trait mindfulness can effectively buffer the negative effects of these factors. Mobile-based mindfulness intervention holds clinical application value for psychosomatic symptom improvement among patients with chronic kidney diseases. Clinical Trial: The Chinese Clinical Trial Registry (no. ChiCTR2500107906). https://www.chictr.org.cn/bin/userProject
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