Date of Award
Summer 7-7-2026
Document Type
Dissertation
Publication Status
Version of Record
Submission Date
July 2026
College Granting Degree
Christine E. Lynn College of Nursing
Degree Name
Doctor of Philosophy (PhD)
Thesis/Dissertation Advisor [Chair]
Debra Hain
Abstract
Background: Older adults with end-stage kidney disease (ESKD) receiving dialysis experience substantial physical, psychological, social, and emotional challenges that affect adaptation to chronic illness and treatment. Resilience is a protective factor that promotes coping, emotional well-being, and quality of life. Guided by Swanson's Theory of Caring (SCT) and the GROW Model of Resilience, this study examined resilience, associated factors, and resilience strategies among older adults with ESKD receiving dialysis in rural communities of Suphan Buri Province, Thailand.
Methods: An explanatory sequential mixed-methods design was employed. The quantitative phase included 110 adults aged 60 years and older receiving hemodialysis (HD) or peritoneal dialysis (PD) who were recruited through purposive sampling from dialysis centers in Suphan Buri Province, Thailand. Participants completed demographic questionnaires and standardized measures of resilience, hope, perceived self-efficacy, and family relationships. Quantitative data were analyzed using descriptive statistics, Pearson correlation, independent-samples t tests, and multiple linear regression in IBM SPSS Statistics Version 28. The qualitative phase included 12 purposively selected participants representing different resilience levels and dialysis modalities. Semi-structured interviews were analyzed using inductive thematic analysis, and findings were integrated through joint displays and meta-inference.
Results: Most participants demonstrated moderate to high resilience. Hope (β = .527, p = .003) and family relationships (β = .270, p = .038) were significant predictors, explaining 53.5% of the variance in resilience. Dialysis vintage approached statistical significance (β = .152, p = .056), whereas perceived self-efficacy and dialysis modality were not significant predictors. Resilience did not differ significantly between HD and PD participants. Qualitative analysis identified six resilience themes: maintaining hope and positive meaning in life; strength from family and social relationships; supportive relationships with healthcare providers; personal adaptation and perceived self-efficacy; spiritual and cultural coping practices; and community connection and social support. Mixed-methods integration demonstrated that resilience developed through interconnected psychological, relational, spiritual, cultural, and adaptive processes.
Conclusions: Older adults receiving dialysis in rural Thailand demonstrated resilience despite the challenges of long-term treatment. Hope and family relationships emerged as the primary determinants of resilience, while qualitative findings highlighted the complementary roles of caring healthcare relationships, spirituality, adaptive self-management, and community support. These findings support culturally responsive, family-centered, and resilience-focused nursing interventions to promote adaptation, wellbeing, and quality of life among older adults living with ESKD.
Recommended Citation
Yuenyong, Sineeporn, "RESILIENCE AMONG OLDER ADULTS WITH END-STAGE KIDNEY DISEASE RECEIVING DIALYSIS IN RURAL COMMUNITIES OF SUPHAN BURI PROVINCE IN THAILAND: MIXED METHODS STUDY" (2026). Electronic Theses and Dissertations. 440.
https://digitalcommons.fau.edu/etd_general/440