Mortality salience weakens health learning in peritoneal dialysis patients: The mediating role of death-thought accessibility and the moderating role of patient compliance.

BACKGROUND

Peritoneal dialysis patients in war-risk regions face both illness and war-threat-induced death fears. Whether enhancing health self-esteem and compliance alleviates these fears and supports health learning, or undermines confidence, remains largely unexplored.

OBJECTIVE

Drawing on Terror Management Theory (TMT), this study examines how war-threat-induced mortality salience (MS) impacts death-thought accessibility (DTA) and health learning attitudes in peritoneal dialysis patients with differing levels of health self-esteem and compliance.

METHODS

In an experimental design, 102 peritoneal dialysis patients were assessed for health self-esteem and compliance levels, then randomly assigned to an MS or control group. DTA and health learning attitudes were measured post-exposure. We applied hierarchical regression analysis and a mediation and moderation analysis to examine the effects of MS on health learning attitudes, with health self-esteem and patient compliance as moderators, and DTA as a mediator.

RESULTS

MS exposure significantly increased DTA and reduced health learning attitudes. DTA was negatively associated with health learning attitudes and partially mediated the MS-health learning relationship. The most compliant patient group exhibited poorer learning attitudes under MS stimulation (effect = -0.23, p < .001, 95 % CI [-0.36, -0.10]). Higher health self-esteem did not mitigate the impact of MS on DTA or learning attitudes.

CONCLUSIONS

This study suggests that peritoneal dialysis patients should avoid mortality cues, particularly those with higher compliance. Caregivers should assist them in developing alternative defenses against the effects of MS. Additionally, clinicians should be attentive to patients' psychological states during health education to prevent disengagement from learning.