Health Literacy, Social Support, and Kidney‐Specific Quality of Life Among Hemodialysis Patients in Saudi Arabia: Implications for Nurse Managers Organizing Patient and Family Education

Abstract

Introduction Limited health literacy and strong family involvement are both common among hemodialysis patients in Saudi Arabia, yet how each relates to kidney‐specific quality of life (KDCS), and what this implies for how dialysis units organize patient and family education, has not been examined. Decisions about education protocols, staff competencies, materials, timing, family inclusion, and quality monitoring are made by unit nurse managers, who currently lack local evidence to guide them. Aim To examine the associations of health literacy and perceived social support with KDCS among hemodialysis patients in Hail, Saudi Arabia, and to identify what these associations imply for how nurse managers organize patient and family education in dialysis units. Methods A cross‐sectional correlational design was employed with 215 patients recruited from two dialysis centers in Hail, Saudi Arabia. Health literacy, social support, and quality of life were measured using three validated Arabic‐language tools: the HLS‐EU‐Q47 (health literacy), the MSPSS (multidimensional social support), and the KDQOL–SF 1.3 (KDCS). Questionnaires were administered in a mixed mode: 81.9% (176/215) were interviewer‐administered following a standardized verbal protocol, and 18.1% were self‐completed with a researcher present. Descriptive statistics were calculated for all variables. Pearson correlations examined bivariate associations among the continuous scores. The primary inferential analysis was a multiple linear regression with continuous KDCS as the dependent variable and health literacy and social support as predictors, controlling for age and education. As a secondary, exploratory analysis, a chi‐square test examined the association between HLS‐EU‐Q47 health literacy categories and KDCS dichotomized at the sample mean. Results We observed a pattern we descriptively term the “Support Paradox”: perceived family support was at the ceiling (M = 6.99/7.0, SD = 0.06), yet showed no association with KDCS (r = −0.09, p = 0.188; β = −0.08, p = 0.202). This null association may be explained by near‐ceiling family support scores and the resulting restricted variance, interviewer‐assisted administration (81.9% of surveys), and potential social desirability bias, and should be regarded as an observed pattern rather than evidence that family support is unrelated to quality of life. In the primary multiple linear regression model, health literacy was the only significant predictor (β = 0.19, p = 0.012), but the model explained less than 7% of KDCS variance (R 2 = 0.068, adjusted R 2 = 0.050), indicating a statistically significant but clinically modest association; 93.2% of KDCS variance remained unexplained by the model. In the exploratory categorical analysis, 91.7% of participants had limited health literacy, and sufficient health literacy was associated with “Good” KDCS (X 2 = 22.12, p < 0.001, Cramér’s V = 0.32). At the unit level, limited health literacy was near‐universal (91.7%), and most participants (81.9%), although literate, opted for verbal administration because completing written material during dialysis was impractical. Conclusion Health literacy was a statistically significant but small contributor to KDCS, and perceived family support, although at the ceiling, was unrelated to it. Nearly all patients (91.7%) had limited health literacy, and most (81.9%) opted for verbal rather than written administration during dialysis, indicating that the response lies at the level of how the unit organizes education rather than with individual patients. Implications for Nursing Management The findings define three responsibilities for nurse managers in dialysis units: organizing health literacy interventions, supporting culturally responsive patient and family education, and improving the quality of education. Because limited health literacy was near‐universal, managers should adopt a universal‐precautions approach in which plain‐language, verbal, and visual education with teach‐back is the default for every patient, supported by staff training and a standardized unit education protocol. Because families are consistently present and highly involved, managers should build culturally responsive, family‐inclusive education workflows that use Arabic‐language, visually based materials reflecting local food, religious, and family practices, and that direct teach‐back to the patient first to preserve patient autonomy and self‐management. Managers should monitor education quality through documented teach‐back, comprehension audits, caregiver attendance, and periodic reassessment of health literacy and QoL. Given the small effect size observed, these measures are necessary foundations whose impact on QoL must be evaluated prospectively.