Background: Spiritual well-being, social support, health literacy, and resilience may affect the quality of life (QOL) in patients undergoing hemodialysis. Objectives: The purpose of this study was to investigate the effect of perceived social support, spiritual well-being, health literacy, and resilience on the QOL in patients under hemodialysis. Methods: This descriptive cross-sectioanl study randomly included 260 patients from three educational hospitals in Ahvaz, Iran. Data were collected using a 36-item QOL questionnaire, Spiritual Health Questionnaire (SHQ), Perceived Social Support (PSS) Questionnaire, Resilience Questionnaire, and Montazeri et al.’s Health Literacy for Iranian Adults (HELIA) Questionnaire. Stata software version 14 was used for data analysis. The results were evaluated using descriptive statistics and a structural equation model (SEM). Results: In this study, a total of 260 patients (male: 138 vs. female: 122; mean age: 51.73 ± 15.32 years) undergoing hemodialysis were included. Most of the patients were married (76.9%) and had at least one comorbid disease (59.2%). Findings showed that health literacy, spiritual well-being, and social support had a significant correlation with the QOL (P < 0.001). However, resilience was not significantly related to the patients’ QOL (P > 0.58). Conclusions: To improve the QOL of patients undergoing hemodialysis, health care providers need to improve patients’ health literacy, social relationships, and spiritual well-being.

<p>Marital satisfaction and stability in course of couple relationship has been the topic of interest in many studies. Some of couples are dissatisfied with their marriage and they end in divorce. Dissatisfying marriages are not always ended. In order to find better understanding on the reasons behind the formation, continuous and end of relationship, social exchange theory is usually utilized. The purpose of this study was to find out the factors that caused dissatisfied married individuals to hold their relationship together. This study was a qualitative study that used semi-structured deep interview. 12 married individuals were selected by purposeful sampling. Data analysis addressed the content of marriage functions among Iranian married individual with low marital satisfaction. 6 main themes and 20 subthemes were emerged from the data. These main themes revealed marriage functions of psychological, child- related, value- related, sex, social, and economic which made participants hold their marriage together.<strong> </strong>It was explained in the discussion part of the study that how some of basic components of social exchange theory differ between our participants in the current study. </p>

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