Contrasting Cultures, Shared Struggles: A Qualitative Analysis of the Experiences of End-Stage Kidney Disease Patients and Their Caregivers in Poland and Sri Lanka.

Introduction: End-stage kidney disease (ESKD) represents the final stage of chronic kidney disease, profoundly impacting patients and their caregivers through a wide range of physical, psychological, and social challenges. Cultural values and healthcare system disparities often shape these experiences, but comparative cross-cultural perspectives remain limited. Objective: This study explores the psychosocial experiences and treatment processes of individuals with ESKD and their caregivers in Sri Lanka and Poland, focusing on cultural, systemic, and personal influences on wellbeing. Methods: An exploratory qualitative design was employed, utilizing semistructured interviews with 27 participants, including 18 individuals undergoing hemodialysis (10 from the Sri Lankan sample and eight from the Polish sample) and nine caregivers (five from the Sri Lankan sample and four from the Polish sample). The interviews were analyzed using conventional qualitative content analysis, identifying thematic similarities and differences across the two cultural contexts. Results: Three interconnected themes emerged: quality of life, coping strategies, and medical experiences. In Poland, the "Power of (My)Self" reflected individual resilience and personal agency as dominant factors influencing wellbeing. In contrast, the Sri Lankan context was shaped by the "Power of Tradition," with cultural practices, religious rituals, and communal values playing pivotal roles. Participants in Sri Lanka faced significant resource limitations and infrastructural challenges, while Polish participants benefited from more comprehensive healthcare systems but reported challenges such as depression and emotional isolation. Conclusion: The findings highlight the profound impact of cultural frameworks and systemic disparities on the lives of individuals with ESKD and their caregivers. While Polish participants emphasized autonomy and self-management, Sri Lankan participants relied heavily on traditional and familial support systems. The proposed conceptual model encapsulates these dynamics, providing a framework for culturally sensitive interventions that address both universal and context-specific needs.