Background <p>The ability to find benefits in adverse situations has been shown to foster a positive outlook and enhance quality of life among patients undergoing medical treatment. However, factors influencing benefit finding in hemodialysis patients remain underexplored from a multi-level perspective. This study explores the perspectives of hemodialysis patients regarding the factors influencing benefit finding, framed within the social-ecological model.</p> Methods <p>This qualitative study is part of a longitudinal mixed-methods project that was conducted between June and December of 2023 across five hemodialysis centers in Shanghai, China. Twenty-five hemodialysis patients participated. Data were analyzed using directed content analysis guided by the Social Ecological Model, incorporating both synchronic and diachronic methods to explore patterns and the evolution of benefit finding over time.</p> Results <p>Four levels were identified as factors influencing benefit finding: (i) Intrapersonal Initiative, including experiences related to hemodialysis diagnosis and treatment, physical condition, optimistic mindset, and self-care competence; (ii) Relational Bonds, including support from family, healthcare professionals, and social contacts; (iii) Surrounding Support, including resources from medical institutions, communities, and interest groups; and (iv) Societal Scaffolding, including public policies and technological advances. Three representative case vignettes illustrated how variations in factors affect benefit finding.</p> Conclusions <p>The study highlights the utility of the social-ecological model in understanding multi-level factors that promote benefit finding in hemodialysis patients. Findings emphasize the need for integrated, multi-level interventions to improve well-being and quality of life in future studies.</p> Clinical trial number <p>Not applicable.</p>