Mexican Americans have as much as a six-times greater risk of end-stage renal disease (ESRD) than non-Hispanic white Americans, and women show a faster rate of decline in diabetic renal functioning. The leading treatment for ESRD is hemodialysis, an intensive, complex treatment regimen associated with high levels of patient nonadherence. Previous studies of patient adherence have adopted a biomedical, practitioner-oriented approach focused on performance of fixed behaviors and ignoring contextual and motivational factors. The author describes a social constructivist approach to understanding how female Mexican American dialysis patients experience their disease, the treatment regimen, and the consequences of that experience. Mexican American women's perceptions and psychosocial factors were examined to understand what these women viewed as important to their realities as dialysis patients. Poverty, longer treatment history, and immigrant status emerged as factors that appeared to influence treatment nonadherence. Perceived identity losses, heightened awareness of mortality and family dysfunction emerged as themes that participants viewed as preeminent in their day-to-day lives. A social constructivist perspective is highly compatible with social work principles of person-in-environment and starting where the client is. This perspective provides a valuable framework for informing social work practice with this special population of Mexican American dialysis patients.