Objective To explore the current status of preoperative hope level and its influencing factors in scoliosis patients, focusing on the role of medical coping, social support and self-care ability on the hope level, and to provide a basis for optimising perioperative psychological interventions. Methods Preoperative scoliosis patients at West China Hospital of Sichuan University between January 2024 and January 2025 were selected. Patients were included in the survey using a general information questionnaire, Herth Hope Index (HHI), Medical Coping Questionnaire, Social Support Rating Scale (SSRS), and Daily Living Ability Scale. Multiple linear regression analyses were performed and influential factors were explored with HHI score as the dependent variable. Results A total of 156 patients were investigated. Among them, there were 104 females (66.67%); The average HHI score was (36.88±4.04) points; 41.03% (64 cases) of patients were at a low to moderate hope level (HHI≤35 points). There were statistically significant differences in HHI scores among patients with different marital statuses and disease durations (P<0.05). The correlation analysis results showed that social support was positively correlated with HHI (r=0.207, P=0.010); Medical coping (r=−0.015, P=0.852) and self-care ability (r=0.010, P=0.903) were not correlated with HHI. The results of multiple linear regression analysis showed that the total SSRS score affected the HHI score of preoperative scoliosis patients (P=0.040). Conclusion Multidisciplinary interventions should be implemented for patients with low levels of hope, focusing on married patients with a disease duration of 1-5 years, and improving their level of hope by strengthening the social support network.