Subjective hemodialysis adequacy can also be measured: Development and psychometric properties evaluation of subjective adequacy questionnaire

Long-term prognosis of chronic hemodialysis patients is affected by dialysis adequacy that can have effect on the hemodialysis (HD) outcomes, especially mortality rate. Given the limited knowledge about HD patient's perceptions and experiences about subjective HD adequacy (SHA) and the lack of SHA measuring questionnaire (SHAMQ), this study was conducted with the aim of developing the SHAMQ and evaluating its psychometric properties based on the operational definition of SAH concept. This mixed-method sequential exploratory design study was conducted from 2016 to 2018 in eight HD units of Mashhad, Iran. In qualitative phase, conventional content analysis method was used, and participants were recruited through purposive, snowball, and selective sampling techniques. Data were collected through semi-structured interviews with 25 HD patients, dialysis nurses, caregivers, and nephrologists, and analyzed using MAXQDA software (V10). SHAMQ was developed based on operational definitions extracted from qualitative phase. Quantitative and qualitative face and content validity; construct validity; internal consistency; and stability were used for psychometric properties evaluation of SHAMQ. Data were analyzed using Statistical Package for Social Sciences version 22.0 (IBM Corp., Armonk, NY, USA). Physical vitality, inner consistency, a sense of well-being, positive social interactions, effective self-empowerment, and weathering financial crisis were 6 generic categories emerged from qualitative phase. The final version of SHAMQ included 30 itemsin four factors (subscales). Scale-content validity index, Θ, and intraclass correlation were 0.92, 0.88, and 0.91, respectively. The results of this study showed that factors such as well-being, self-enforcement to effective care, physical vitality, and spiritual health are the most important SHA outcomes. The development of a scale for measuring SHA can help to the better evaluation of HD patients' conditions and accordingly perform effective interventions.