Development and Psychometric Validation of a Multidimensional Ecological Model-Based Awareness Scale for Patients with Stage 3–4 Chronic Kidney Disease
Healthcare (Switzerland), vol.14, no.7, 2026 (SCI-Expanded, SSCI, Scopus)
- Publication Type: Article / Article
- Volume: 14 Issue: 7
- Publication Date: 2026
- Doi Number: 10.3390/healthcare14070876
- Journal Name: Healthcare (Switzerland)
- Journal Indexes: Science Citation Index Expanded (SCI-EXPANDED), Social Sciences Citation Index (SSCI), Scopus, CINAHL, Health Research Premium Collection (ProQuest)
- Keywords: chronic kidney disease, disease awareness, health literacy, patient-reported outcome, psychometric evaluation, scale development, scale validation, socioecological model
- Hacettepe University Affiliated: Yes
Abstract
Background and Objectives: Despite critically low levels of chronic kidney disease (CKD) awareness worldwide, there is no psychometrically validated instrument to comprehensively assess CKD awareness across socioecological levels. This study aimed to develop, psychometrically evaluate and validate a multidimensional awareness scale grounded in socioecological theory for patients with stage 3–4 CKD. Materials and Methods: This methodological study enrolled 908 stage 3–4 CKD patients. Scale development proceeded through systematic stages: comprehensive literature review, qualitative interviews (n = 15), expert panel evaluation (n = 25), and pilot testing. The initial 72-item pool was refined to 41 items (Content Validity Index = 0.912). The sample was randomly split for exploratory factor analysis (EFA; n = 454) and confirmatory factor analysis (CFA; n = 454). Psychometric evaluation encompassed internal consistency (Cronbach’s α, McDonald’s ω), test–retest reliability (n = 30; 4-week interval), convergent validity (average variance extracted [AVE], composite reliability [CR]), discriminant validity (Fornell–Larcker criterion), and criterion validity (correlation with Turkish Health Literacy Scale-32 [TSOY-32]). Results: EFA revealed a seven-factor structure with an acceptable explained variance of 43.8%. Following iterative item elimination based on communalities (h2 < 0.20) and factor loadings (λ < 0.30), CFA confirmed the final 34-item model with good fit (CFI = 0.972; RMSEA = 0.070 [90% CI: 0.067–0.074]). The factor structure captured awareness across core socioecological levels (Individual, Interpersonal/Institutional, Community, and Systemic), complemented by Treatment Adherence and Social Impact dimensions. Internal consistency coefficients were α = 0.884 and ω = 0.889 for the total scale. Test–retest reliability yielded an ICC of 0.954 (95% CI: 0.907–0.978). Convergent and discriminant validity were confirmed via composite reliability (CR: 0.740–0.953) and the Fornell–Larcker criterion. Criterion validity analysis revealed a significant correlation with TSOY-32 (r = 0.810, p < 0.001). Conclusions: The CKD Awareness Scale (CKD-AS-34) represents a novel, psychometrically validated, multidimensional awareness instrument for CKD. This scale enables clinicians to identify awareness deficits spanning individual to systemic levels, facilitating personalised patient education and targeted public health interventions.