AIMS Medical Science, 2020, 7(3): 106-121. doi: 10.3934/medsci.2020010

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Development and psychometric evaluation of the Beliefs about Home Hemodialysis Scale for patients on in-center hemodialysis
Running title: Health beliefs and home hemodialysis

Department of Internal Medicine Nursing, Faculty of Health Sciences, Yüksek İhtisas University, Ankara, Turkey

Objective: There is no valid and reliable instrument that evaluates health beliefs related to home hemodialysis of patients.   This study aimed to develop the Beliefs about Home Hemodialysis Scale (BHHS) and evaluate its psychometric properties in a sample of patients on in-center hemodialysis. Methods: This methodological study was carried out with 102 patients on in-center hemodialysis. Data were collected by a questionnaire, the Perceived Social Support from Family Scale, and the BHHS. The analysis of data was carried out using descriptive statistics, Mann-Whitney U test, Pearson’s correlation coefficients, and psychometric tests. Results: The overall content validity index of the scale was satisfactory with 1.00 for relevance and 0.97 for clarity. The exploratory factor analysis yielded a four-factor structure (perceived benefits, perceived barriers toward the environment, perceived barriers toward the procedure, and perceived barriers toward socioeconomic support) accounting for 64.5% of the total variance. The BHHS had acceptable internal consistency (Cronbach’s alpha coefficient = 0.69–0.91), test-retest reliability (intraclass correlation coefficient = 0.88–0.95), concurrent validity with the Perceived Social Support from Family Scale scores and known group validity with wanting to start home hemodialysis. Conclusions: The initial psychometric testing of the BHHS is favorable. The BHHS is a valid and reliable instrument for assessing the perceived benefits and barriers to home hemodialysis in patients on in-center hemodialysis. The results of this study will gain a better understanding of the beliefs about home hemodialysis of patients and will lead to more effective intervention strategies.
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1. Leonberg-Yoo A, Weiner D (2016) Epidemiology of end-stage renal disease. In: Magee C, Tucker J, Singh A, Eds., Core Concepts in Dialysis and Continuous Therapies, Boston, MA, USA: Springer, 3–13.

2. Süleymanlar G, Ateş K, Seyahi N (2019) The Nephrology, Dialysis and Transplantation in Turkey: Registry 2018. Ankara, Turkey: Miki Matbaacılık.

3. Kara B (2020) COVID-19 pandemic and hemodialysis: A review of the literature. AIMS Medical Science 7: 90–92.    

4. Hajj JJ, Laudanski K (2017) Home hemodialysis (HHD) treatment as effective yet underutilized treatment modality in the United States. Healthcare (Basel) 5: 90.

5. Seshasai RK, Wong T, Glickman JD, et al. (2019) The home hemodialysis patient experience: A qualitative assessment of modality use and discontinuation. Hemodial Int 23: 139–150.    

6. Weiner DE, Watnick SG (2020) Hemodialysis and COVID-19: An achilles' heel in the pandemic healthcare response in the United States. Kidney Med 2: 227−230.

7. Bolgg A, Hyde C (2006) Enhancing lifestyle through home haemodialysis. J Ren Care 32: 179−182.

8. Cafazzo JA, Leonard K, Easty AC, et al. (2009) Patient-perceived barriers to the adoption of nocturnal home hemodialysis. Clin J Am Soc Nephrol 4: 784−789.

9. Cafazzo JA, Leonard K, Easty AC, et al. (2010) Patient perceptions of remote monitoring for nocturnal home hemodialysis. Hemodial Int 14: 471−477.

10. Cases A, Dempster M, Davies M, et al. (2011) The experience of individuals with renal failure participating in home haemodialysis: An interpretative phenomenological analysis. J Health Psychol 16: 884−894.

11. Jayanti A, Morris J, Stenvinkel P, et al. (2014) Home hemodialysis: Beliefs, attitudes, and practice patterns. Hemodial Int 18: 767−776.

12. Kara B (2016) The beliefs and experiences about home hemodialysis: A review of the current evidences. Turk Neph Dial Transpl 25: 17−23. (in Turkish)

13. Kara B, Yazıcıoğlu İ (2018) Knowledge, beliefs and attitudes of Turkish patients on in-center hemodialysis toward home hemodialysis: A pilot study. J Clin Pract Nurs 1: 23−25.

14. Pipkin M, Eggers PW, Larive B, et al. (2010) Recruitment and training for home hemodialysis: Experience and lessons from the nocturnal dialysis trial. Clin J Am Soc Nephrol 5: 1614−1620.

15. Polaschek N (2005) Haemodialysing at home: The client experience of self-treatment. EDTNA ERCA J 31: 27−30.

16. Rygh E, Arild E, Johnsen E, et al. (2012) Choosing to live with home dialysis-patients' experiences and potential for telemedicine support: A qualitative study. BMC Nephrol 13: 13.    

17. Seshasai RK, Mitra N, Chaknos CM, et al. (2016) Factors associated with discontinuation of home hemodialysis. Am J Kidney Dis 67: 629−637.

18. Tong A, Palmer S, Manns B, et al. (2013) The beliefs and expectations of patients and caregivers about home haemodialysis: An interview study. BMJ Open 3: e002148.    

19. Walker RC, Howard K, Morton RL, et al. (2016) Patient and caregiver values, beliefs and experiences when considering home dialysis as a treatment option: A semi-structured interview study. Nephrol Dial Transplant 31: 133−141.

20. Wong J, Eakin J, Migram P, et al. (2009) Patients' experiences with learning a complex medical device for the self-administration of nocturnal home hemodialysis. Nephrol Nurs J 36: 27−32.

21. Rosenstock IM (1966) Why people use health services. Milbank Mem Fund Q 44: 94–127.    

22. Janz NK, Becker MH (1984) The Health Belief Model: A decade later. Health Educ Q 11: 1−47.

23. Janz NK, Champion VL, Strecher VJ (2002) The Health Belief Model. In: Glanz K, Rimer BK, Lewis FM, Eds., Health Behavior and Health Education. San Fransisco, USA: Jossey-Buss Co, 45–63.

24. Rosenstock IM, Strecher VJ, Becker MH (1988) Social learning theory and the Health Belief Model. Health Educ Q 15: 175–183.    

25. Tinsley HE, Tinsley DJ (1987) Uses of factor analysis in counseling psychological research. J Couns Psychol 34: 414−424.

26. Kara B (2017) Self-rated health and associated factors in older Turkish adults with type 2 diabetes: A pilot study. J Transcult Nurs 28: 40−47.

27. Eskin M (1993) Reliability of the Turkish version of the perceived social support from friends and family scales, scale for ınterpersonal behavior, and suicide probability scale. J Clin Psychol 49: 512−522.

28. Lynn MR (1986) Determination and quantification of content validity. Nurs Res 35: 382–385.

29. Davis LL (1992) Instrument review: Getting the most from a panel of experts. Appl Nurs Res 5: 194−197.

30. Halek M, Holle D, Bartholomeyczik S (2017) Development and evaluation of the content validity, practicability and feasibility of the innovative dementia-oriented assessment system for challenging behaviour in residents with dementia. BMC Health Serv Res 17: 554.    

31. Fan S, Lê Q (2011) Developing a valid and reliable instrument to evaluate users' perception of web-based learning in an Australian university context. J Online Learn Teach 7: 366−374.

32. Tolmie A, Muijs D, McAteer E (2011) Quantitative Methods in Educational and Social Research Using SPSS. UK: Open University Press.

33. Kara B (2014) Health beliefs related to salt-restricted diet in patients on hemodialysis: Psychometric evaluation of the Turkish version of the Beliefs about Dietary Compliance Scale. J Transcult Nurs 25: 256−264.

34. Koo TK, Li MY (2016) A guideline of selecting and reporting intraclass correlation coefficients for reliability research. J Chiropr Med 15: 155–163.    

35. Fowler J, Jarvis P, Chevannes M (2002) Practical Statistics for Nursing and Health Care. West Sussex, UK: John Wiley & Sons.

36. Williams B, Brown T, Onsman A (2010) Exploratory factor analysis: A five-step guide for novices. Australas J Paramedicine 8: 1−13.

37. Polit DF, Beck CT (2006) The content validity index: Are you sure you know what's being reported? Critique and recommendations. Res Nurs Health 29: 489–497.    

38. Engelman KK, Daley CM, Gajewski BJ, et al. (2010) An assessment of American Indian women's mammography experiences. BMC Women's Health 10: 34.    

39. Tennankore KK, Hingwala J, Watson D, et al. (2013) Attitudes and perceptions of nephrology nurses towards dialysis modality selection: A survey study. BMC Nephrol 14: 192.    

40. Davidson M (2014) Known-groups validity. In: Michalos AC, Ed., Encyclopedia of Quality of Life and Well-Being Research. Dordrecht, Netherlands: Springer, 3481–3482.

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