Development and preliminary psychometric evaluation of the hemodialysis patient care dependency scale (HD-CDS)

BACKGROUND: Assessing the care dependency of patients undergoing hemodialysis (HD) may be crucial for disease management and control across various stages. Currently, the tools used to measure care dependency are primarily applicable to stroke patients, and comprehensive and reliable assessment tools specifically for patients undergoing HD are lacking. In this study, we developed a care dependency scale suitable for patients undergoing HD and evaluated its psychometric properties. METHODS: This exploratory, sequential mixed-methods study comprised two stages: (1) scale development and (2) psychometric evaluation, including refining the scale and assessing its psychometric properties. The items were generated through a literature review, semi-structured interviews, the nominal group technique, the Delphi method, and pilot testing. We recruited 395 patients undergoing HD for the psychometric evaluation. The psychometric properties of the HD-CDS were examined through item analysis, exploratory factor analysis, assessments of content and convergent validity, internal consistency, and test-retest reliability; 39 clinically stable participants were included in the test-retest analysis. RESULTS: The final scale comprises 17 items across three dimensions (50 scoring criteria in total): basic needs, HD treatment, and social support. The content validity index was 0.914. The exploratory factor analysis accounted for 69.683% of the total item variance, and all items demonstrated good discriminative ability. Convergent validity was supported by a strong negative correlation with the Barthel Index (r = -0.715, p < 0.001). The overall scale showed good internal consistency reliability (Cronbach's α = 0.893, split-half reliability = 0.885), and test-retest reliability among the 39 participants included in the analysis was excellent (intraclass correlation coefficient = 0.965). Significant associations were found between the HD patient care dependency scale scores and education, dialysis sessions, vascular access type, dialysis vintage, and pre‑dialysis blood pressure (all p < 0.01). CONCLUSIONS: The HD-CDS demonstrated promising preliminary psychometric properties in this single-center sample and may provide a useful framework for assessing care dependency among patients undergoing HD. Further multicenter studies, including independent structural validation and inter-rater reliability assessment, are required before routine clinical implementation.