Enhancing Patient-Centered Communication in Hemodialysis Symptom Management Care-Development and Validation of the HSB-HD Scale for Assessing Help-Seeking Behavior in Hemodialysis Patients: A Multiphase Cross-Sectional Study.

BACKGROUND

Chronic kidney disease (CKD) is a global health challenge, and hemodialysis is a common treatment for end-stage renal disease. Patients undergoing hemodialysis often face significant symptom burden, affecting their quality of life. Timely help-seeking behavior (HSB) is crucial for initiating patient-centered communication and effective symptom management. Yet, the specific behavioral patterns and barriers to help-seeking in this group remain poorly understood. However, tools to assess HSB in this population are lacking.

METHODS

This multiphase cross-sectional study was conducted across three hospitals in China from August to October 2024, involving 425 participants. The study developed the HSB for hemodialysis symptoms (HSB-HD) scale based on literature reviews, expert consultations, and patient interviews. Psychometric evaluation was performed using classical test theory (CTT) and item response theory (IRT), focusing on reliability, validity (content, construct, criterion-related, discriminant, and convergent), and measurement invariance.

RESULTS

The exploratory factor analysis (EFA) revealed a four-factor structure (symptom detection, symptom interpretation, decision-making for help-seeking, and timely disclosure and action), explaining 72.9% of variance. Confirmatory factor analysis (CFA) showed a good model fit (CFI = 0.964, RMSEA = 0.045). Cronbach's α was 0.953, indicating excellent internal consistency. Validity tests showed significant correlations with the EQ-5D-5L pain, anxiety, and VAS scores. Measurement invariance was confirmed across gender and age groups.

CONCLUSIONS

The HSB-HD scale is a reliable and valid tool for assessing HSB in hemodialysis patients. It offers a patient-centered approach to symptom management, providing health care providers with a means to identify those who may benefit from targeted interventions, thereby improving care and quality of life.