Effat AFAGHI, Eesa MOHAMMADI, Fazlollah AHMADI, Anoshirvan KAZEMNEJAD
Turkish Journal of Nephrology - 2026;35(4):266-275
Background: Patients undergoing hemodialysis encounter numerous stressors in their daily lives, necessitating effective adaptation strategies to cope with these challenges. Although several instruments exist to assess adaptation, most are generic and not specifically designed for particular stressful contexts such as hemodialysis. This study aimed to design and evaluate the psychometric properties of the Hemodialysis Patient Adaptation Questionnaire (HPAQ). Methods: This methodological study used a sequential exploratory mixed-methods approach conducted in Tehran, Iran, from February 2024 to July 2025. It comprised three phases. In phase one, a qualitative study was conducted to gain a detailed understanding of the concept and dimensions of adaptation among hemodialysis patients. In phase two, the HPAQ was developed based on the qualitative findings. Phase three focused on assessing its psychometric properties. Results: Initially, 47 items were generated based on seven identified dimensions of adaptation. Psychometric evaluation demonstrated strong validity and reliability (scale content validity index [SCVI] = 0.90; Cronbach's alpha = 0.917). Following content and construct validity analyses, the final questionnaire included 30 items across four factors: (1) Gradual Acceptance of Reality, (2) Perceived Support, (3) Situation Management, and (4) Submission to Divine Decree. The results confirmed that the HPAQ possesses satisfactory validity, reliability, and psychometric soundness. Conclusion: The findings indicate that the developed questionnaire is a comprehensive, specific, valid, and reliable indigenous instrument for assessing adaptation among patients undergoing hemodialysis in Iran. It can be utilized to design and implement targeted interventions to enhance patient adaptation. Further studies are recommended to re-evaluate the HPAQ in other hemodialysis populations to ensure its broader applicability.
