Development and validation of a self-management module for patients with excess fluid volume undergoing hemodialysis

Abstract

Excess fluid volume is a critical issue faced by patients undergoing hemodialysis and is associated with increased morbidity and reduced quality of life. Effective self-management is essential in controlling fluid intake; however, tailored educational modules are limited. This study aimed to develop and validate a self-management module to improve fluid restriction behavior among patients undergoing hemodialysis. A Design-Based Research (DBR) approach using a modified Borg & Gall model was employed. The study was conducted in three phases: (1) preliminary research through an integrative literature review to define domains and construct the module framework; (2) design and development of the module and supporting handbook based on evidence and theory; and (3) content validation by a panel of five experts in nephrology and patient education. Content validity was assessed using the Item-Level Content Validity Index (I-CVI), with a cut-off value of ≥0.80. The module covered key domains of fluid self-management, including knowledge enhancement, behavioral strategies, and self-monitoring tools. Expert validation confirmed high content relevance, with all items achieving I-CVI ≥0.80. Feedback from experts also supported the cultural appropriateness and practical applicability of the module for use in hemodialysis settings. The developed self-management module demonstrates strong content validity and provides a structured educational tool to support fluid restriction behavior in patients undergoing hemodialysis. Further testing is recommended to evaluate its impact on patient outcomes in clinical practice