Ahmed Fatema, Ye Qingyuan, Li Li, Ksebe Waleed, Wu Chen, Wang Kefang
School of Nursing and Rehabilitation, Shandong University, Wenhua Xi Road No.44, Jinan, Shandong Province, 250012, China.
School of Nursing, Xi'an Jiaotong University, Xi'an, China.
BMC Nephrol. 2025 Sep 26;26(1):535. doi: 10.1186/s12882-025-04461-0.
Interactive e-learning modules are increasingly being used to educate nurses about preventing and detecting chronic kidney disease (CKD). These modules aim to improve knowledge, screening practices, skills, and self-management behaviours. This Delphi study aims to provide a prioritized list of strategies, content, and delivery methods to guide future implementation efforts and improve primary and secondary prevention of conservative CKD care in Syria.
A second-round Delphi study was performed using the input of 15 CKD clinical content experts (nephrologist-scientist & medical educator) involved in education and clinical practice from March to the end of April 2025. Eligible participants sent an e-mail containing an information sheet and an invitation to participate in the study. Consent is obtained before participants proceed to the survey. In the first round, we identified several potential strategies for CKD prevention education. However, consensus was not reached on all of them. We modified and refined these strategies based on the CKD clinical content experts ' opinions. We asked them to re-evaluate and re-rank these modified strategies in the second round via e-mail. Experts use predefined statements to score the effectiveness of CKD prevention strategies and delivery methods based on existing best practices specified in clinical guidelines, systematic reviews, and research studies. Descriptive statistics such as the median, interquartile range (IQR), and percentage agreement are used to assess consensus. Inferential statistics were used to measure participant agreement using Kendall's coefficient, and for stability between rounds, the Wilcoxon rank-sum test was used.
We identified (9 primary and 32 secondary strategies) evidence-based CKD prevention strategies to implement within Syria and limited resource areas. Three strategies were deleted as not feasible and related to the Syrian context, and nine strategies were modified based on expert feedback on rationale and suggestions related to culture availability and cost-effectiveness. We added one strategy to replace the Genetic screening strategies with early and regular screening for high-risk populations. Challenges to implementing evidence-based CKD prevention strategies seem to exist in professional, organizational, and external contexts, which should all be considered to increase implementation success within resource-limited areas such as Syria.
Using the Delphi approach to tailor the e-learning module content to the specific needs of nurses, depending on the realities of the Syrian context, by synthesizing clinical work with evidence-based CKD prevention strategies and an obvious need to create a common foundation for nurses' knowledge of CKD prevention. This study offers actionable strategies to strengthen CKD prevention in resource-limited settings like Syria. Prioritizing cost-effective tools, culturally adapted education, offline modules, Arabic translations, and nurse-friendly protocols is a blueprint for similar conflict-affected regions.
交互式电子学习模块越来越多地用于培训护士预防和检测慢性肾脏病（CKD）。这些模块旨在提高知识水平、筛查实践能力、技能以及自我管理行为。这项德尔菲研究旨在提供一份按优先级排列的策略、内容和交付方法清单，以指导未来的实施工作，并改善叙利亚对CKD保守治疗的一级和二级预防。
2025年3月至4月底，利用15名参与教育和临床实践的CKD临床内容专家（肾脏病学家兼科学家和医学教育工作者）的意见进行了第二轮德尔菲研究。符合条件的参与者收到一封包含信息表和参与研究邀请的电子邮件。在参与者进行调查之前获得同意。在第一轮中，我们确定了几种CKD预防教育的潜在策略。然而，并非所有策略都达成了共识。我们根据CKD临床内容专家的意见对这些策略进行了修改和完善。我们要求他们在第二轮中通过电子邮件对这些修改后的策略进行重新评估和重新排序。专家们根据临床指南、系统评价和研究中规定的现有最佳实践，使用预定义的陈述对CKD预防策略和交付方法的有效性进行评分。使用中位数、四分位间距（IQR）和百分比一致性等描述性统计数据来评估共识。使用肯德尔系数进行推断统计以衡量参与者的一致性，并且为了衡量两轮之间的稳定性，使用威尔科克森秩和检验。
我们确定了（9项主要策略和32项次要策略）基于证据的CKD预防策略，以便在叙利亚和资源有限地区实施。三项策略因不可行且与叙利亚国情相关而被删除，九项策略根据专家对与文化可用性和成本效益相关的基本原理和建议的反馈进行了修改。我们添加了一项策略，即用对高危人群进行早期和定期筛查取代基因筛查策略。在专业、组织和外部环境中似乎存在实施基于证据的CKD预防策略的挑战，在叙利亚等资源有限的地区，所有这些都应予以考虑，以提高实施的成功率。
采用德尔菲方法，根据叙利亚的实际情况，将电子学习模块的内容与护士的具体需求相匹配，将临床工作与基于证据的CKD预防策略相结合，显然需要为护士的CKD预防知识建立一个共同基础。本研究提供了可操作的策略，以加强叙利亚等资源有限地区的CKD预防。优先考虑具有成本效益的工具、适应文化的教育、离线模块、阿拉伯语翻译以及对护士友好的方案，是受冲突影响的类似地区的蓝图。
