Exploratory Factor Analysis and Reliability of a Self-Management Assessment Instrument in Patients with End-Stage Renal Disease Undergoing Hemodialysis

Penpayome Sakorn, Chutchavan Wongsaree — Fri, 10 Apr 2026 00:00:00 +0700

Background: Patients with end-stage renal disease (ESRD) undergoing hemodialysis often experience reduced self-care capacity and increased caregiver burden. Effective self-management can mitigate complications and improve quality of life; however, a valid and context-appropriate instrument to assess self-management behaviors among Thai hemodialysis patients remains limited. This study modified and enhanced an existing 37-item questionnaire to improve its validity and applicability in clinical practice.
Objective: To examine the exploratory factor structure and internal consistency of a self-management assessment tool for patients with ESRD undergoing hemodialysis.
Materials and Methods: A descriptive study was conducted among 150 ESRD patients receiving hemodialysis at three private dialysis centers in Bangkok between August and September 2024. The newly developed self-management assessment was evaluated using exploratory factor analysis (EFA). Component extraction was based on eigenvalues >1 and total variance explained. Principal component analysis with varimax rotation was applied. Data suitability was assessed using the Kaiser–Meyer–Olkin (KMO) measure and Bartlett’s test of sphericity. Internal consistency reliability was analyzed using Cronbach’s alpha.
Results: Participants had a mean age of 54.2 ± 13.1 years, and 52.0% were male. The data were suitable for factor analysis (KMO = 0.93; Bartlett’s test p < 0.001). Seven components were initially extracted, with eigenvalues ranging from 1.07 to 17.69, explaining 72.18% of the total variance. Factor loadings ranged from 0.48 to 0.87, indicating good associations between items and latent components. Due to the limited number of indicators in components 3–7, items were synthesized into three refined components: communication and engagement in care, adherence to medical recommendations, and self-monitoring and prevention. The final instrument demonstrated excellent internal consistency (Cronbach’s alpha = 0.96).
Conclusion: The developed instrument demonstrated strong reliability and a clear factor structure, covering key self-management behaviors relevant to the health outcomes of ESRD patients undergoing hemodialysis. It is suitable for individual assessment, nursing care planning, and development of targeted self-management enhancement programs in dialysis settings. Further confirmatory factor analysis is recommended to validate the structural model in diverse populations.

Lampang Medical Journal

Exploratory Factor Analysis and Reliability of a Self-Management Assessment Instrument in Patients with End-Stage Renal Disease Undergoing Hemodialysis