Exploring feasible factors to improve the practice of chronic kidney disease prevention among healthcare professionals in syria: a Q-methodology study

Fatema Ahmed; Qingyuan Ye; Li Li; Waleed Ksebe; Ruiyang Xu; Haya Radwan; Chen Wu; Kefang Wang

doi:10.1186/s12912-025-03375-4

Exploring feasible factors to improve the practice of chronic kidney disease prevention among healthcare professionals in syria: a Q-methodology study

BMC Nurs. 2025 Jul 1;24(1):707. doi: 10.1186/s12912-025-03375-4.

Authors

Fatema Ahmed¹, Qingyuan Ye¹, Li Li¹, Waleed Ksebe², Ruiyang Xu¹, Haya Radwan³, Chen Wu⁴, Kefang Wang⁵

Affiliations

¹ School of Nursing and Rehabilitation, Shandong University, Wenhua Xi Road No.44, Jinan, Shandong Province, 250012, China.
² School of Nursing, Xi'an Jiaotong University, Shannxi, Xi'an, China.
³ Private Nephrology Clinic, Consultant Nephrologist, Latakia, Syria.
⁴ School of Nursing and Rehabilitation, Shandong University, Wenhua Xi Road No.44, Jinan, Shandong Province, 250012, China. wuchen@sdu.edu.cn.
⁵ School of Nursing and Rehabilitation, Shandong University, Wenhua Xi Road No.44, Jinan, Shandong Province, 250012, China. wangkf@email.sdu.edu.cn.

Abstract

Background: Effective prevention is a proactive approach to safeguard individual health, reduce systemic healthcare costs, and enhance overall community well-being, yet barriers often impede the implementation of CKD prevention strategies. This study aims to use the Q-methodology to examine the feasibility of overcoming these barriers, which impedes healthcare professionals (HCPs) in Syria from effectively preventing CKD, with the aim of facilitating behavior change and implementing appropriate interventions.

Methods: We utilized the Q-methodological approach to rank 37 statements made by HCPs regarding barriers to the prevention of CKD. A Q-sample was constructed from interviews with 12 HCPs from different healthcare settings in Syria, followed by selecting a P-sample (the participants who ranked the statements) of 25 HCPs through structured questionnaires. They would perform Q-sorting under professional guidance. To analyze the data, KADE software, which includes techniques of principal component analysis and factor rotation, was used.

Results: A total of eight distinct factors were identified, with eigenvalues ranging from 14.7804 to 0.5351 and accounting for 88% of the cumulative variance. The eigenvalues of the first five factors are all greater than 1, and the cumulative explained variation is 80%. The most significant, amenable barriers were categorized into individual factors ('lack of knowledge and awareness about risk factors and early detection among nursing staff, clinical guidelines and consulting among physicians', 'perceived challenging nature of CKD prevention for timely diagnosis and management preconditions among HCPs,' and 'perceived lack of adequate training among nurses'); interpersonal factors ('poor communication between physicians and nephrologists'); and community/societal factors ('lower apriority of CKD as a clinical issue,' 'lack of patient education resources about CKD prevention', and 'a fragmented healthcare system').

Conclusion: The findings from this study provide valuable insight for policymakers, healthcare administrators, and practitioners in Syria, providing them with targeted strategies for improving the prevention of CKD. Therefore, by addressing these barriers, CKD-related burdens in Syria may be reduced, alongside improvements in patient outcomes and healthcare costs.

Keywords: Barrier identification; Behavioral change; Early detection; Healthcare professionals; Prevention; Q-methodology; Renal insufficiency; Syria.