The Reliability and Validity of the Turkish Version of Patient on Hemodialysis Resilience Scale

The Reliability and Validity of the Turkish Version of Patient on Hemodialysis Resilience Scale | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article The Reliability and Validity of the Turkish Version of Patient on Hemodialysis Resilience Scale Özge SUKUT, Elif BULBUL, Gül DİKEÇ This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7199611/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background By assessing resilience, healthcare professionals can identify patients who may be struggling emotionally or psychologically, allowing for timely support and resources, and it may also foster a more supportive therapeutic relationship. With insights into patients' resilience, health professionals can implement targeted psychological and social interventions that are aimed at improving mental health and overall well-being. By focusing on resilience, healthcare professionals can help patients develop coping strategies and foster a sense of empowerment in managing their illness, which can lead to improved quality of life. The study aimed to validate the psychometric properties of the Turkish version of the Patient on Hemodialysis Resilience Scale. Method This methodological design study was conducted in hemodialysis with 187 patients in a unit between September 2022 and April 2023. The data was collected with information from the Patient on Hemodialysis Resilience Scale and Brief Resilience Scale— Confirmatory Factor Analysis performed to evaluate the data. Results The 3-factor, 20-question scale demonstrated a good fit in adapting to Turkish culture, with significant test-retest results obtained from 24 patients. The factor loadings ranged between 0.68 and 0.76, and the unidimensional structure was confirmed. All items show strong item-total correlations (> 0.85). Cronbach range of the scale was between 0.70-0.89. Conclusion This scale served as a reliable measurement tool for assessing the resilience levels of hemodialysis patients within the Turkish cultural context. Clinical trial number Not applicable. Reliability validity resilience hemodialysis Figures Figure 1 Introduction The assessment of resilience in hemodialysis patients is crucial for understanding their psychological well-being and enhancing their coping mechanisms in the face of chronic illness. Resilience scales serve as valuable tools for measuring this construct, allowing healthcare providers to identify patients who may benefit from targeted interventions to improve their mental health and treatment adherence. Resilience scales, such as the Connor-Davidson Resilience Scale (CD-RISC) and the Brief Resilience Scale, have been widely utilized in various populations, including those undergoing hemodialysis. These scales provide a quantitative measure of an individual's ability to adapt to stress and adversity, which is particularly relevant for patients facing the challenges associated with chronic kidney disease (CKD) and the demands of regular dialysis treatment ((1–3). However, these two scales primarily assess the individual's competence and tendencies without considering the resilience characteristics of hemodialysis patients (4). The significance of resilience scales extends beyond mere measurement; they facilitate the identification of patients who may require additional psychological support. As noted by Qiu et al., low resilience is associated with higher levels of depression and lower health-promoting behaviors among patients receiving hemodialysis, highlighting the need for clinical interventions aimed at enhancing resilience (5). Furthermore, the use of resilience scales can guide healthcare professionals in developing personalized care plans that incorporate resilience-building strategies, such as cognitive-behavioral therapy and mindfulness practices, which have shown effectiveness in improving mental health outcomes (3,6). Resilience scales are vital for assessing and enhancing psychological resilience among hemodialysis patients. They provide insights into patients' coping abilities and inform clinical interventions aimed at improving mental health and treatment adherence. Most patients with end-stage renal failure have hope of survival with hemodialysis treatment. Hemodialysis patients typically undergo two to three dialysis sessions per week, subject to many psychological and physical challenges due to repeated needle punctures, fluid and dietary restrictions, and dialysis complications and symptom burden. Therefore, it is particularly necessary to address the psychological problems of hemodialysis patients and to improve their psychological adjustment (7,8). Psychological resilience, defined as the ability to adapt to adversity, recover from adversity or significant sources of stress, and the capacity to ‘bounce back,’ is a personal characteristic that can be developed (9). Resilience among patients undergoing hemodialysis is a multidimensional construct that significantly impacts their quality of life and ability to cope with the chronic stressors associated with renal disease. Resilience is crucial for these patients, particularly given the challenging nature of their treatment regimen, which can lead to feelings of isolation and a diminished sense of well-being(8,10). Personal factors such as self-efficacy are pivotal in enhancing resilience, allowing patients to manage their conditions better and engage in self-care practices essential for their health (10,11). Resilience among hemodialysis patients plays a vital role in their psychological well-being and overall treatment outcomes. These individuals encounter numerous challenges, with the most significant being the necessity of lifelong hemodialysis. To thrive and lead fulfilling lives, they must navigate and overcome the difficulties associated with this treatment (4). Resilience can significantly enhance patients' adherence to their treatment regimens, regular attendance at appointments, and compliance with dietary restrictions. It is essential to encourage patients to take an active role in their treatment. The study aims to validate the psychometric properties of the Turkish version of the Patient on Hemodialysis Resilience Scale. Methods Design This methodological design study aimed to validate the psychometric properties of the Turkish version of the Patient on Hemodialysis Resilience Scale. Study Setting and Sampling The study population consisted of hemodialysis patients undergoing treatment at a dialysis center in Istanbul, Turkey. Participants were recruited through convenience sampling from those inpatients in the hemodialysis unit between September 2022 and April 2023. The average age of participants was 60.67 years (with a standard deviation of 12.94). The sample included 187 individuals who met the inclusion criteria. Among them, 54.5% were male, and 61.6% had graduated from middle or high school. The mean duration of treatment received by patients was 5.58 years (with a standard deviation of 5.14), and 94% of the patients underwent dialysis three times a week. Inclusion and Exclusion Criteria Patients were required to have received a diagnosis of chronic kidney disease at least three months prior and to be currently undergoing hemodialysis. Furthermore, participants were excluded if they had any mental health disorders and were required to be capable of effective communication and collaboration to engage in the study. As a result, 6 patients excluded due to length of chronic kidney diseases. Measures Data were collected with Personal Information forms, a Brief Resilience Scale, and a Patient on Hemodialysis Resilience Scale. Personal Information form The form includes questions regarding the Patient’s age, gender, education level, duration of treatment, and frequency with which patients receive their treatment each week. The Brief Resilience Scale (BRS) The BRS was developed by Smith et al. in 2008 to measure resilience, which is defined as the ability to recover from stress (12). The Turkish adaptation of the Brief Resilience Scale (BRS) was conducted by Doğan in 2015. It specifically focuses on how individuals respond to stressors and their capacity to return to their baseline levels of functioning after experiencing difficulties. The BRS consists of six items that reflect different aspects of resilience. Respondents indicate their level of agreement with each statement using a 5-point Likert scale, ranging from one (strongly disagree) to five (strongly agree). Items are scored and summed to create a total score, with higher scores indicating greater resilience. Some items may need to be reverse-scored to ensure consistency across the scale. The Brief Resilience Scale (BRS) score ranged between 0 and 30. The Cronbach’s alpha for the scale was determined to be 0.83(13). In this study reported a value of 0.71. Patient on Hemodialysis Resilience Scale (PHRS) The Patient on Hemodialysis Resilience Scale was developed by Kim et al. in 2020 to assess the resilience of individuals undergoing hemodialysis. This scale was meticulously developed, incorporating insights from existing literature and results from in-depth interviews. It consists of 20 items measured on a 5-point Likert scale and categorized into three factors (4). Factor one focuses on pursuing positive meaning in the present, emphasizing the importance of finding significance in current experiences, and includes 10 items. Factor two addresses the acceptance of hemodialysis in daily life, reflecting patients’ strong inclination to integrate hemodialysis into their everyday routines, comprising six items. Factor 3 pertains to the development of the will to live through close human relationships, highlighting how patients draw strength from familial and social connections, with four items. This structured approach facilitates a comprehensive evaluation of how patients interact with their treatment and navigate hemodialysis's emotional and psychological challenges. Higher scores on the scale indicate greater resilience. For the Confirmatory Factor Analysis conducted with 116 patients, various fit indices, such as CFI, TLI, and RMSEA, were reported to assess the model’s fit to the data. Good fit indices (with CFI > 0.90 and RMSEA < 0.08) suggest strong construct validity (4). Data Analysis Content Validity Three professionals specializing in psychiatric and mental health nursing, and internal medicine nursing, all proficient in both languages, translated the PRHS from English to Turkish. A panel of nine experts analyzed and confirmed the translation’s content validity. Four academicians from internal medicine nursing, three from psychiatric and mental health nursing, one nephrologist, and one sociologist were consulted for expert opinion. Analysis Data were analyzed using SPSS (IBM Statistical Package for Social Science for Windows 26.0) software for descriptive statistics and Pearson correlation analysis. Cronbach's alpha is used to assess the reliability or internal consistency of a set of scale or test items. A split-half analysis is conducted to assess the reliability of a test by dividing its items into two halves. The suitability of the dataset and sample size for analysis was determined by Kaiser Meyer Olkin (KMO) and Barlet’s sphericity test. A KMO value >0.60 and a significant Barlet’s sphericity test indicate the sample's adequacy and the suitability of the data set for analysis. Paired sample t-test was also performed for test-retest results. Confirmatory Factor Analysis (CFA) was conducted using the R package lavaan to test the hypothesized three-factor model. The initial CFA model and subsequent modifications, targeting fit indices such as RMSEA, were performed in lava. In Confirmatory Factor Analyses, Chi-square/df, root mean square error of approximation (RMSEA), comparative fit index (CFI), Tucker Lewis index (TLI) standardized root mean square residual (SRMR), and root mean square residual (RMR) values were examined. A CMIN/DF value of 0.90, an SRMR value, and an RMR value of 0.90 indicate that the ft indices of the scale are acceptable. A p-value of <0.05 was considered statistically significant. Ethical Considerations At the outset of the study, permission was obtained from Eun Young Kim, who created the Patient on Hemodialysis Resilience Scale to validate the psychometric properties of the Turkish version. Ethical approval was given by the Hamidiye Ethical Board Institutional Review Board University of Health Sciences. (number: E-46418926-050.01.04-47574, date: 12.07.2021). The participants also gave verbal and written informed consent to participate in the study. The ethical guidelines of the Declaration of Helsinki were used to conduct the study. Results Content Validity Results In the study, the item-based content validity index was 0.93 and was evaluated between 0.71-1.00. Construct Validity KMO and Barlett’s Sphericity Test were conducted to check the suitability of the sample size and the suitability of the dataset for analysis. The KMO value was found to be 0.884. Barlett’s Sphericity Test was found to be significant (χ2=2066.524; p=0.000). As a result of the CFA analysis, the factor loadings ranged between 0.68 and 0.76, and the unidimensional structure was confirmed. All items show strong item-total correlations (> 0.85) (Table 1). Table 1. Items factor loading of Hemodialysis Resilience Scale (n=187) Reliability Analysis The reliability analysis conducted for this study yielded a total item Cronbach's alpha value of 0.91, indicating an excellent level of internal consistency among the items measured. Furthermore, as detailed in Table 2, the factor-specific Cronbach's alpha values ranged from 0.70 to 0.89 (Table 2). Table 2. Patient on Hemodialysis Resilience Scale Reliability Analysis (n=187) The results of the additional reliability assessments further substantiate the consistency of the measurement tool utilized in this study. The Spearman-Brown correlation coefficient was calculated to be 0.84, indicating a strong positive correlation among the test items. This high value suggests that splitting the test into two halves would yield similar results, reinforcing the reliability of the instrument for the constructs being measured. Additionally, the Guttman Split Half correlation was found to be 0.83, which also indicates a high level of internal consistency across the tested items. This metric demonstrates that the items effectively represent a unified construct, as both the Spearman-Brown and Guttman correlations converge on similar reliability estimates. These findings, presented in Table 3, highlight the robustness of the measurement tool and confirm its applicability for future research. The strong correlations suggest that the instruments can be confidently used in both clinical and research settings, as they exhibit a high degree of reliability in assessing the constructs of interest. Table 3. Patient on Hemodialysis Resilience Scale Split Half Analyses (n=187) Confirmatory Factor Analysis According to the results of the CFA analyses, in the first model, χ2/sd was 2.68, RMSEA was 0.09, RMR was 0.06, GFI was 0.83, AGFI was 0.77, TLI was 0.85, SRMR was 0.07, CFI was 0.87, NFI was 0.84, and IFI was 0.86. Refining the initial model parameters, such as reexamining factor relationships and error covariances, led to a model with an improved overall fit to the modification results. After modification, it was found that χ2/sd was 2.01, RMSEA was 0.07, RMR was 0.06, GFI was 0.91, AGFI was 0.84, TLI was 0.91, SRMR was 0.06, CFI was 0.93, NFI was 0.91, and IFI was 0.93 (Table 4; Figure 1.). Table 4. Confirmatory Factor Analysis Results of Patient on Hemodialysis Resilience Scale (n=187) Test-Retest reliability The correlation value observed as a result of the test-retest measurements applied to 24 patients 15 days apart to evaluate the scale’s consistency over time was found to be r=0.99. It was found that there was a statistically significant and very strong positive correlation between the test and re-test scores on PHRS (r: 0.99, p0.05; Table 5). Table 5. Test-Retest Results of Patient on Hemodialysis Resilience Scale (n=24) Parallel form reliability For parallel form reliability, the correlation between the Patient on the Hemodialysis Resilience Scale and the Brief Resilience Scale had a statistically positive weak correlation (r: 0.226 p <0.01; Table 6). Table 6. Correlation between the Brief Resilience Scale and Patient on Hemodialysis Resilience Scale (n=187) Discussion The study aimed to validate the psychometric properties of the Turkish version of the Patient on Hemodialysis Resilience Scale. The analysis revealed that the results were significant and demonstrated a firm fit. Bartlett’s and the Keiser-Meyer-Olkin (KMO) tests are essential for determining the adequacy and appropriateness of data for factor analysis. The KMO values between 0.8 to 1.0 indicate the sampling is adequate (14). In the study KMO value was found to be above 0.70. Barlett’s Sphericity Test was found to be significant. A factor loading of >0.30 is a requirement for the scale to be acceptable (15). Between the range 0.8 to 1 indicated that strong relation (16). All factors’ loadings are acceptable in the scale’s validity. All correlation coefficients in the present study were above 0.30, indicating good item-total consistency for all items(17,18). The reliability analysis conducted for this study yielded a total item Cronbach's alpha value of 0.91, indicating an excellent level of internal consistency among the items measured. This high alpha value suggests that the scale used is reliable for assessing the constructs in question, supporting the notion that the items are adequately capturing the underlying theoretical framework. Furthermore, as detailed in Table 2, the factor-specific Cronbach's alpha values ranged from 0.70 to 0.89. These values indicate acceptable to high reliability for the individual factors identified in the analysis. Specifically, a Cronbach's alpha of 0.70 is generally regarded as the minimum threshold for good reliability, while values above 0.80 are considered very good. The factor with the highest reliability score reflects a particularly strong correlation among its items, therefore affirming its robustness as a construct. These findings align with previous research in the field, which emphasizes the importance of utilizing reliable instruments for accurate measurement in psychological and social research. While the scale development study revealed higher internal consistency values among hemodialysis patients, this study, which focused on the adaptation to Turkish culture, also demonstrated internal consistency levels within an acceptable range (4). The split-half reliability analysis showed that the Spearman–Brown correlation (r = 0.84) and the Guttman split-half (r = 0.083) values were acceptable. In terms of scale adaptation and development, scales with reliability values of 0.70 or higher are considered adequately reliable (15). According to the results of the CFA analyses, in the first analysis some results indicated unaccepted fit. Therefore, new modification refined the initial model parameters such as reexamining factor relationships and error covariances, which led to a model with improved overall fit the modification results. After modification; fit indices of the scale were calculated as; χ2/sd: 2.01, RMSEA: 0.07, RMR:0.06, GFI: 0.91, AGFI: 0.84, TLI: 0.91, SRMR: 0.06, CFI: 0.93, NFI: 0.91 and IFI: 0.93. Model fit was evaluated using confirmatory factor analysis based on three indices: χ2/df, CFI, and RMSEA. A χ2/df value <2 (19) or <3 (15) shows a good fit. Comparative fit index values ≥ 0.90 and RMSEA values ≤ 0.06 reflect a good fit (15,19). As a result of CFA, acceptable levels of fit indices were defined as χ2/df not exceeding 5, SRMR being lower than 0.08, and TLI being higher than 0.90 (20–22). Standardized root-mean-square residual values of 0.05–0.10 and CFI values of 0.090–0.095 indicate an acceptable fit (18). While the scale development study χ2/df value was found 1.809; RMSEA was found 0.08, CFI was found 0.908. In test-rest result with 24 patients had statically significant result and strong correlation. And the parallel form analysis indicated that weak correlation between the resilience scales. Within this framework, it was concluded that the fit indices of the scale were at satisfactory and outstanding levels. The 20-question, three-factor structure scale served as a reliable measurement tool for assessing the resilience levels of hemodialysis patients within the Turkish cultural context. One of the notable limitations of this study pertains to the characteristics of the research population. The sample was comprised exclusively of Turkish-speaking patients undergoing hemodialysis at designated centers. While this targeted approach facilitates a comprehensive examination of resilience within this specific cohort, it concurrently restricts the generalizability of the findings to other populations. The sociodemographic composition of the sample, encompassing factors such as age, gender, socioeconomic status, and educational background, may not adequately represent the broader hemodialysis patient population. For example, if the sample predominantly consisted of younger patients or individuals from a particular socioeconomic background, the results may not accurately reflect the resilience levels of older patients or those from diverse socioeconomic contexts. The other limitation of the study is that other researchers conducted a Turkish validity and reliability study of the scale during the publication process (23). While these researchers identified item distributions across different sub-dimensions, this study's error covariance assignment demonstrated the final parallelism, ensuring that the original structure of the scale remained intact. Conclusion The Turkish version of the Patient on Hemodialysis Resilience Scale consists of 20 items and three sub-dimensions. The results indicate that the scale demonstrates validity and reliability within the Turkish sample. By validating the psychometric properties of the Turkish version of the scale in evaluating patients’ resilience, appropriate support can be given to patients in need by raising awareness. A reliable and valid scale allows healthcare professionals to accurately assess the resilience levels of Turkish hemodialysis patients. Understanding individual resilience can guide tailored interventions. By assessing resilience, healthcare professionals can identify patients who may be struggling emotionally or psychologically, allowing for timely support and resources. With insights into patients' resilience, health professionals can implement targeted psychological and social interventions that are aimed at improving mental health and overall well-being. By focusing on resilience, health professionals can help patients develop coping strategies and foster a sense of empowerment in managing their illness, which can lead to improved quality of life. Using a scale to assess resilience can enhance communication between patients and healthcare providers, fostering a more supportive therapeutic relationship. The validated scale can serve as a tool for future research, facilitating studies aimed at understanding resilience in diverse populations and contexts within clinical settings. It can assist healthcare facilities in monitoring the effectiveness of interventions aimed at enhancing psychological resilience among patients. Declarations Declaration of conflicting interests The authors declared that there is no conflict of interest. Fundings The authors received no financial support for the research, authorship, and/or publication of this article. Ethic Ethical approval was given by the Institutional Review Board University of Health Sciences (Hamidiye Ethical Board) (number: E-46418926-050.01.04-47574, date: 12.07.2021) Author Contribution O.S, E.B, G.D. Designed the study.O.S. wrote the main manuscript text, prepared figure and tables, and analysed the data. E.B. collected the data. O.S, E.B, G.D. All authors reviewed the manuscript. References Gill W, Kate M B, Jane N. A Methodology Review of Resilience Measurement Scales. Health Qual Life Outcomes. 2011;9(1):2–18. Vitorino LM, Lucchetti G, Leão FC, Vallada H, Peres MFP. The association between spirituality and religiousness and mental health. Sci Rep. 2018;8(1):1–9. Kukihara H, Yamawaki N, Ando M, Nishio M, Kimura H, Tamura Y. The mediating effect of resilience between family functioning and mental well-being in hemodialysis patients in Japan: A cross-sectional design. Health Qual Life Outcomes. 2020;18(1):1–8. Kim E, Lee Y, Chang S. Measuring the Resilience of Patients on Hemodialysis: Development of a Patient on Hemodialysis Resilience Scale. Nephrol Nurs J. 2020 May 1;47:229–37. Qiu Y, Huang Y, Wang Y, Ren L, Jiang H, Zhang L, et al. The Role of Socioeconomic Status, Family Resilience, and Social Support in Predicting Psychological Resilience Among Chinese Maintenance Hemodialysis Patients. Front Psychiatry. 2021;12(September):1–8. Lerma A, Ordónez G, Mendoza L, Salazar-Robles E, Rivero J, Pérez-Granados E, et al. Psychometric properties of the resilience scale in Mexican patients with chronic hemodialysis. Salud Mental. 2019;42(3):121–9. Liu YM, Chang HJ, Wang RH, Yang LK, Lu KC, Hou YC. Role of resilience and social support in alleviating depression in patients receiving maintenance hemodialysis. Ther Clin Risk Manag. 2018;14:441–51. Wang Y, Qiu Y, Ren L, Jiang H, Chen M, Dong C. Social support, family resilience and psychological resilience among maintenance hemodialysis patients: a longitudinal study. BMC Psychiatry. 2024;24(1):1–12. Jenaabadi H, Mir F. Role of Trust in God and Resilience in Hope for Life of Hemodialysis Patients. Health, Spirituality and Medical Ethics [Internet]. 2019 Mar 1;6(1):33–8. Available from: http://jhsme.muq.ac.ir/article-1-254-en.html Ghorbani Hanouj A, Khandan M, Jahani Y. The effectiveness of training based on Bandura’s self-efficacy theory on hemodialysis patients’ resilience during the COVID-19 outbreak: A quasi-experimental study. Journal of Multidisciplinary Care [Internet]. 2023;12(1):18–23. Available from: https://doi.org/10.34172/jmdc.1162 Shokrpour N, Sheidaie S, Amirkhani M, Bazrafkan L, Modreki A. Effect of positive thinking training on stress, anxiety, depression, and quality of life among hemodialysis patients: A randomized controlled clinical trial. J Educ Health Promot. 2021;10(1):1–9. Smith BW, Dalen J, Wiggins K, Tooley E, Christopher P, Bernard J. The brief resilience scale: Assessing the ability to bounce back. Int J Behav Med. 2008;15(3):194–200. Doğan T. Kısa Psikolojik Sağlamlık Ölçeği’nin Türkçe uyarlaması: Geçerlik ve güvenirlik çalışması Adaptation of the Brief Resilience Scale into Turkish: A validity and reliability study. The Journal of Happiness & Well-Being. 2015;3(1):93–102. Shrestha N. Factor Analysis as a Tool for Survey Analysis. Am J Appl Math Stat. 2021;9(1):4–11. Seçer İ. Practical Data Analysis, Analysis and Reporting with SPSS and LISREL. Anı Yayıncılık; 2015. Akoglu H. User’s guide to correlation coefficients. Turk J Emerg Med. 2018;18(3):91–3. Osborne JW, Costello AB, Kellow JT. Best Practices in Exploratory Factor Analysis. Best Practices in Quantitative Methods. 2011. 86–99 p. Ratner B. The correlation coefficient: Its values range between 1/1, or do they. Journal of Targeting, Measurement and Analysis for Marketing. 2009;17(2):139–42. Şimşek Ö. Yapısal Eşitlik Modellemesine Giriş: Temel Ilkeler ve LISREL Uygulamaları [Internet]. Ekinoks Eğitim Danışmanlık Hizmet ve Basın Yayın; 2020. Available from: https://books.google.com.tr/books?id=TD7YDwAAQBAJ Erkorkmaz Ü, EtIkan I, DemIr O, Özdamar K, SanIsoǧlu SY. Confirmatory factor analysis and fit indices: Review. Turkiye Klinikleri Journal of Medical Sciences. 2013;33(1):210–23. Aksu G, Eser MT, Oktay GC. Exploratory and confirmatory factor analysis and structural equation model applications. Detay Yayıncılık; 2017. Bae BR. Structural equation modeling with Amos 24. Chenngram Books; 2017. 76–309 p. Eler ÇÖ, Kav S. Validity and Reliability of the Turkish Version of the Patient on Hemodialysis Resilience Scale. Therapeutic Apheresis and Dialysis. 2024;28(5):745–53. Tables Table 1. Items factor loading of Hemodialysis Resilience Scale (n=187) Factors Item Standardized Loading Item Total Correlation Factor 1 1 0.72 0.89 2 0.75 0.89 3 0.70 0.90 4 0.73 0.90 5 0.68 0.88 11 0.74 0.89 12 0.76 0.89 13 0.71 0.89 14 0.69 0.90 19 0.72 0.89 Factor 2 9 0.70 0.88 15 0.73 0.91 16 0.71 0.90 17 0.69 0.89 18 0.74 0.88 20 0.70 0.89 Factor 3 6 0.68 0.85 7 0.72 0.88 8 0.70 0.87 10 0.71 0.88 All standardized loadings were statistically significant at conventional levels (e.g., p < .001). Table 2. Patient on Hemodialysis Resilience Scale Reliability Analysis (n=187) Scale Original study In this study Total items 0.936 0.913 The pursuit of positive meaning in the present 0.926 0.892 Acceptance of hemodialysis as a part of daily life 0.882 0.706 Building the will to live through close human relationships 0.834 0.762 Table 3. Patient on Hemodialysis Resilience Scale Split Half Analyses (n=187) Internal Consistency Scale Half 1 r 0.88 Scale Half 2 r 0.82 Total Item 20 Correlation Value Between Scales 0.72 Spearman-Brown (r) 0.84 Guttman Split-Half (r) 0.83 Table 4. Confirmatory Factor Analysis Results of Patient on Hemodialysis Resilience Scale (n=187) Fit Indicates Threshold Before Modification After Modification χ2/d f χ2/df ≤3 2.68 2.01 RMSEA 0≤RMSEA≤0.08 0.09 0.07 RMR ≤0.08 0.06 0.06 GFI 0.90≤GFI ≤1.00 0.83 0.91 AGFI 0.80≤AGFI≤1.00 0.77 0.84 TLI >0.90 0.85 0.91 SRMR 0.90 0.86 0.93 χ2: Chi-Square Test Statistic; df : Degrees of Freedom; RMSEA: Root Mean Square Error of Approximation; RMR: Root Mean Square Residual; GFI: Goodness of Fit Index; AGFI: Adjusted Goodness of Fit Index; TLI: Tucker-Lewis Index; SRMR: Standardized Root Mean Square Residual; CFI: Comparative Fit Index; NFI: Normal Fit Index; IFI: Incremental Fit Index Table 5. Test-Retest Results of Patient on Hemodialysis Resilience Scale (n=24) Scale Scale scores means Statistic results First-test X(sd) Retest X(sd) t p r p PHRS Total 79.37(17.73) 79.79(16.54) -0.934 0.360 0.995 0000 Sd: Standart Deviation, t: Paired sample t test, r: Pearson correlation coefficient; p<0.001, PHRS: Patient on Hemodialysis Resilience Scale Table 6. Correlation between the Brief Resilience Scale and Patient on Hemodialysis Resilience Scale (n=187) PHRS Total Score BRS Score PHRS Total Score 1 BRS Total Score (r) 0.226 1 PHRS: Patient on Hemodialysis Resilience Scale; BRS: Brief Resilience Scale, r: Pearson Correlation, p<0.01 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7199611","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":504058817,"identity":"5ebacbb6-bdd5-41a9-9925-cda6490a74b8","order_by":0,"name":"Özge SUKUT","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA40lEQVRIie3RsQqCQBjA8U8EXa5cz6Ve4URoqYe5CPQBWhqCdHGSdqGH6BGUg2txaWtLcW3QrcGhM4i2O8eg+8PBHdwPPu4AdLofjgCYef7e5qOJZdEPMaKRBBEYRRzncq2gZz65px1De5hNb9RudhLiRuWWGAlbED45M8TBd2/UiEvZQEUaYCNiqzeZRLA+D0Q2GWEofIrBBEHVQA5qwm0OYA2DIRgIJSripsjE6yT0XR6Q4sSxl5V1nMmIeLG6bfuld2SsaR/71Xx62eSdjACI76DfExZL+ZN2pbig0+l0f98LMUVScURZtg8AAAAASUVORK5CYII=","orcid":"","institution":"Istanbul University - Cerrahpaşa","correspondingAuthor":true,"prefix":"","firstName":"Özge","middleName":"","lastName":"SUKUT","suffix":""},{"id":504058818,"identity":"f400600c-437a-41cb-874e-ad97e9849792","order_by":1,"name":"Elif BULBUL","email":"","orcid":"","institution":"University of Health Sciences","correspondingAuthor":false,"prefix":"","firstName":"Elif","middleName":"","lastName":"BULBUL","suffix":""},{"id":504058821,"identity":"bf967141-8d25-4674-9570-7aab6e26c77f","order_by":2,"name":"Gül DİKEÇ","email":"","orcid":"","institution":"Fenerbahçe University","correspondingAuthor":false,"prefix":"","firstName":"Gül","middleName":"","lastName":"DİKEÇ","suffix":""}],"badges":[],"createdAt":"2025-07-23 20:38:15","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7199611/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7199611/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":89973830,"identity":"d6b7c55e-7226-4bca-b269-7b7137751445","added_by":"auto","created_at":"2025-08-27 05:52:20","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":74368,"visible":true,"origin":"","legend":"\u003cp\u003ePath Diagram\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7199611/v1/f88f837774e9ac4f989ed3f5.png"},{"id":102791883,"identity":"37620358-a5a1-43f6-b961-053421d58b53","added_by":"auto","created_at":"2026-02-16 17:25:37","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1178778,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7199611/v1/4e412919-64ea-4c4d-8e84-c388c0d60d5f.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"The Reliability and Validity of the Turkish Version of Patient on Hemodialysis Resilience Scale","fulltext":[{"header":"Introduction","content":"\u003cp\u003eThe assessment of resilience in hemodialysis patients is crucial for understanding their psychological well-being and enhancing their coping mechanisms in the face of chronic illness. Resilience scales serve as valuable tools for measuring this construct, allowing healthcare providers to identify patients who may benefit from targeted interventions to improve their mental health and treatment adherence. Resilience scales, such as the Connor-Davidson Resilience Scale (CD-RISC) and the Brief Resilience Scale, have been widely utilized in various populations, including those undergoing hemodialysis. These scales provide a quantitative measure of an individual\u0026apos;s ability to adapt to stress and adversity, which is particularly relevant for patients facing the challenges associated with chronic kidney disease (CKD) and the demands of regular dialysis treatment ((1\u0026ndash;3). However, these two scales primarily assess the individual\u0026apos;s competence and tendencies without considering the resilience characteristics of hemodialysis patients (4).\u003c/p\u003e\n\u003cp\u003eThe significance of resilience scales extends beyond mere measurement; they facilitate the identification of patients who may require additional psychological support. As noted by Qiu et al., low resilience is associated with higher levels of depression and lower health-promoting behaviors among patients receiving hemodialysis, highlighting the need for clinical interventions aimed at enhancing resilience (5). Furthermore, the use of resilience scales can guide healthcare professionals in developing personalized care plans that incorporate resilience-building strategies, such as cognitive-behavioral therapy and mindfulness practices, which have shown effectiveness in improving mental health outcomes (3,6).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eResilience scales are vital for assessing and enhancing psychological resilience among hemodialysis patients. They provide insights into patients\u0026apos; coping abilities and inform clinical interventions aimed at improving mental health and treatment adherence.\u003c/p\u003e\n\u003cp\u003eMost patients with end-stage renal failure have hope of survival with hemodialysis treatment. Hemodialysis patients typically undergo two to three dialysis sessions per week, subject to many psychological and physical challenges due to repeated needle punctures, fluid and dietary restrictions, and dialysis complications and symptom burden. Therefore, it is particularly necessary to address the psychological problems of hemodialysis patients and to improve their psychological adjustment (7,8). Psychological resilience, defined as the ability to adapt to adversity, recover from adversity or significant sources of stress, and the capacity to \u0026lsquo;bounce back,\u0026rsquo; is a personal characteristic that can be developed \u003cspan lang=\"TR\"\u003e(9).\u003c/span\u003e\u0026nbsp; Resilience among patients undergoing hemodialysis is a multidimensional construct that significantly impacts their quality of life and ability to cope with the chronic stressors associated with renal disease. Resilience is crucial for these patients, particularly given the challenging nature of their treatment regimen, which can lead to feelings of isolation and a diminished sense of well-being(8,10). Personal factors such as self-efficacy are pivotal in enhancing resilience, allowing patients to manage their conditions better and engage in self-care practices essential for their health (10,11).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eResilience among hemodialysis patients plays a vital role in their psychological well-being and overall treatment outcomes. These individuals encounter numerous challenges, with the most significant being the necessity of lifelong hemodialysis. To thrive and lead fulfilling lives, they must navigate and overcome the difficulties associated with this treatment (4). \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eResilience can significantly enhance patients\u0026apos; adherence to their treatment regimens, regular attendance at appointments, and compliance with dietary restrictions. It is essential to encourage patients to take an active role in their treatment. The study aims to validate the psychometric properties of the Turkish version of the Patient on Hemodialysis Resilience Scale.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cstrong\u003eDesign\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis methodological design study aimed to validate the psychometric properties of the Turkish version of the Patient on Hemodialysis Resilience Scale.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudy Setting and Sampling\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study population consisted of hemodialysis patients undergoing treatment at a dialysis center in Istanbul, Turkey. Participants were recruited through convenience sampling from those inpatients in the hemodialysis unit between September 2022 and April 2023. The average age of participants was 60.67 years (with a standard deviation of 12.94). The sample included 187 individuals who met the inclusion criteria. Among them, 54.5% were male, and 61.6% had graduated from middle or high school. The mean duration of treatment received by patients was 5.58 years (with a standard deviation of 5.14), and 94% of the patients underwent dialysis three times a week.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInclusion and Exclusion Criteria\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePatients were required to have received a diagnosis of chronic kidney disease at least three months prior and to be currently undergoing hemodialysis. Furthermore, participants were excluded if they had any mental health disorders and were required to be capable of effective communication and collaboration to engage in the study. As a result, 6 patients excluded due to length of chronic kidney diseases.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMeasures\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData were collected with Personal Information forms, a Brief Resilience Scale, and a Patient on Hemodialysis Resilience Scale.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePersonal Information form\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;The form includes questions regarding the Patient\u0026rsquo;s age, gender, education level, duration of treatment, and frequency with which patients receive their treatment each week.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eThe Brief Resilience Scale (BRS)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe BRS was developed by Smith et al. in 2008 to measure resilience, which is defined as the ability to recover from stress (12).\u003csup\u003e\u0026nbsp;\u003c/sup\u003eThe Turkish adaptation of the\u0026nbsp;Brief Resilience Scale (BRS)\u0026nbsp;was conducted by Doğan in 2015. It specifically focuses on how individuals respond to stressors and their capacity to return to their baseline levels of functioning after experiencing difficulties. The BRS consists of\u0026nbsp;six items\u0026nbsp;that reflect different aspects of resilience. Respondents indicate their level of agreement with each statement using a\u0026nbsp;5-point Likert scale, ranging from\u0026nbsp;one (strongly disagree)\u0026nbsp;to\u0026nbsp;five (strongly agree).\u0026nbsp;Items are scored and summed to create a total score, with higher scores indicating greater resilience. Some items may need to be reverse-scored to ensure consistency across the scale. The Brief Resilience Scale (BRS) score ranged between 0 and 30. The Cronbach\u0026rsquo;s alpha for the scale was determined to be 0.83(13). \u003csup\u003e\u0026nbsp;\u003c/sup\u003eIn this study reported a value of 0.71.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePatient on Hemodialysis Resilience Scale (PHRS)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe Patient on Hemodialysis Resilience Scale was developed by Kim et al. in 2020 to assess the resilience of individuals undergoing hemodialysis. This scale was meticulously developed, incorporating insights from existing literature and results from in-depth interviews. It consists of 20 items measured on a 5-point Likert scale and categorized into three factors (4).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFactor one focuses on pursuing positive meaning in the present, emphasizing the importance of finding significance in current experiences, and includes 10 items. Factor two addresses the acceptance of hemodialysis in daily life, reflecting patients\u0026rsquo; strong inclination to integrate hemodialysis into their everyday routines, comprising six items. Factor 3 pertains to the development of the will to live through close human relationships, highlighting how patients draw strength from familial and social connections, with four items.\u003c/p\u003e\n\u003cp\u003eThis structured approach facilitates a comprehensive evaluation of how patients interact with their treatment and navigate hemodialysis\u0026apos;s emotional and psychological challenges. Higher scores on the scale indicate greater resilience. For the Confirmatory Factor Analysis conducted with 116 patients, various fit indices, such as CFI, TLI, and RMSEA, were reported to assess the model\u0026rsquo;s fit to the data. Good fit indices (with CFI \u0026gt; 0.90 and RMSEA \u0026lt; 0.08) suggest strong construct validity (4).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eContent Validity\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThree professionals specializing in psychiatric and mental health nursing, and internal medicine nursing, all proficient in both languages, translated the PRHS from English to Turkish. A panel of nine experts analyzed and confirmed the translation\u0026rsquo;s content validity. Four academicians from internal medicine nursing, three from psychiatric and mental health nursing, one nephrologist, and one sociologist were consulted for expert opinion.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAnalysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData were analyzed using SPSS (IBM Statistical Package for Social Science for Windows 26.0) software for descriptive statistics and Pearson correlation analysis. Cronbach\u0026apos;s alpha is used to assess the reliability or internal consistency of a set of scale or test items. A split-half analysis is conducted to assess the reliability of a test by dividing its items into two halves. The suitability of the dataset and sample size for analysis was determined by Kaiser Meyer Olkin (KMO) and Barlet\u0026rsquo;s sphericity test. A KMO value \u0026gt;0.60 and a significant Barlet\u0026rsquo;s sphericity test indicate the sample\u0026apos;s adequacy and the suitability of the data set for analysis. Paired sample t-test was also performed for test-retest results. Confirmatory Factor Analysis (CFA) was conducted using the R package lavaan to test the hypothesized three-factor model. The initial CFA model and subsequent modifications, targeting fit indices such as RMSEA, were performed in lava. In Confirmatory Factor Analyses, Chi-square/df, root mean square error of approximation (RMSEA), comparative fit index (CFI), Tucker Lewis index (TLI) standardized root mean square residual (SRMR), and root mean square residual (RMR) values were examined. A CMIN/DF value of 0.90, an SRMR value, and an RMR value of 0.90 indicate that the ft indices of the scale are acceptable.\u0026nbsp;A p-value of \u0026lt;0.05 was considered statistically significant.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical Considerations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;At the outset of the study, permission was obtained from Eun Young Kim, who created the Patient on Hemodialysis Resilience Scale to validate the psychometric properties of the Turkish version. Ethical approval was given by the Hamidiye Ethical Board Institutional Review Board University of Health Sciences. (number: E-46418926-050.01.04-47574, date: 12.07.2021). The participants also gave verbal and written informed consent to participate in the study. The ethical guidelines of the Declaration of Helsinki were used to conduct the study.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003eContent Validity Results\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn the study, the item-based content validity index was 0.93 and was evaluated between 0.71-1.00.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConstruct Validity\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eKMO and Barlett\u0026rsquo;s Sphericity Test were conducted to check the suitability of the sample size and the suitability of the dataset for analysis. The KMO value was found to be 0.884. Barlett\u0026rsquo;s Sphericity Test was found to be significant (\u0026chi;2=2066.524; p=0.000). As a result of the CFA analysis, the factor loadings ranged between 0.68 and 0.76, and the unidimensional structure was confirmed. All items show strong item-total correlations (\u0026gt; 0.85) (Table 1).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1. Items factor loading of\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eHemodialysis Resilience Scale\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;(n=187)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eReliability Analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe reliability analysis conducted for this study yielded a total item Cronbach\u0026apos;s alpha value of 0.91, indicating an excellent level of internal consistency among the items measured. \u0026nbsp;Furthermore, as detailed in Table 2, the factor-specific Cronbach\u0026apos;s alpha values ranged from 0.70 to 0.89 (Table 2).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2. Patient on Hemodialysis Resilience Scale Reliability Analysis (n=187)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe results of the additional reliability assessments further substantiate the consistency of the measurement tool utilized in this study. The Spearman-Brown correlation coefficient was calculated to be 0.84, indicating a strong positive correlation among the test items. This high value suggests that splitting the test into two halves would yield similar results, reinforcing the reliability of the instrument for the constructs being measured. Additionally, the Guttman Split Half correlation was found to be 0.83, which also indicates a high level of internal consistency across the tested items. This metric demonstrates that the items effectively represent a unified construct, as both the Spearman-Brown and Guttman correlations converge on similar reliability estimates. These findings, presented in Table 3, highlight the robustness of the measurement tool and confirm its applicability for future research. The strong correlations suggest that the instruments can be confidently used in both clinical and research settings, as they exhibit a high degree of reliability in assessing the constructs of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3.\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003ePatient on Hemodialysis Resilience Scale\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;Split Half Analyses (n=187)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConfirmatory Factor Analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAccording to the results of the CFA analyses, in the first model, \u0026chi;2/sd was 2.68, RMSEA was 0.09, RMR was 0.06, GFI was 0.83, AGFI was 0.77, TLI was 0.85, SRMR was 0.07, CFI was 0.87, NFI was 0.84, and IFI was 0.86. Refining the initial model parameters, such as reexamining factor relationships and error covariances, led to a model with an improved overall fit to the modification results. After modification, it was found that \u0026chi;2/sd was 2.01, RMSEA was 0.07, RMR was 0.06, GFI was 0.91, AGFI was 0.84, TLI was 0.91, SRMR was 0.06, CFI was 0.93, NFI was 0.91, and IFI was 0.93 (Table 4; Figure 1.).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4. Confirmatory Factor Analysis Results of\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003ePatient on Hemodialysis Resilience Scale\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;(n=187)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTest-Retest reliability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe correlation value observed as a result of the test-retest measurements applied to 24 patients 15 days apart to evaluate the scale\u0026rsquo;s consistency over time was found to be r=0.99. It was found that there was a statistically significant and very strong positive correlation between the test and re-test scores on PHRS (r: 0.99, p\u0026lt;0.001). There was also no statistically significant difference between the test-retest measurement results (p\u0026gt;0.05; Table 5).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 5. Test-Retest Results of\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003ePatient on Hemodialysis Resilience Scale\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;(n=24)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eParallel form reliability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFor parallel form reliability, the correlation between the Patient on the Hemodialysis Resilience Scale and the Brief Resilience Scale had a statistically positive weak correlation (r: 0.226 p \u0026lt;0.01; Table 6).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 6. Correlation between the Brief Resilience Scale and\u003c/strong\u003e \u003cstrong\u003ePatient on Hemodialysis Resilience Scale (n=187)\u003c/strong\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe study\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eaimed to validate the psychometric properties of the Turkish version of the Patient on Hemodialysis Resilience Scale. The analysis revealed that the results were significant and demonstrated a firm fit.\u003c/p\u003e\n\u003cp\u003eBartlett\u0026rsquo;s and the Keiser-Meyer-Olkin (KMO) tests are essential for determining the adequacy and appropriateness of data for factor analysis. The KMO values between 0.8 to 1.0 indicate the sampling is adequate (14). In the study KMO value was found to be above 0.70. Barlett\u0026rsquo;s Sphericity Test was found to be significant. A factor loading of \u0026gt;0.30 is a requirement for the scale to be acceptable (15). Between the range 0.8 to 1 indicated that strong relation (16). All factors\u0026rsquo; loadings are acceptable in the scale\u0026rsquo;s validity. All correlation coefficients in the present study were above 0.30, indicating good item-total consistency for all items(17,18).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe reliability analysis conducted for this study yielded a total item Cronbach\u0026apos;s alpha value of 0.91, indicating an excellent level of internal consistency among the items measured. This high alpha value suggests that the scale used is reliable for assessing the constructs in question, supporting the notion that the items are adequately capturing the underlying theoretical framework. Furthermore, as detailed in Table 2, the factor-specific Cronbach\u0026apos;s alpha values ranged from 0.70 to 0.89. These values indicate acceptable to high reliability for the individual factors identified in the analysis. Specifically, a Cronbach\u0026apos;s alpha of 0.70 is generally regarded as the minimum threshold for good reliability, while values above 0.80 are considered very good. The factor with the highest reliability score reflects a particularly strong correlation among its items, therefore affirming its robustness as a construct. These findings align with previous research in the field, which emphasizes the importance of utilizing reliable instruments for accurate measurement in psychological and social research. While the scale development study revealed higher internal consistency values among hemodialysis patients, this study, which focused on the adaptation to Turkish culture, also demonstrated internal consistency levels within an acceptable range\u0026nbsp;(4). The split-half reliability analysis showed that the Spearman\u0026ndash;Brown correlation (r = 0.84) and the Guttman split-half (r = 0.083) values were acceptable. In terms of scale adaptation and development, scales with reliability values of 0.70 or higher are considered adequately reliable (15).\u003c/p\u003e\n\u003cp\u003eAccording to the results of the CFA analyses, in the first analysis some results indicated unaccepted fit. Therefore, new modification refined the initial model parameters such as reexamining factor relationships and error covariances, which led to a model with improved overall fit the modification results. After modification; fit indices of the scale were calculated as; \u0026chi;2/sd: 2.01, RMSEA: 0.07, RMR:0.06, GFI: 0.91, AGFI: 0.84, TLI: 0.91, SRMR: 0.06, CFI: 0.93, NFI: 0.91 and IFI: 0.93. Model fit was evaluated using confirmatory factor analysis based on three indices: \u0026chi;2/df, CFI, and RMSEA. A \u0026chi;2/df value \u0026lt;2 (19)\u0026nbsp; or \u0026lt;3 (15) shows a good fit. Comparative fit index values \u0026ge; 0.90 and RMSEA values \u0026le; 0.06 reflect a good fit (15,19). As a result of CFA, acceptable levels of fit indices were defined as \u0026chi;2/df not exceeding 5, SRMR being lower than 0.08, and TLI being higher than 0.90 (20\u0026ndash;22). Standardized root-mean-square residual values of 0.05\u0026ndash;0.10 and CFI values of 0.090\u0026ndash;0.095 indicate an acceptable fit (18). While the scale development study \u0026chi;2/df value was found 1.809; RMSEA was found 0.08, CFI was found 0.908. In test-rest result with 24 patients had statically significant result and strong correlation. And the parallel form analysis indicated that weak correlation between the resilience scales. Within this framework, it was concluded that the fit indices of the scale were at satisfactory and outstanding levels. The 20-question, three-factor structure scale served as a reliable measurement tool for assessing the resilience levels of hemodialysis patients within the Turkish cultural context.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;One of the notable limitations of this study pertains to the characteristics of the research population. The sample was comprised exclusively of Turkish-speaking patients undergoing hemodialysis at designated centers. While this targeted approach facilitates a comprehensive examination of resilience within this specific cohort, it concurrently restricts the generalizability of the findings to other populations. The sociodemographic composition of the sample, encompassing factors such as age, gender, socioeconomic status, and educational background, may not adequately represent the broader hemodialysis patient population. For example, if the sample predominantly consisted of younger patients or individuals from a particular socioeconomic background, the results may not accurately reflect the resilience levels of older patients or those from diverse socioeconomic contexts. The other limitation of the study is that other researchers conducted a Turkish validity and reliability study of the scale during the publication process (23). While these researchers identified item distributions across different sub-dimensions, this study\u0026apos;s error covariance assignment demonstrated the final parallelism, ensuring that the original structure of the scale remained intact.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe Turkish version of the Patient on Hemodialysis Resilience Scale consists of 20 items and three sub-dimensions. The results indicate that the scale demonstrates validity and reliability within the Turkish sample. By validating the psychometric properties of the Turkish version of the scale in evaluating patients\u0026rsquo; resilience, appropriate support can be given to patients in need by raising awareness. A reliable and valid scale allows healthcare professionals to accurately assess the resilience levels of Turkish hemodialysis patients. Understanding individual resilience can guide tailored interventions. By assessing resilience, healthcare professionals can identify patients who may be struggling emotionally or psychologically, allowing for timely support and resources. With insights into patients' resilience, health professionals can implement targeted psychological and social interventions that are aimed at improving mental health and overall well-being. By focusing on resilience, health professionals can help patients develop coping strategies and foster a sense of empowerment in managing their illness, which can lead to improved quality of life. Using a scale to assess resilience can enhance communication between patients and healthcare providers, fostering a more supportive therapeutic relationship. The validated scale can serve as a tool for future research, facilitating studies aimed at understanding resilience in diverse populations and contexts within clinical settings. It can assist healthcare facilities in monitoring the effectiveness of interventions aimed at enhancing psychological resilience among patients.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003e\u003cem\u003eDeclaration of conflicting interests\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declared that there is no conflict of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eFundings\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors received no financial support for the research, authorship, and/or publication of this article.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eEthic\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical approval was given by the Institutional Review Board University of Health Sciences (Hamidiye Ethical Board) (number: E-46418926-050.01.04-47574, date: 12.07.2021)\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eO.S, E.B, G.D. Designed the study.O.S. wrote the main manuscript text, prepared figure and tables, and analysed the data. E.B. collected the data. O.S, E.B, G.D. All authors reviewed the manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eGill W, Kate M B, Jane N. A Methodology Review of Resilience Measurement Scales. Health Qual Life Outcomes. 2011;9(1):2\u0026ndash;18. \u003c/li\u003e\n\u003cli\u003eVitorino LM, Lucchetti G, Le\u0026atilde;o FC, Vallada H, Peres MFP. The association between spirituality and religiousness and mental health. Sci Rep. 2018;8(1):1\u0026ndash;9. \u003c/li\u003e\n\u003cli\u003eKukihara H, Yamawaki N, Ando M, Nishio M, Kimura H, Tamura Y. The mediating effect of resilience between family functioning and mental well-being in hemodialysis patients in Japan: A cross-sectional design. Health Qual Life Outcomes. 2020;18(1):1\u0026ndash;8. \u003c/li\u003e\n\u003cli\u003eKim E, Lee Y, Chang S. Measuring the Resilience of Patients on Hemodialysis: Development of a Patient on Hemodialysis Resilience Scale. Nephrol Nurs J. 2020 May 1;47:229\u0026ndash;37. \u003c/li\u003e\n\u003cli\u003eQiu Y, Huang Y, Wang Y, Ren L, Jiang H, Zhang L, et al. The Role of Socioeconomic Status, Family Resilience, and Social Support in Predicting Psychological Resilience Among Chinese Maintenance Hemodialysis Patients. Front Psychiatry. 2021;12(September):1\u0026ndash;8. \u003c/li\u003e\n\u003cli\u003eLerma A, Ord\u0026oacute;nez G, Mendoza L, Salazar-Robles E, Rivero J, P\u0026eacute;rez-Granados E, et al. Psychometric properties of the resilience scale in Mexican patients with chronic hemodialysis. Salud Mental. 2019;42(3):121\u0026ndash;9. \u003c/li\u003e\n\u003cli\u003eLiu YM, Chang HJ, Wang RH, Yang LK, Lu KC, Hou YC. Role of resilience and social support in alleviating depression in patients receiving maintenance hemodialysis. Ther Clin Risk Manag. 2018;14:441\u0026ndash;51. \u003c/li\u003e\n\u003cli\u003eWang Y, Qiu Y, Ren L, Jiang H, Chen M, Dong C. Social support, family resilience and psychological resilience among maintenance hemodialysis patients: a longitudinal study. BMC Psychiatry. 2024;24(1):1\u0026ndash;12. \u003c/li\u003e\n\u003cli\u003eJenaabadi H, Mir F. Role of Trust in God and Resilience in Hope for Life of Hemodialysis Patients. Health, Spirituality and Medical Ethics [Internet]. 2019 Mar 1;6(1):33\u0026ndash;8. Available from: http://jhsme.muq.ac.ir/article-1-254-en.html\u003c/li\u003e\n\u003cli\u003eGhorbani Hanouj A, Khandan M, Jahani Y. The effectiveness of training based on Bandura\u0026rsquo;s self-efficacy theory on hemodialysis patients\u0026rsquo; resilience during the COVID-19 outbreak: A quasi-experimental study. Journal of Multidisciplinary Care [Internet]. 2023;12(1):18\u0026ndash;23. Available from: https://doi.org/10.34172/jmdc.1162\u003c/li\u003e\n\u003cli\u003eShokrpour N, Sheidaie S, Amirkhani M, Bazrafkan L, Modreki A. Effect of positive thinking training on stress, anxiety, depression, and quality of life among hemodialysis patients: A randomized controlled clinical trial. J Educ Health Promot. 2021;10(1):1\u0026ndash;9. \u003c/li\u003e\n\u003cli\u003eSmith BW, Dalen J, Wiggins K, Tooley E, Christopher P, Bernard J. The brief resilience scale: Assessing the ability to bounce back. Int J Behav Med. 2008;15(3):194\u0026ndash;200. \u003c/li\u003e\n\u003cli\u003eDoğan T. Kısa Psikolojik Sağlamlık \u0026Ouml;l\u0026ccedil;eği\u0026rsquo;nin T\u0026uuml;rk\u0026ccedil;e uyarlaması: Ge\u0026ccedil;erlik ve g\u0026uuml;venirlik \u0026ccedil;alışması Adaptation of the Brief Resilience Scale into Turkish: A validity and reliability study. The Journal of Happiness \u0026amp; Well-Being. 2015;3(1):93\u0026ndash;102. \u003c/li\u003e\n\u003cli\u003eShrestha N. Factor Analysis as a Tool for Survey Analysis. Am J Appl Math Stat. 2021;9(1):4\u0026ndash;11. \u003c/li\u003e\n\u003cli\u003eSe\u0026ccedil;er İ. Practical Data Analysis, Analysis and Reporting with SPSS and LISREL. Anı Yayıncılık; 2015. \u003c/li\u003e\n\u003cli\u003eAkoglu H. User\u0026rsquo;s guide to correlation coefficients. Turk J Emerg Med. 2018;18(3):91\u0026ndash;3. \u003c/li\u003e\n\u003cli\u003eOsborne JW, Costello AB, Kellow JT. Best Practices in Exploratory Factor Analysis. Best Practices in Quantitative Methods. 2011. 86\u0026ndash;99 p. \u003c/li\u003e\n\u003cli\u003eRatner B. The correlation coefficient: Its values range between 1/1, or do they. Journal of Targeting, Measurement and Analysis for Marketing. 2009;17(2):139\u0026ndash;42. \u003c/li\u003e\n\u003cli\u003eŞimşek \u0026Ouml;. Yapısal Eşitlik Modellemesine Giriş: Temel Ilkeler ve LISREL Uygulamaları [Internet]. Ekinoks Eğitim Danışmanlık Hizmet ve Basın Yayın; 2020. Available from: https://books.google.com.tr/books?id=TD7YDwAAQBAJ\u003c/li\u003e\n\u003cli\u003eErkorkmaz \u0026Uuml;, EtIkan I, DemIr O, \u0026Ouml;zdamar K, SanIsoǧlu SY. Confirmatory factor analysis and fit indices: Review. Turkiye Klinikleri Journal of Medical Sciences. 2013;33(1):210\u0026ndash;23. \u003c/li\u003e\n\u003cli\u003eAksu G, Eser MT, Oktay GC. Exploratory and confirmatory factor analysis and structural equation model applications. Detay Yayıncılık; 2017. \u003c/li\u003e\n\u003cli\u003eBae BR. Structural equation modeling with Amos 24. Chenngram Books; 2017. 76\u0026ndash;309 p. \u003c/li\u003e\n\u003cli\u003eEler \u0026Ccedil;\u0026Ouml;, Kav S. Validity and Reliability of the Turkish Version of the Patient on Hemodialysis Resilience Scale. Therapeutic Apheresis and Dialysis. 2024;28(5):745\u0026ndash;53. \u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 100%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTable 1. Items factor loading of\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eHemodialysis Resilience Scale\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;(n=187)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.2781%;\"\u003e\n \u003cp\u003eFactors\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.7219%;\"\u003e\n \u003cp\u003eItem\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003eStandardized Loading\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003eItem Total Correlation\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.2781%;\"\u003e\n \u003cp\u003eFactor 1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.7219%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e0.72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e0.89\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.2781%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.7219%;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e0.75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e0.89\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.2781%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.7219%;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e0.70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e0.90\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.2781%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.7219%;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e0.73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e0.90\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.2781%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.7219%;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e0.68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e0.88\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.2781%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.7219%;\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e0.74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e0.89\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.2781%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.7219%;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e0.76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e0.89\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.2781%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.7219%;\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e0.71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e0.89\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.2781%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.7219%;\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e0.69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e0.90\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.2781%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.7219%;\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e0.72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e0.89\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.2781%;\"\u003e\n \u003cp\u003eFactor 2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.7219%;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e0.70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e0.88\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.2781%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.7219%;\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e0.73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e0.91\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.2781%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.7219%;\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e0.71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e0.90\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.2781%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.7219%;\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e0.69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e0.89\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.2781%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.7219%;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e0.74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e0.88\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.2781%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.7219%;\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e0.70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e0.89\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.2781%;\"\u003e\n \u003cp\u003eFactor 3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.7219%;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e0.68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e0.85\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.2781%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.7219%;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e0.72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e0.88\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.2781%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.7219%;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e0.70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e0.87\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.2781%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.7219%;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e0.71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e0.88\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eAll standardized loadings were statistically significant at conventional levels (e.g., p \u0026lt; .001).\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" align=\"left\" width=\"586\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" style=\"width: 586px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTable 2. Patient on Hemodialysis Resilience Scale Reliability Analysis (n=187)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 302px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eScale\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOriginal study\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eIn this study\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 302px;\"\u003e\n \u003cp\u003eTotal items\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e0.936\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e0.913\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 302px;\"\u003e\n \u003cp\u003eThe pursuit of positive meaning in the present\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e0.926\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e0.892\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 302px;\"\u003e\n \u003cp\u003eAcceptance of hemodialysis as a part of daily life\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e0.882\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e0.706\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 302px;\"\u003e\n \u003cp\u003eBuilding the will to live through close human relationships\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u0026nbsp;0.834\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e0.762\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"586\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" style=\"width: 586px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTable 3.\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003ePatient on Hemodialysis Resilience Scale\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;Split Half Analyses (n=187)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cbr\u003e\u0026nbsp;Internal Consistency\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003eScale Half 1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003er\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 220px;\"\u003e\n \u003cp\u003e0.88\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003eScale Half 2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003er\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 220px;\"\u003e\n \u003cp\u003e0.82\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 233px;\"\u003e\n \u003cp\u003eTotal Item\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 220px;\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 365px;\"\u003e\n \u003cp\u003eCorrelation Value Between Scales\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 220px;\"\u003e\n \u003cp\u003e0.72\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 365px;\"\u003e\n \u003cp\u003eSpearman-Brown (r)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 220px;\"\u003e\n \u003cp\u003e0.84\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 365px;\"\u003e\n \u003cp\u003eGuttman Split-Half \u0026nbsp;(r)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 220px;\"\u003e\n \u003cp\u003e0.83\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" align=\"\" width=\"627\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" style=\"width: 627px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTable 4. Confirmatory Factor Analysis Results of\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003ePatient on Hemodialysis Resilience Scale\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;(n=187)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFit Indicates\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 200px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eThreshold\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 163px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBefore Modification\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAfter Modification\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026chi;2/d\u003c/strong\u003e\u003cstrong\u003ef\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 200px;\"\u003e\n \u003cp\u003e\u0026chi;2/df \u0026le;3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 163px;\"\u003e\n \u003cp\u003e2.68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e2.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRMSEA\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 200px;\"\u003e\n \u003cp\u003e0\u0026le;RMSEA\u0026le;0.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 163px;\"\u003e\n \u003cp\u003e0.09\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e0.07\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRMR\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 200px;\"\u003e\n \u003cp\u003e\u0026le;0.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 163px;\"\u003e\n \u003cp\u003e0.06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e0.06\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGFI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 200px;\"\u003e\n \u003cp\u003e0.90\u0026le;GFI \u0026le;1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 163px;\"\u003e\n \u003cp\u003e0.83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e0.91\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAGFI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 200px;\"\u003e\n \u003cp\u003e0.80\u0026le;AGFI\u0026le;1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 163px;\"\u003e\n \u003cp\u003e0.77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e0.84\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTLI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 200px;\"\u003e\n \u003cp\u003e\u0026gt;0.90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 163px;\"\u003e\n \u003cp\u003e0.85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e0.91\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSRMR\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 200px;\"\u003e\n \u003cp\u003e\u0026lt;0.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 163px;\"\u003e\n \u003cp\u003e0.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e0.06\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCFI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 200px;\"\u003e\n \u003cp\u003e0.90\u0026le;CFI\u0026le;1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 163px;\"\u003e\n \u003cp\u003e0.87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e0.93\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNFI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 200px;\"\u003e\n \u003cp\u003e0.80\u0026le;NFI\u0026le;0.89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 163px;\"\u003e\n \u003cp\u003e0.84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e0.91\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eIFI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 200px;\"\u003e\n \u003cp\u003eIFI \u0026gt;0.90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 163px;\"\u003e\n \u003cp\u003e0.86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e0.93\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026chi;2: Chi-Square Test Statistic; \u003cem\u003edf\u003c/em\u003e : Degrees of Freedom; RMSEA: Root Mean Square Error of Approximation; RMR: Root Mean Square Residual; GFI: Goodness of Fit Index; AGFI: Adjusted Goodness of Fit Index; TLI: Tucker-Lewis Index; SRMR: Standardized Root Mean Square Residual; CFI: Comparative Fit Index; NFI: \u0026nbsp;Normal Fit Index; IFI: Incremental Fit Index\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" align=\"\" width=\"627\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"7\" style=\"width: 627px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTable 5. Test-Retest Results of\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003ePatient on Hemodialysis Resilience Scale\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;(n=24)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eScale\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 200px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eScale scores means\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" style=\"width: 313px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eStatistic results\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 100px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFirst-test\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eX(sd)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 100px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRetest\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eX(sd)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e\u003cstrong\u003et\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003er\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePHRS Total\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 100px;\"\u003e\n \u003cp\u003e79.37(17.73)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 100px;\"\u003e\n \u003cp\u003e79.79(16.54)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e-0.934\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e0.360\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e0.995\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e0000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eSd: Standart Deviation, t: Paired sample t test, r: Pearson correlation coefficient; p\u0026lt;0.001, PHRS: Patient on Hemodialysis Resilience Scale\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"616\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 616px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTable 6. Correlation between the Brief Resilience Scale and\u003c/strong\u003e \u003cstrong\u003ePatient on Hemodialysis Resilience Scale (n=187)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 205px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 205px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePHRS Total Score\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 205px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBRS Score\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 205px;\"\u003e\n \u003cp\u003ePHRS Total Score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 205px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 205px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 205px;\"\u003e\n \u003cp\u003eBRS Total Score (r)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 205px;\"\u003e\n \u003cp\u003e0.226\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 205px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003ePHRS: Patient on Hemodialysis Resilience Scale; BRS: Brief Resilience Scale, r: Pearson Correlation, p\u0026lt;0.01\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Reliability, validity, resilience, hemodialysis","lastPublishedDoi":"10.21203/rs.3.rs-7199611/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7199611/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eBy assessing resilience, healthcare professionals can identify patients who may be struggling emotionally or psychologically, allowing for timely support and resources, and it may also foster a more supportive therapeutic relationship. With insights into patients' resilience, health professionals can implement targeted psychological and social interventions that are aimed at improving mental health and overall well-being. By focusing on resilience, healthcare professionals can help patients develop coping strategies and foster a sense of empowerment in managing their illness, which can lead to improved quality of life. The study aimed to validate the psychometric properties of the Turkish version of the Patient on Hemodialysis Resilience Scale.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethod\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis methodological design study was conducted in hemodialysis with 187 patients in a unit between September 2022 and April 2023. The data was collected with information from the Patient on Hemodialysis Resilience Scale and Brief Resilience Scale— Confirmatory Factor Analysis performed to evaluate the data.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe 3-factor, 20-question scale demonstrated a good fit in adapting to Turkish culture, with significant test-retest results obtained from 24 patients. The factor loadings ranged between 0.68 and 0.76, and the unidimensional structure was confirmed. All items show strong item-total correlations (\u0026gt; 0.85). Cronbach range of the scale was between 0.70-0.89.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis scale served as a reliable measurement tool for assessing the resilience levels of hemodialysis patients within the Turkish cultural context.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e","manuscriptTitle":"The Reliability and Validity of the Turkish Version of Patient on Hemodialysis Resilience Scale","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-08-27 05:52:16","doi":"10.21203/rs.3.rs-7199611/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"6b231b2f-d28f-41fe-802b-be4def52c52a","owner":[],"postedDate":"August 27th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-02-16T17:24:58+00:00","versionOfRecord":[],"versionCreatedAt":"2025-08-27 05:52:16","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7199611","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7199611","identity":"rs-7199611","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}