{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,16]],"date-time":"2025-10-16T18:12:25Z","timestamp":1760638345798,"version":"build-2065373602"},"reference-count":42,"publisher":"Public Library of Science (PLoS)","issue":"10","license":[{"start":{"date-parts":[[2025,10,16]],"date-time":"2025-10-16T00:00:00Z","timestamp":1760572800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>Patients undergoing maintenance hemodialysis (MHD) in Arabic-speaking regions, particularly in Palestine, face unique sociopolitical and cultural barriers affecting their care and quality of life. Existing assessment tools rarely address the multi-level determinants of support within these populations, highlighting the need for a culturally validated instrument based on the Social-Ecological Model (SEM).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Objective<\/jats:title>\n<jats:p>To develop and validate an Arabic-language questionnaire grounded in the SEM to assess the multi-level (community, interpersonal, organizational, and policy) support factors influencing MHD patients in the Gaza Strip.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Methods<\/jats:title>\n<jats:p>A cross-sectional study was conducted from November 2024 to February 2025 at three governmental dialysis centers in Gaza, enrolling 101 Arabic-speaking adult MHD patients through systematic random sampling. The validation process encompassed item analysis, content and face validity, and psychometric testing, including exploratory factor analysis (EFA), assessment of convergent and discriminant validity which includes average variance extracted, factor loadings, composite reliability, Cronbach\u2019s alpha, Fornell-Larcker criterion, cross-loadings, and Heterotrait-Monotrait ratio.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Results<\/jats:title>\n<jats:p>The EFA identified a four-factor structure corresponding to Community, Interpersonal, Organizational, and Policy Support, explaining 65.15% of the variance. The final validated questionnaire comprised 31 items, with the Community Support domain demonstrating the strongest psychometric properties (factor loadings: 0.821\u20130.923; Cronbach\u2019s alpha\u2009=\u20090.972; AVE\u2009=\u20090.796). While Interpersonal and Organizational domains showed acceptable reliability and validity, the Policy Support domain displayed marginal construct validity. Overall, the instrument had strong content, face, convergent, and discriminant validity.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec005\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>The Arabic SEM-based questionnaire is a reliable and valid tool for assessing multi-level support factors among MHD patients in Arabic-speaking contexts. It enables comprehensive evaluation for research and clinical practice. Future research should confirm its structure using confirmatory factor analysis, extend validation to diverse Arab populations, and examine temporal stability.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0333740","type":"journal-article","created":{"date-parts":[[2025,10,16]],"date-time":"2025-10-16T17:29:02Z","timestamp":1760635742000},"page":"e0333740","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Development and validation of the arabic version of the social-ecological model questionnaire for patients undergoing maintenance hemodialysis"],"prefix":"10.1371","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0756-9833","authenticated-orcid":true,"given":"Ayman S.","family":"Abutair","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0706-2920","authenticated-orcid":true,"given":"Md 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Liyanage","year":"2015","journal-title":"Lancet"},{"issue":"2","key":"pone.0333740.ref003","first-page":"1","article-title":"Psychological impact of chronic kidney disease and hemodialysis: narrative review","volume":"4","author":"A Alkhaqani","year":"2022","journal-title":"Psychosom Med Res"},{"issue":"6","key":"pone.0333740.ref004","doi-asserted-by":"crossref","first-page":"1584","DOI":"10.3390\/jcm11061584","article-title":"Quality of Life in Patients with End-Stage Renal Disease Undergoing Hemodialysis","volume":"11","author":"E Dembowska","year":"2022","journal-title":"J Clin Med"},{"issue":"1","key":"pone.0333740.ref005","doi-asserted-by":"crossref","first-page":"326","DOI":"10.1186\/s12882-024-03768-8","article-title":"Predictive role of spiritual health, resilience, and mental well-being in treatment adherence among hemodialysis patients","volume":"25","author":"F Saedi","year":"2024","journal-title":"BMC Nephrol"},{"issue":"11","key":"pone.0333740.ref006","doi-asserted-by":"crossref","first-page":"1405","DOI":"10.2215\/CJN.0000000000000529","article-title":"Experiences of Social Isolation and Loneliness in Chronic Kidney Disease: A Secondary Qualitative Analysis","volume":"19","author":"A Sluiter","year":"2024","journal-title":"Clin J Am Soc Nephrol"},{"issue":"4","key":"pone.0333740.ref007","doi-asserted-by":"crossref","first-page":"351","DOI":"10.1177\/109019818801500401","article-title":"An ecological perspective on health promotion programs","volume":"15","author":"KR McLeroy","year":"1988","journal-title":"Health Educ Q"},{"issue":"29","key":"pone.0333740.ref008","first-page":"1","article-title":"Foundations of health promotion and the socio-ecological model","volume":"48","author":"JC Gan","year":"2024","journal-title":"Health Promotion Moving Forward: A Population Health Approach"},{"key":"pone.0333740.ref009","doi-asserted-by":"crossref","first-page":"884678","DOI":"10.3389\/fpubh.2022.884678","article-title":"A Socio-Ecological Framework for Cancer Prevention in Low and Middle-Income Countries","volume":"10","author":"T Akinyemiju","year":"2022","journal-title":"Front Public Health"},{"issue":"3","key":"pone.0333740.ref010","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0214142","article-title":"Developing a socio-ecological model of dietary behaviour for people living with diabetes or high blood glucose levels in urban Nepal: A qualitative investigation","volume":"14","author":"L Caperon","year":"2019","journal-title":"PLoS One"},{"key":"pone.0333740.ref011","doi-asserted-by":"crossref","DOI":"10.1177\/1090198115575098","article-title":"Upending the social ecological model to guide health promotion efforts toward policy and environmental change","volume":"42","author":"SD Golden","year":"2015","journal-title":"Health Educ Behav"},{"issue":"7","key":"pone.0333740.ref012","doi-asserted-by":"crossref","first-page":"1636","DOI":"10.1080\/21645515.2018.1477458","article-title":"The use of technology to promote vaccination: A social ecological model based framework","volume":"14","author":"CA Kolff","year":"2018","journal-title":"Hum Vaccin Immunother"},{"issue":"4","key":"pone.0333740.ref013","doi-asserted-by":"crossref","first-page":"964","DOI":"10.1002\/jcop.22166","article-title":"Muslims and mental health concerns: A social ecological model perspective","volume":"47","author":"A Tanhan","year":"2019","journal-title":"J Community Psychol"},{"issue":"1","key":"pone.0333740.ref014","doi-asserted-by":"crossref","first-page":"1093","DOI":"10.1186\/s12889-019-7416-7","article-title":"Influence of urban green open space on residents\u2019 physical activity in China","volume":"19","author":"H Wang","year":"2019","journal-title":"BMC Public Health"},{"issue":"3","key":"pone.0333740.ref015","doi-asserted-by":"crossref","first-page":"239","DOI":"10.1177\/1043659620919162","article-title":"Socioecological Factors Affecting Fluid Restriction Adherence Among Korean Patients Receiving Hemodialysis: A Qualitative Study","volume":"32","author":"EJ Lee","year":"2021","journal-title":"J Transcult Nurs"},{"issue":"2","key":"pone.0333740.ref016","doi-asserted-by":"crossref","first-page":"286","DOI":"10.1177\/1742395320959411","article-title":"Factors influencing decision making for kidney transplantation among Black and Latino patients on dialysis: A qualitative study applying the social ecological model","volume":"18","author":"D Wong","year":"2022","journal-title":"Chronic Illn"},{"key":"pone.0333740.ref017","unstructured":"Cornacchione VJ. Gaza\u2019s Healthcare System in Collapse: An Exploratory Analysis of Healthcare Attacks in Occupied Palestinian Territories (OPTs) and Israel since October 2023. 2024."},{"issue":"10","key":"pone.0333740.ref018","doi-asserted-by":"crossref","first-page":"1107","DOI":"10.1016\/j.jclinepi.2012.04.007","article-title":"The eight-item modified Medical Outcomes Study Social Support Survey: psychometric evaluation showed excellent performance","volume":"65","author":"A Moser","year":"2012","journal-title":"J Clin Epidemiol"},{"issue":"6","key":"pone.0333740.ref019","doi-asserted-by":"crossref","first-page":"705","DOI":"10.1016\/0277-9536(91)90150-B","article-title":"The MOS social support survey","volume":"32","author":"CD Sherbourne","year":"1991","journal-title":"Soc Sci Med"},{"key":"pone.0333740.ref020","article-title":"Duke Social Support Index","author":"R Landerman","year":"1989","journal-title":"PsycTESTS Dataset. American Psychological Association (APA)"},{"key":"pone.0333740.ref021","first-page":"53","article-title":"Instrument of self-perception and knowledge of dental erosion: cross-cultural adaptation to the Brazilian population","volume":"29","author":"da Silva SB","year":"2015","journal-title":"Braz Oral Res"},{"key":"pone.0333740.ref022","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1111\/jocn.13775","article-title":"The role of the family in supporting the self-management of chronic conditions: A qualitative systematic review","volume":"27","author":"L Whitehead","year":"2018","journal-title":"J Clin Nurs"},{"key":"pone.0333740.ref023","volume-title":"Health behavior: Theory, research, and practice","author":"K Glanz","year":"2015"},{"issue":"5","key":"pone.0333740.ref024","doi-asserted-by":"crossref","first-page":"412","DOI":"10.4103\/ijmr.ijmr_3570_21","article-title":"Development, validation & pilot testing of a questionnaire to assess healthcare seeking behaviour, healthcare service utilization & out-of-pocket expenditure of Particularly Vulnerable Tribal Groups of Odisha, India","volume":"157","author":"J Ghosal","year":"2023","journal-title":"Indian J Med Res"},{"key":"pone.0333740.ref025","author":"H Tang","year":"2020","journal-title":"Translation and Cross-Cultural Adaptation of the Questionnaire of Sleep Health for Using in Chinese Older. Springer Science and Business Media LLC"},{"key":"pone.0333740.ref026","author":"Y Zhang","year":"2023","journal-title":"Develop and test the reliability and validity of the postoperative visual function rehabilitation compliance assessment scale for children with congenital cataract. Research Square Platform LLC"},{"issue":"2","key":"pone.0333740.ref027","article-title":"Development and Validity Testing of an Assessment Tool for Oncofertility Barriers in Multidisciplinary Healthcare Providers on the Breast Cancer Team","volume":"30","author":"S-M Huang","year":"2022","journal-title":"J Nurs Res"},{"key":"pone.0333740.ref028","article-title":"Psychometric Properties of an Instrument to Determine the Factors Affecting Treatment Adherence Among Patients Receiving Hemodialysis in Sri Lanka","volume":"10","author":"C Lasanthika","year":"2023","journal-title":"J Patient Exp"},{"issue":"1","key":"pone.0333740.ref029","doi-asserted-by":"crossref","first-page":"540","DOI":"10.1186\/s12891-017-1914-5","article-title":"Development and validation of a new tool to measure the facilitators, barriers and preferences to exercise in people with osteoporosis","volume":"18","author":"IB Rodrigues","year":"2017","journal-title":"BMC Musculoskelet Disord"},{"key":"pone.0333740.ref030","author":"A Kachouchi","year":"2023","journal-title":"Cross-cultural adaptation and validation of the Moroccan Arabic version of the The Schizophrenia Quality of Life short-version questionnaire (SQoL-18). Research Square Platform LLC"},{"issue":"7","key":"pone.0333740.ref031","doi-asserted-by":"crossref","first-page":"1893","DOI":"10.1007\/s11136-018-1847-y","article-title":"The importance of content and face validity in instrument development: lessons learnt from service users when developing the Recovering Quality of Life measure (ReQoL)","volume":"27","author":"J Connell","year":"2018","journal-title":"Qual Life Res"},{"key":"pone.0333740.ref032","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1186\/s12879-015-1332-y","article-title":"Physicians\u2019 attitudes and knowledge concerning antibiotic prescription and resistance: questionnaire development and reliability","volume":"16","author":"A Teixeira Rodrigues","year":"2016","journal-title":"BMC Infect Dis"},{"issue":"8","key":"pone.0333740.ref033","doi-asserted-by":"crossref","first-page":"4170","DOI":"10.3390\/ijerph18084170","article-title":"Development of the Mobile Technology Vulnerability Scale among Youth and Young Adults Living with HIV","volume":"18","author":"NE Lisha","year":"2021","journal-title":"Int J Environ Res Public Health"},{"issue":"6","key":"pone.0333740.ref034","first-page":"382","article-title":"Determination and quantification of content validity","volume":"35","author":"MR Lynn","year":"1986","journal-title":"Nurs Res"},{"issue":"5","key":"pone.0333740.ref035","doi-asserted-by":"crossref","first-page":"489","DOI":"10.1002\/nur.20147","article-title":"The content validity index: are you sure you know what\u2019s being reported? Critique and recommendations","volume":"29","author":"DF Polit","year":"2006","journal-title":"Res Nurs Health"},{"key":"pone.0333740.ref036","doi-asserted-by":"crossref","first-page":"113193","DOI":"10.1016\/j.socscimed.2020.113193","article-title":"Perceived social support and health-related quality of life in older adults who have multiple chronic conditions and their caregivers: a dyadic analysis","volume":"262","author":"M De Maria","year":"2020","journal-title":"Soc Sci Med"},{"key":"pone.0333740.ref037","doi-asserted-by":"crossref","unstructured":"Jabeen S, Zakar R, Fischer F. Development and validation of the socio-ecological scale for identifying delays in treatment for breast cancer patients. 2023.","DOI":"10.21203\/rs.3.rs-3258954\/v1"},{"key":"pone.0333740.ref038","article-title":"Achieving equity in dialysis care and outcomes: the role of policies","author":"DC Crews","year":"2020","journal-title":"Seminars in Dialysis"},{"key":"pone.0333740.ref039","doi-asserted-by":"crossref","first-page":"1432648","DOI":"10.3389\/fcvm.2025.1432648","article-title":"The association of illness perception and related factors with treatment adherence among chronic hemodialysis patients with cardio-renal syndrome in Yemen","volume":"12","author":"AO Laradhi","year":"2025","journal-title":"Front Cardiovasc Med"},{"key":"pone.0333740.ref040","unstructured":"Bakhit F. The integral role of home health care in Arab and Muslim communities. 2024. Available from: https:\/\/americancommunitymedia.org\/health-care\/the-integral-role-of-home-health-care-in-arab-and-muslim-communities\/"},{"key":"pone.0333740.ref041","first-page":"43","article-title":"Ecological models of health behavior","volume-title":"Health behavior: Theory, research, and practice","author":"JF Sallis","year":"2015"},{"issue":"4","key":"pone.0333740.ref042","doi-asserted-by":"crossref","first-page":"336","DOI":"10.1111\/j.1547-5069.2005.00058.x","article-title":"Conceptual model of health-related quality of life","volume":"37","author":"CE Ferrans","year":"2005","journal-title":"J Nurs Scholarsh"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0333740","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,16]],"date-time":"2025-10-16T17:29:12Z","timestamp":1760635752000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0333740"}},"subtitle":[],"editor":[{"given":"I Gede","family":"Juanamasta","sequence":"first","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2025,10,16]]},"references-count":42,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2025,10,16]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0333740","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,16]]}}}