ArticleNursing open2026
Development and Validation of CKD-MKAP: A Malnutrition Perceived Knowledge, Attitude, and Practice (KAP) Scale for Patients With Chronic Kidney Diseases (CKD) in China.
Article in Nursing open, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
aimThis study aimed to develop and validate a culturally tailored scale (CKD-MKAP) for assessing malnutrition-related perceived knowledge, attitude and practice (KAP) among patients with chronic kidney disease (CKD) in China.
methodsThe initial item pool was developed through a comprehensive literature review, semi-structured interviews and the Delphi method. Content validity was evaluated by an experts panel. Construct validity was initially explored using exploratory factor analysis (EFA) and subsequently verified via confirmatory factor analysis (CFA).
resultsDuring the development phase, a 27-item scale was established following content validity assessment and a pilot study. Subsequent item analysis of the 'Perceived Knowledge (K)' domain led to the deletion of item K1. EFA (n = 152) for the 'Attitude (A)' and 'Practice (P)' domains yielded factor loadings exceeding 0.50, explaining 69.87% and 61.84% of the total variance, respectively. CFA (n = 151) demonstrated that the final 6-item model for the 'K' domain exhibited a good model fit: RMSEA (90% CI) = 0.070 (0.000-0.124), CFI = 0.978, TLI = 0.963 and SRMR = 0.061. Similarly, the 9-item 'A' domain and the 10-item 'P' domain exhibited excellent fit indices. The three domains demonstrated satisfactory to excellent internal consistency, with Cronbach's alpha coefficients of 0.740 for Perceived Knowledge, 0.970 for Attitude and 0.958 for Practice.
conclusionThe CKD-MKAP is a valid and reliable instrument that can be effectively utilized by clinical nurses to evaluate the malnutrition-related KAP among CKD patients in mainland China. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: The CKD-MKAP scale offers healthcare professionals a valid, culturally tailored and time-efficient tool to assess malnutrition-related cognition and behaviours in CKD patients. Identifying specific deficits in perceived knowledge, attitudes or practices allows for personalized nutritional interventions, optimizing patient care and self-management. IMPACT: This study addresses a critical gap in CKD management in China by introducing a multidimensional nutritional KAP assessment tool. The application of this scale can facilitate the early identification of malnutrition risks, improve the precision of patient education and ultimately contribute to slowing CKD progression and reducing the disease burden associated with malnutrition. REPORTING
methodThe methodology and findings of this multiphase quantitative study are reported in accordance with standard psychometric validation procedures. PATIENT OR PUBLIC CONTRIBUTION: Patients' lived experiences, shared during qualitative interviews, were used to generate the initial item pool and ensure the scale reflected patient perspectives and cultural nuances.
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