Psychometric Properties of End Stage Renal Disease-adherence Questionnaire-indonesian Version Among Patients Receiving Haemodialysis

Objectives: This study aimed to validate the Indonesian version of the End-Stage Renal Disease Adherence Questionnaire (ESRD-AQ) to assess treatment adherence among hemodialysis patients, ensuring its reliability and cultural relevance. Methods: A cross-sectional validation was conducted with 300 adult hemodialysis patients in West Java. Exploratory factor analysis (EFA) identified the scale's structure, followed by confirmatory factor analysis (CFA) for model fit. Construct validity was examined using the Morisky Medication Adherence Scale-8 (MMAS-8) and selected domains of the Kidney Disease Quality of Life Short Form (KDQOL-SF). Internal consistency was evaluated using Cronbach’s alpha, and test-retest reliability over a two-week interval was assessed via intraclass correlation coefficients (ICCs). Results: EFA revealed a five-factor model: Hemodialysis Session Adherence, Medication Adherence, Fluid Restriction, Dietary Adherence, and Understanding & Perception, explaining 67.4% of the variance. CFA indicated a good model fit (χ²/df = 2.54; CFI = 0.93; TLI = 0.91; RMSEA = 0.05). The questionnaire showed strong convergent validity with MMAS-8 scores (r = 0.57–1.00, p < 0.001) and satisfactory discriminant validity with unrelated KDQOL-SF subscales. Internal consistency was high (Cronbach’s α = 0.78–0.89), and test-retest reliability was good to excellent (ICC = 0.79–0.88). Conclusions: The Indonesian ESRD-AQ is a valid and reliable tool for assessing treatment adherence in Indonesian hemodialysis patients. Its use can enhance clinical monitoring and guide culturally sensitive interventions to improve adherence.