An e-Learning Program for Nurses on Evidence-Based Prevention of CKD

Development of Adaptive Intervention for Early Detection and Management of Chronic Kidney Disease in Syria

Electronic training course to help Syrian nurses prevent chronic kidney disease Why are the investigators doing this study? Chronic kidney disease (CKD) is common in Syria, yet many nurses have not received up-to-date training on early detection or patient education for risk reduction. The investigators aim to determine whether a brief, phone-friendly online course can improve nurses' knowledge, day-to-day practice, confidence, and satisfaction.

What will happen? Registered nurses employed in nephrology, cardiology, or endocrinology units will be invited to participate.

Each nurse will complete a short online quiz and questionnaire before the course.

Participants will then work through seven brief learning modules (videos, posters, case stories, quizzes) on a phone or computer over four weeks.

Two weeks after the final module, participants will repeat the same quiz and questionnaire so the investigators can measure any change.

The investigators will also request feedback on course acceptability and suggestions for improvement.

Possible benefits If the course proves effective, the investigators plan to offer it to additional nurses across Syria and distribute the materials free of charge.

Number of volunteers the investigators plan to enrol 30 nurses (single group; no randomisation). Primary outcome the investigators will measure Change in CKD-prevention knowledge score from baseline to immediately post-course.

Study Overview

• Status: Completed
• Conditions: Nursing Education
• Intervention / Treatment: Behavioral: CKD-prevention e-learning course (Your Kidney... our priority)

Detailed Description

Study design Prospective, single-arm, pre-test/post-test pilot trial to estimate preliminary effect, feasibility, and acceptability of a seven-module asynchronous e-learning programme on Syrian hospital nurses' CKD-prevention knowledge, self-reported practice, confidence, and satisfaction. No control or randomization will be used.

Setting & recruitment Thirty registered nurses employed in nephrology, cardiology, or endocrinology wards of Syrian hospitals will be recruited through convenience sampling (hospital WhatsApp groups, professional associations, social-media promotion). Inclusion criteria: (1) registered nurse license, (2) access to smartphone/tablet, (3) willingness to provide electronic informed consent. A dedicated WhatsApp group will be created for announcements and technical support only; no teaching will occur in this group.

Intervention development Content was constructed by the study team and refined through a two-round Delphi panel (two nephrologists, two nutritionists, one senior nurse). Modules map to 2022 KDIGO prevention guidelines and WHO self-care recommendations. All assets (slide-casts ≤ 12 min, branching case vignettes, infographic posters, patient hand-outs) will be bilingual (Arabic/English subtitles) and compressed to ≤ 25 MB to allow offline download.

Delivery logistics Google Classroom will release two modules per week for four weeks. Each module contains: (1) voiced micro-lecture or animation, (2) interactive case study with branched questions, (3) downloadable poster & patient hand-out, (4) 5-item quiz (pass mark 75 %; unlimited attempts). Engagement analytics (views, quiz attempts, offline downloads) will be extracted from the Google Workspace admin console. Participants will receive a 5 USD mobile-data stipend to mitigate connectivity barriers; no other incentive will be offered.

Data collection timeline Day 0 - Baseline Qualtrics link (demographics, 38-item CKD-knowledge scale, 7-item attitude, 5-item practice, 24-item confidence).

Weeks 1-4 - Intervention delivered. Week 6 - Post-intervention Qualtrics link (same instruments plus 30-item E-Learning Satisfaction Questionnaire and one open-ended feedback item).

No biological samples or patient-level data will be collected. Outcomes Primary: change in CKD-prevention knowledge score (0-38; KR-20 = 0.83). Secondary: change in attitude (7-item, 5-point Likert, CVI = 0.89), self-reported practice (5-item, test-retest r = 0.78), confidence (24-item, Cronbach α = 0.92); module-quiz performance (% correct, attempts to pass); overall satisfaction (0-100; α = 0.93 Arabic version); qualitative feedback (inductive thematic analysis, two independent coders, κ target > 0.80).

Sample size Thirty participants will be enrolled. This number meets pilot-guidance (≥ 30) to detect a large within-group effect (Cohen's d ≥ 0.8) and allows 15 % attrition.

Analysis plan Normality will be examined with Shapiro-Wilk tests. Pre-post differences will be analysed using Wilcoxon signed-rank tests (two-tailed, α = 0.05). Effect size will be reported as r (Z/√N) and Cohen's d with 95 % CIs. Feasibility benchmarks: recruitment ≥ 80 % of target within four weeks, module-completion ≥ 70 %, mean satisfaction ≥ 4/5. Qualitative data will follow Braun & Clarke six-step thematic analysis.

Ethics & dissemination Approvals obtained from Shandong University IRB (No. 2023-R-091) and Tishreen University IRB (Ref. N14218). Electronic informed consent will be secured; withdrawal permitted at any time without penalty. Data will be stored on password-protected Qualtrics and OneDrive (256-bit AES). Findings will be submitted to a peer-reviewed journal and presented at nephrology/nursing-education conferences. De-identified dataset and e-learning package will be shared on reasonable request after publication.

• Study Type: Interventional
• Enrollment (Actual): 30
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Syria
  • Latakia, Syria, 000000
    • Tishreen University

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

1. Registered nurse currently employed in a Syrian hospital
2. Works in nephrology, endocrinology, or cardiology ward
3. Age 18 - 60 years
4. Has smartphone or computer access with internet connection
5. Willing to complete pre- and post-course questionnaires
6. Provides electronic informed consent

Exclusion Criteria:

1. Not a registered nurse (e.g., nursing assistant, student)
2. Outside the specified age range
3. Unable to access online materials (no device / no internet)
4. Previous participation in the same e-learning pilot
5. Refuses to give informed consent

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Health Services Research
• Allocation: N/A
• Interventional Model: Single Group Assignment
• Masking: None (Open Label)

Number of Arms

1

Arms and Interventions

Participant Group / Arm

Intervention / Treatment

Experimental: E-learning group; All eligible nurses receive the 7-module asynchronous e-learning programme on evidence-based CKD prevention.

Behavioral: CKD-prevention e-learning course (Your Kidney... our priority); 'Seven online modules (videos, infographics, case studies, quizzes) delivered via Google Classroom over 4 weeks. Content covers CKD risk-factor screening, lifestyle & dietary counselling, co-morbidity management, patient education, and program evaluation. Each module includes a short lecture (<12 min), interactive case, downloadable poster, and 5-item quiz (pass ≥75 %). Participants can download materials for offline use.'

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in CKD-prevention knowledge score from baseline to immediately post-intervention	38-item multiple-choice quiz; score range 0-38; higher score indicates better knowledge.	Baseline and Week 6

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in self-reported practice	5-item Likert scale (1-5); total score 5-25.	Baseline and Week 6
Change in confidence level	24-item Likert scale (1-5); total score 24-120.	Baseline and Week 6
Change in attitude toward CKD prevention	7-item Likert scale (1-5); total score 7-35.	Baseline and Week 6
Overall satisfaction with the e-learning programme	30-item validated satisfaction scale (0-100 %).	Week 6
Module quiz performance	Percentage of correct answers per 5-item quiz.	After each of the 7 modules (Weeks 1-4)

Collaborators and Investigators

• Sponsor: Shandong University
• Investigators: Study Director: Kefang Wang, PhD, Shandong University , School of Nursing and Rehabilitation

Study record dates

Study Major Dates

• Study Start (Actual): June 21, 2025
• Primary Completion (Actual): July 31, 2025
• Study Completion (Actual): October 16, 2025

Study Registration Dates

• First Submitted: November 19, 2025
• First Submitted That Met QC Criteria: November 27, 2025
• First Posted (Estimated): December 2, 2025

Study Record Updates

• Last Update Posted (Actual): December 8, 2025
• Last Update Submitted That Met QC Criteria: December 1, 2025
• Last Verified: December 1, 2025

More Information

Terms related to this study

• Keywords: pilot study; nurses; e-learning; pre-post; Syria; CKD prevention; professional development
• Other Study ID Numbers: 2023-R-091

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES
• IPD Plan Description: De-identified participant-level data for knowledge, practice, confidence, attitude, and satisfaction scores, together with the study protocol and analytic code, will be made available to researchers who provide a methodologically sound proposal approved by the corresponding author. Data will be shared via a secure, password-protected cloud link for 5 years after publication. Proposals should be directed to fatema92w@gmail.com
• IPD Sharing Time Frame: Beginning 3 months after the publication of primary results and ending 5 years post-publication
• IPD Sharing Access Criteria: Researchers must submit a scientifically relevant proposal, sign a data-use agreement, and use the data only for non-commercial research. Ethical approval may be required
• IPD Sharing Supporting Information Type: STUDY_PROTOCOL; SAP; ICF; ANALYTIC_CODE; CSR

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No