Abstract
BACKGROUND:
Fluid management remains a cornerstone of hemodialysis care; however, suboptimal adherence frequently precipitates life-threatening complications, including hypertension and cardiovascular morbidity. While educational interventions are essential to mitigate these risks, empirical evidence regarding the efficacy of video-enhanced instruction in this population remains limited. This study aimed to evaluate the impact of a structured video-enhanced educational intervention on knowledge, practice, and fluid adherence among patients undergoing hemodialysis.
MATERIALS AND METHODS:
This randomized controlled trial evaluated outcomes using a knowledge questionnaire (reliability 0.88), a practice checklist (0.79), and intradialytic weight gain (IDWG) in 128 hemodialysis patients at South Indian tertiary hospital. Participants (n = 64 per experimental and control group, block randomized) received video-enhanced fluid management education or standard care; analysis included t-test, repeated measures of ANOVA, and Bonferroni tests (P < 0.05 significant).
RESULTS:
The experimental group showed significant improvements in mean knowledge scores (11.4 ± 2.2) vs control, P = 0.001) and practice scores (13.6 ± 1.0 vs control 9.1 ± 1.5, P = 0.001) from pretest to post-test 2. Repeated measures ANOVA confirmed differences in practice scores within (F = 102.76, P = 0.001) and between groups (F = 8121.19, P = 0.001), with fluid adherence also improving significantly in the experimental group (P < 0.001).
CONCLUSION:
Video-enhanced instruction is an effective strategy to improve clinical outcomes in hemodialysis patients. Integrating a structured audiovisual tool into routine dialysis care can enhance patient outcomes and support healthcare policy initiatives to improve chronic disease management.
Keywords: Attitude, practice, fluid restriction, health knowledge, kidney failure, patient compliance, renal dialysis, video-aided instruction
Introduction
Chronic kidney disease (CKD) is a progressive condition characterized by a gradual decline in renal function over time, often culminating in end-stage renal disease (ESRD), which requires renal replacement therapy most commonly in the form of hemodialysis (HD). The global burden of CKD continues to rise, presenting a substantial public health challenge due to its associated morbidity, mortality, and significant healthcare expenditures.[1,2] Effective management of patients undergoing HD is multifaceted, requiring strict adherence to treatment regimens, including dietary modifications, medication adherence, and, in particular, fluid restriction.
Fluid management is a critical component of care in hemodialysis patients, as excessive fluid intake can lead to complications such as hypertension, cardiovascular events, and increased mortality.[1] However, adherence to fluid and dietary restrictions remains a major challenge, with studies reporting a high prevalence of nonadherence among hemodialysis patients worldwide.[3,4,5,6] Nonadherence has been associated with poor clinical outcomes, including increased hospitalization rates and reduced quality of life.[5,7]
Multiple factors influence adherence in CKD patients, including psychological, social, and educational aspects.[8,9] Patients often struggle with the burden of lifelong dietary and fluid restrictions and their ability to adhere is closely linked to their understanding of the disease and its management.[10,11] Evidence suggests that knowledge alone may not always translate into behavioral compliance, highlighting of adherence behavior in this population.[12]
Patient education has been identified as a key strategy to improve adherence and promote self-management in chronic disease, including CKD.[14,15] Educational interventions that focus on enhancing patient knowledge, skills and motivation have shown positive effects on treatment adherence and quality of life among hemodialysis patients.[16,17] Traditional educational methods, however, may not always be effective at sustaining long-term behavioral change.
In recent years, video-based and technology-assisted educational interventions have gained attention for their potential to improve patient engagement and understanding. Audiovisual learning tools enhance comprehension, retention, and recall by presenting information in an interactive and accessible manner.[19,20,21] Studies have demonstrated that video-assisted education can significantly improve knowledge; its impact on actual practice and adherence requires further exploration.
Study Novelty: This study addresses a critical gap in regional clinical education by evaluating the effectiveness of interactive audiovisual tools versus traditional verbal instruction in the South Indian tertiary care context.
Conceptual framework
Research hypothesis
Video-assisted educational intervention for fluid management affects knowledge, practice, and adherence among patients undergoing hemodialysis.
Theoretical framework
The study is grounded in Ernestine Wiedenbach’s helping Art of Clinical Nursing Theory (1964). This framework guides the nursing process through four phases:
Identification: Assessing the patient’s baseline knowledge and barriers to fluid management.
Ministration: Implementing the video-enhanced educational intervention.
Validation: Verifying patient comprehension and practice improvements.
Coordination/Feedback: Measuring the result increase in knowledge and adherence.
Materials and Methods
Study design and setting
A randomized controlled trial was conducted to evaluate the effectiveness of video-enhanced instruction of fluid management among patients undergoing hemodialysis. The study was carried out in the dialysis unit of a tertiary care hospital in South India.
Study participants and sampling
The sample size was estimated, considering fluid adherence as the primary outcome variable, using the following formula. The estimated sample size was 54; considering the attrition rate, a total sample of 128 was included, 64 in the experimental group and 64 in the control group.
Sample size calculation
n = sample size per group
Z1-α/2 = 1.96 at α = 0.05
Z1-β =0.84 at 80% power
σ = anticipated population standard deviation of the outcome variable (adherence) = 4.7
d = clinically significant difference = 2
m = number of time points = 3
ρ = Intra class correlation = 0.4
Accounting for a drop-out rate of 10%, 
per group
A total of 128 patients undergoing hemodialysis were included. Inclusion criteria: 20–70 years, communicating in Tamil or English, willing to participate, undergoing 3 to 4 hours of dialysis, and having completed at least 8 dialysis cycles. Participants were allocated to experimental (n = 64) and control groups using computer-generated block randomization. Exclusion criteria involved patients with cognitive, hearing, or visual impairments, those who were hemodynamically unstable, undergoing hemodialysis only once a week, on a ventilator, or requiring emergency dialysis.
Randomization
Randomization was used to allocate patients equally to the experimental and control groups, ensuring each participant had an equal chance of being assigned to either group. To maintain a balance between groups, block randomization was employed. A total of 128 samples were randomized into 13 blocks of 10 each, generated by a computer with assistance from a biostatistician. In these blocks, the number 1 was assigned to the experimental group, and 2 to the nonexperimental group. Each block was individually sealed in an opaque envelope, marked with a sequential number, and kept under the research investigator’s custody.
Data collection tool and technique
This study was conducted from December 2022 to March 2023, and participant selection adhered to predefined inclusion and exclusion parameters. Following informed consent, sociodemographic and clinical data were collected using a structured knowledge questionnaire and a practice checklist to assess fluid-management behavior. Fluid adherence was assessed using intradialytic weight gain measurements.
-
Knowledge: 22-item multiple-choice questionnaire (reliability: 0.88)
(It has four components: fluid and sodium restriction, symptoms and complications of fluid overload, dietary patterns for hemodialysis patients, and control measures to prevent fluid overload. Each correct answer was worth 1 point, for a maximum of 22 points, with scoring criteria defining knowledge levels as adequate (17–22), moderately adequate (11–16), or inadequate (0–11).
-
Practice: 15-item dichotomous checklist (reliability: 0.79)
(This has a checklist of 15 dichotomous questions to evaluate daily fluid management practices, with scores indicating unsatisfactory (<8), satisfactory (8–11), or excellent (12–15) practices).
Adherence: Measured via intradialytic weight gain (IDWG)
Standard Care (Control): Standard care consisted of routine verbal instruction from healthcare professionals regarding fluid and dietary restrictions during the dialysis session, without structured audiovisual aids.
Intervention (Experimental): A 10–15-min validated video-enhanced instruction module covering fluid restriction, dietary modifications, and complications.
Data were collected at three time points: baseline (pretest), post-test 1, and post-test 2. When patients were admitted for dialysis, eligibility was assessed, and the study details were explained to them. Their assigned nurse was given a sealed envelope with a number, which was read aloud to the investigator. If the number was 1, the patient was assigned to the experimental group; if it was 2, they were assigned to the control group. Each patient received a code number based on the randomization. Following group allocation, the study procedure was explained in detail, and written informed consent was obtained from all participants.
Blinding was not performed in this study due to the nature of the educational intervention. This has been acknowledged as a potential limitation.
Validity and reliability
Experts in the field established the tool’s content validity, and reliability was assessed using appropriate statistical methods. The reliability coefficients were 0.88 for the knowledge questionnaire and 0.79 for the practice checklist, indicating good internal consistency.
Outcome measures
This study assessed the impact of fluid management interventions on hemodialysis patients, focusing on knowledge, practice, and adherence as primary outcomes. Knowledge of fluid management was evaluated using a 22-item multiple-choice questionnaire, and practice levels were measured using a 15-item dichotomous checklist. Adherence to fluid management was assessed by monitoring weight changes during dialysis sessions and interpreting these changes to determine patient compliance with fluid guidelines.
Ethical consideration
The investigation conformed to ethical standards and obtained approval from the Institutional Ethics Committee (IEC) of the study setting, with approval reference number IEC REF: CSP/22/AUG/115/461. Before the study, written informed consent was acquired, and data confidentiality was ensured.
Statistical analysis method
The data collected from 128 participants were analyzed using SPSS software (Version 21.0). Descriptive statistics, such as the mean and standard deviation, were used to summarize the data. Inferential statistics, including an independent t-test, were used to compare differences between the experimental and control groups. Repeated measures analysis of variance (ANOVA) was used to assess changes over time within and between groups. A post hoc Bonferroni test was applied for multiple comparisons. A P-value of less than 0.05 was considered statistically significant.
Results
In the study, 128 hemodialysis patients were included, with 64 patients assigned to each of the experimental and control groups. The CONSORT flow diagram, as shown in Figure 1, illustrates the progression of 128 participants through enrollment allocation, and 14 day follow up with zero attrition (n = 0 lost to follow up). The majority of study patients as shown in Figure 2, were aged between 51 and 60 years (29; 45.3%). A significant portion of the sample was male, 40 (62.5%). The majority of the patients had completed secondary school education but were unemployed and had been diagnosed with the illness for less than 1 year. Additionally, hypertension was reported as a major health issue; the majority had no unhealthy habits but had to undergo hemodialysis twice a week, as shown in Figure 3. Many received information on fluid management from physicians. Table 1 presents the patient's background variables. No significant differences were found between the two groups in the outcome measures at baseline.
Figure 1.
CONSORT flow diagram of the participants
Figure 2.
Percentage and distribution of age among patients undergoing hemodialysis in experimental and control group (N = 128)
Figure 3.
Percentage and distribution of duration of hemodialysis among patients undergoing hemodialysis in experimental and control group (N = 128)
Table 1.
Baseline characteristics of participants in experimental and control groups (n=128)
| Background variables | Experimental group (n=64) | Control group (n=64) | Chi-square (χ2) & P | |||||||
|---|---|---|---|---|---|---|---|---|---|---|
|
|
|
|||||||||
| n | % | n | % | |||||||
| Age in years |
χ2=14.11 P=0.11 (NS) |
|||||||||
| 20-35 years | 9 | 14.1 | 11 | 17.2 | ||||||
| 36-50 years | 19 | 29.7 | 22 | 34.4 | ||||||
| 51-65 years | 29 | 45.3 | 22 | 34.4 | ||||||
| Above 65 years | 7 | 10.9 | 9 | 14.1 | ||||||
| Gender |
χ2=0.41 P=0.60 (NS) |
|||||||||
| Male | 40 | 62.5 | 34 | 53.1 | ||||||
| Female | 24 | 37.5 | 30 | 46.9 | ||||||
| Education status |
χ2=11.08 P=0.27 (NS) |
|||||||||
| Non-formal education | 5 | 7.8 | 5 | 7.8 | ||||||
| Primary education | 11 | 17.2 | 8 | 12.5 | ||||||
| Secondary education | 28 | 43.8 | 30 | 46.9 | ||||||
| Graduate and above | 20 | 31.3 | 21 | 32.8 | ||||||
| Occupation |
χ2=9.53 P=0.39 (NS) |
|||||||||
| Unemployed | 27 | 42.2 | 24 | 37.5 | ||||||
| Semi-professional | 8 | 12.5 | 8 | 12.5 | ||||||
| Professional | 14 | 21.9 | 17 | 26.6 | ||||||
| Homemaker | 15 | 23.4 | 15 | 23.4 | ||||||
| Duration of haemodialysis |
χ2=12.88 P=0.16 (NS) |
|||||||||
| <1 year | 27 | 42.2 | 20 | 31.3 | ||||||
| 1-2 years | 20 | 31.3 | 21 | 32.8 | ||||||
| 3-4 years | 11 | 17.2 | 15 | 23.4 | ||||||
| >5 years | 6 | 9.4 | 8 | 12.5 | ||||||
| Associated health problems |
χ2=9.58 P=0.65 (NS) |
|||||||||
| Hypertension | 23 | 35.9 | 20 | 31.3 | ||||||
| Diabetes mellitus | 8 | 12.5 | 12 | 18.8 | ||||||
| Diabetes mellitus & Hypertension | 14 | 21.9 | 8 | 12.5 | ||||||
| Anaemia | 2 | 3.1 | 6 | 9.4 | ||||||
| Arthritis | 0 | 0.0 | 2 | 3.1 | ||||||
| None | 17 | 26.6 | 16 | 25.0 | ||||||
| Do you have any of the following habits | ||||||||||
| Alcoholism | 6 | 9.4 | 7 | 10.9 |
χ2=13.35 P=0.64 (NS) |
|||||
| Smoking | 3 | 4.7 | 4 | 6.3 | ||||||
| Betel leaf chewing | 4 | 6.3 | 4 | 6.3 | ||||||
| Tobacco usage | 6 | 9.4 | 9 | 14.1 | ||||||
| None | 45 | 70.3 | 40 | 62.5 | ||||||
| Number of haemodialysis per week | ||||||||||
| One | 3 | 4.7 | 3 | 4.7 |
χ2=3.01 P=0.55 (NS) |
|||||
| Two | 46 | 71.9 | 45 | 70.3 | ||||||
| Three | 15 | 23.4 | 16 | 25.0 | ||||||
| Previous Knowledge about fluid overload management | ||||||||||
| Yes | 63 | 98.4 | 64 | 100.0 | ----- | |||||
| No | 1 | 1.6 | 0 | 0.0 | ||||||
| Source of Knowledge | ||||||||||
| Dietitian | 14 | 21.9 | 17 | 26.6 |
χ2=10.61 P=0.30 (NS) |
|||||
| Physician | 40 | 62.5 | 37 | 57.8 | ||||||
| Nurse | 9 | 14.1 | 10 | 15.7 | ||||||
| None | 1 | 1.8 | 0 | 0.0 | ||||||
| Any Family Members Undergoing Haemodialysis | ||||||||||
| Yes | 6 | 9.4 | 7 | 10.9 |
χ2=0.81 P=0.48 (NS) |
|||||
| No | 58 | 90.6 | 57 | 89.1 | ||||||
(P>0.05 Not Significant) NS: Non-Significant
The mean pretest knowledge scores in the experimental and control groups were 11.4 ± 2.2 and 11.9 ± 2.2, respectively, as shown in Table 2. Knowledge scores in the experimental group demonstrated a consistent and significant improvement on the post-test compared with the control group. The video-enhanced instruction significantly affected group performance (P = 0.001), as [Figure 4] determined by repeated measures ANOVA in Table 3.
Table 2.
Comparison of knowledge scores between experimental and control groups across study phases
| Outcome variables | Group |
MD | 95%of CI | t-test & P | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Experimental (n=64) | Control (n=64) | |||||||||||||||
|
|
|
|
||||||||||||||
| Mean | SD | Mean | SD | LL | UL | |||||||||||
| Knowledge Score | 11.4 | 2.2 | 11.9 | 2.2 | 0.4 | 0.3 | 1.2 | t=1.13, P=0.25 (NS) | ||||||||
| Practice Score | 9.5 | 2.1 | 9.1 | 1.4 | 0.4 | 0.10 | 0.19 | t=1.31, P=0.18 (NS) | ||||||||
(P>0.05 Not Significant) NS: Non-Significant, MD-Mean difference, SD: Standard deviation
Figure 4.
Mean profile plot showing knowledge scores among patients undergoing hemodialysis in the experimental group and the control group (N = 128). To statistically test the video enhanced educational intervention for fluid management on knowledge scores within the group and between the group repeated measures of ANOVA was computed. It revealed that knowledge scores between the group (F = 200.68 and P = 0.001) and within the experimental group (F = 603.6 and P = 0.001) statistically significant. The findings indicated that knowledge among patients undergoing hemodialysis improved after the intervention
Table 3.
Repeated measures ANOVA for knowledge scores within and between groups
| Knowledge | Mean square | F | df | P | η 2 P | |||||
|---|---|---|---|---|---|---|---|---|---|---|
| Between the group (n=64) | 76981.69 | 200.68 | 1 | 0.001 | 0.986 | |||||
| Within the group (n=64) | 611.38 | 603.10 | 2 | 0.001 | 0.827 |
Note: df=degree of freedom; η2P=partial eta (effect size)
In Table 4, the pretest mean practice scores in the experimental and control groups were 9.5 ± 2.1 and 9.1 ± 1.4, respectively. The experimental group showed a consistently greater increase in practice scores than the control group. The analysis in Table 5 showed that video enhanced instruction had a significant impact, with a statistically significant difference between the groups (P = 0.001) determined by repeated measures ANOVA [Figure 5].
Table 4.
Comparison of practice scores between experimental and control groups across study phases
| Group | Pretest Mean±SD | Post-test 1 Mean±SD | Post-test 2 Mean±SD | P | ||||
|---|---|---|---|---|---|---|---|---|
| Experimental (n=64) | 9.50±2.10 | 12.40±1.50 | 13.60±1.00 | <0.001 (S) | ||||
| Control (n=64) | 9.10±1.40 | 9.30±1.50 | 9.50±1.60 | >0.05 (NS) |
(P<0.001 significant level) S-Significant, NS: Non-significant, SD: Standard deviation
Table 5.
Repeated measures ANOVA for practice scores within and between groups
| Source of variation | Mean square | F | df | P | η 2 P | |||||
|---|---|---|---|---|---|---|---|---|---|---|
| Within group | 150.72 | 102.76 | 1.75 | <0.001 | 0.449 | |||||
| Between group | 661.50 | 8121.19 | 1 | <0.001 | 0.985 |
Note: df=degree of freedom; η2P=partial eta (effect size)
Figure 5.
Mean profile plot showing practice scores among patients undergoing hemodialysis in the experimental group and the control group (N = 128). To statistically test the video enhanced educational intervention for fluid management on practice scores within the group and between the group repeated measures of ANOVA was computed. It revealed that, practice scores between the group (F = 8121.19 and P = 0.001) and within the experimental group (F = 102.76 and P = 0.001) statistically significant. The findings indicated that practices among patients undergoing hemodialysis improved after the intervention
A comparison of intradialytic weight between the experimental and control groups at baseline showed no statistically significant difference in fluid adherence status (P > 0.05). However, in Table 6, the experimental group demonstrated a gradual improvement in adherence, with statistical significance at P = 0.01.
Table 6.
Comparison of intradialytic weight gain (fluid adherence) between experimental and control groups
| Group | Pretest Mean±SD | Post-test Mean±SD | P | |||
|---|---|---|---|---|---|---|
| Experimental (n=64) | 3.10±0.80 | 2.10±0.60 | 0.01(S) | |||
| Control (n=64) | 3.00±0.70 | 2.90±0.80 | >0.05 (NS) |
(P<0.001: Significant level) S: Significant, NS: Non-Significant, SD: Standard deviation
Table 7 presents the correlation between knowledge and practice scores in both experimental and control groups. It showed no correlation between knowledge and practice scores during the pretest, post-test 1, and post-test 2.
Table 7.
Correlation between knowledge and practice scores across study phases
| Group | Time points | Variables | n | Mean | SD | Pearson’s co-relation (r) & P | ||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Experimental group | Pretest | knowledge scores | 64 | 11.48 | 2.26 |
r=0.05 & p=0.66 (NS) |
||||||
| Practice scores | 64 | 9.53 | 2.10 | |||||||||
| Post-test 1 | knowledge scores | 64 | 17.70 | 1.09 |
r=0.00 & p=0.99(NS) |
|||||||
| Practice scores | 64 | 12.16 | 1.71 | |||||||||
| Post-test 2 | knowledge scores | 64 | 19.75 | 0.95 |
r=0.02 & p=0.83(NS) |
|||||||
| Practice scores | 64 | 13.61 | 1.06 | |||||||||
| Control group | Pretest | knowledge scores | 64 | 11.94 | 2.25 |
r=0.14 & p=0.25(NS) |
||||||
| Practice scores | 64 | 9.11 | 1.46 | |||||||||
| Post-test 1 | knowledge scores | 64 | 12.00 | 2.17 |
r=0.12 & p=0.31(NS) |
|||||||
| Practice scores | 64 | 9.13 | 1.55 | |||||||||
| Post-test 2 | knowledge scores | 64 | 12.08 | 2.18 |
r=0.08 & p=0.50 (NS) |
|||||||
| Practice scores | 64 | 9.19 | 1.56 |
(P<0.05 significant level) S-Significant, NS: Non-Significant, SD: Standard deviation
Discussion
This study evaluated the effectiveness of video-enhanced instruction on fluid management among patients undergoing hemodialysis. The findings demonstrated a statistically significant improvement in knowledge, practice, and adherence to fluid management in the experimental group compared to the control group, supporting the study hypothesis.
The improvement in knowledge scores among patients in the experimental group indicates that video-assisted teaching is an effective educational strategy. Audiovisual methods enhance understanding by engaging multiple senses, thereby improving retention and comprehension. This finding is consistent with recent studies reporting improved patient knowledge following structured educational interventions in chronic disease management.[16,22]
Similarly, the practice scores showed a significant increase in the experimental group compared to the control group. This suggests that improved knowledge translates into better behavioral practices regarding fluid restriction. Educational interventions that combine visual and auditory learning components have been shown to positively influence patient behavior, particularly in long-term conditions such as hemodialysis.[14,15]
Adherence to fluid management, as measured by intradialytic weight gain, also improved significantly in the experimental group. This is a clinically important finding, as poor fluid adherence is associated with increased morbidity and hospitalization in patients undergoing hemodialysis.[5,11] The reduction in weight gain indicates better compliance with fluid restrictions, highlighting the effectiveness of the interventions in achieving meaningful clinical outcomes.
The findings of the present study are consistent with prior research emphasizing the importance of patient education in improving adherence and self-management among patients with CKD.[13,14] Studies conducted in similar settings have demonstrated that structured educational programs significantly improve knowledge and behavioral outcomes, thereby enhancing overall patient care.[17]
Despite these positive findings, certain limitations must be considered. The study was conducted in a single center, which may limit the generalizability of the results. Additionally, blinding was not performed due to the nature of the intervention, which may introduce potential bias. The follow-up period was relatively short, and long-term adherence could not be assessed.
However, this study has notable strengths. The use of a randomized controlled design enhances the internal validity of the findings. The inclusion of multiple outcome measures, including knowledge, practice, and adherence, provides a comprehensive evaluation of the intervention. Furthermore, the use of validated tools with good reliability supports the accuracy of the results.
The study findings indicated that video-enhanced instruction significantly improved knowledge, practice, and adherence to fluid management among hemodialysis patients in the experimental group, with statistically significant improvements from pretest to post-test 1 and post-test 2 (P = 0.05). Conversely, the control group exhibited no significant changes in these measures.
The findings support the hypothesis that video-assisted education significantly impacts knowledge and behavior. Consistent with Alikari et al., education improves quality of life, though our data align with Dursoe et al., in finding that knowledge increase does not always correlate linearly with practice (P = 0.01).
Additionally, adherence behavior is influenced by multiple psychosocial and motivational factors, as highlighted in previous studies,[18] indicating that educational interventions should be complemented with behavioral and psychological support strategies.
Future research should focus on long-term follow-up to assess sustained adherence to fluid management practices. Multicenter studies with larger sample sizes are recommended to improve generalizability. Additionally, the integration of digital health technologies, such as mobile applications and telehealth-based education, may further enhance patient engagement and outcomes.
Strengths and limitations of the study
Strengths
This study used a randomized controlled design with block randomization, which minimizes selection bias and enhances internal validity. The use of validated tools with good reliability (0.88 and 0.79) strengthens the accuracy of the findings. Additionally, repeated follow-up assessments allowed evaluation of sustained intervention effects.
Limitations
The study was conducted at a single tertiary care center with a relatively small sample size, which may limit generalizability. Blinding of outcome assessors was not performed, which may introduce assessment bias. The short follow-up period limits understanding of long-term adherence behavior.
Implications for clinical practice
The implication from the present study is an important concern to the health care team, clinical nurse educators, and clinical researchers. Patients with CKD can improve their treatment adherence by taking responsibility for fluid restriction, actively engaging in life, and following a renal plan, thereby positively influencing their treatment regimen and overall self-care.
Conclusion
Integrating standardized audiovisual educational modules into dialysis care protocols aligns with health policy benchmarks for chronic disease management by reducing fluid-overload complications and lowering the healthcare burden and improving quality of life.
AI usage statement
The authors declare that no artificial intelligence tools were used in the data collection, analysis, or interpretation of the study. AI tools were only used for language editing and manuscript preparation. The authors take full responsibility for the content of the manuscript.
Abbreviations
CKD: Chronic Kidney Disease; HD: Hemodialysis; IEC: Institutional Ethics Committee; ESRD: End Stage Renal Disease; IDWG: Intradialytic Weight Gain.
Author’s contributions
Conceptualization: Idea generation, framing the research question-JFHS and HPS, Data Collection: HPS, Statistical Analysis: HPS and JS, Manuscript Drafting: HPS, Supervision: JFHS, RC and JS.
Data availability statement
The datasets analyzed during the study are not publicly available due to confidentiality and institutional regulations, but are available from the corresponding author on reasonable request.
Conflicts of interest
There are no conflicts of interest.
Acknowledgement
The authors are grateful to all participants involved in the study.
Funding Statement
Nil.
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
The datasets analyzed during the study are not publicly available due to confidentiality and institutional regulations, but are available from the corresponding author on reasonable request.