Delphi study on evidence-based CKD prevention strategies for nurses in resource-limited settings: focus on e-learning implementation.

Background: Interactive e-learning modules are increasingly being used to educate nurses about preventing and detecting chronic kidney disease (CKD). These modules aim to improve knowledge, screening practices, skills, and self-management behaviours. This Delphi study aims to provide a prioritized list of strategies, content, and delivery methods to guide future implementation efforts and improve primary and secondary prevention of conservative CKD care in Syria.

Methods: A second-round Delphi study was performed using the input of 15 CKD clinical content experts (nephrologist-scientist & medical educator) involved in education and clinical practice from March to the end of April 2025. Eligible participants sent an e-mail containing an information sheet and an invitation to participate in the study. Consent is obtained before participants proceed to the survey. In the first round, we identified several potential strategies for CKD prevention education. However, consensus was not reached on all of them. We modified and refined these strategies based on the CKD clinical content experts ' opinions. We asked them to re-evaluate and re-rank these modified strategies in the second round via e-mail. Experts use predefined statements to score the effectiveness of CKD prevention strategies and delivery methods based on existing best practices specified in clinical guidelines, systematic reviews, and research studies. Descriptive statistics such as the median, interquartile range (IQR), and percentage agreement are used to assess consensus. Inferential statistics were used to measure participant agreement using Kendall's coefficient, and for stability between rounds, the Wilcoxon rank-sum test was used.

Results: We identified (9 primary and 32 secondary strategies) evidence-based CKD prevention strategies to implement within Syria and limited resource areas. Three strategies were deleted as not feasible and related to the Syrian context, and nine strategies were modified based on expert feedback on rationale and suggestions related to culture availability and cost-effectiveness. We added one strategy to replace the Genetic screening strategies with early and regular screening for high-risk populations. Challenges to implementing evidence-based CKD prevention strategies seem to exist in professional, organizational, and external contexts, which should all be considered to increase implementation success within resource-limited areas such as Syria.

Conclusion: Using the Delphi approach to tailor the e-learning module content to the specific needs of nurses, depending on the realities of the Syrian context, by synthesizing clinical work with evidence-based CKD prevention strategies and an obvious need to create a common foundation for nurses' knowledge of CKD prevention. This study offers actionable strategies to strengthen CKD prevention in resource-limited settings like Syria. Prioritizing cost-effective tools, culturally adapted education, offline modules, Arabic translations, and nurse-friendly protocols is a blueprint for similar conflict-affected regions.