Cross-cultural adaptation and psychometric validation of the persian version of the needling patient-reported experience measure in older adults undergoing hemodialysis

The Needling Patient-Reported Experience Measure (NPREM) is the first disease-specific instrument developed to assess this experience, but no culturally adapted, psychometrically validated Persian version exists for use with Iranian patients. The present study aimed to translate, cross-culturally adapt, and psychometrically validate the Persian version of the NPREM for older adults receiving maintenance hemodialysis in Iran. This methodological cross-sectional psychometric validation study was conducted in 2026 across eight hemodialysis centers in Mazandaran Province, Iran. The NPREM was translated and cross-culturally adapted according to Beaton’s guidelines, with two clinically inapplicable buttonhole cannulation items removed. Of the 655 eligible older adults receiving maintenance hemodialysis, 600 completed the survey (response rate: 91.6%). The final sample was selected using stratified random sampling and randomly divided into two independent subsamples for exploratory factor analysis (EFA; n = 300) and confirmatory factor analysis (CFA; n = 300). Content and construct validity, measurement invariance, reliability, measurement error, and floor and ceiling effects were evaluated. Exploratory factor analysis supported a five-factor structure, explaining 59.90% of total variance, consistent with the original NPREM domains: Communicating with the Team, My Fistula/Graft and Needling, Steps in Needling, Working Together, and My Personal Experience. This structure was corroborated by exploratory graph analysis and confirmed by confirmatory factor analysis, which showed acceptable-to-good fit for both first- and second-order models (CFI = 0.980, TLI = 0.978, RMSEA = 0.035, SRMR = 0.036). Measurement invariance was supported at the configural and metric levels. All subscales demonstrated satisfactory internal consistency (α = 0.808–0.904; ω = 0.816–0.905), composite reliability (0.840–0.916), convergent validity (AVE = 0.584–0.687), and discriminant validity (HTMT = 0.435–0.589). Test–retest reliability was excellent (ICC = 0.906–0.972). Random forest analysis identified Working Together as the domain with the greatest predictive importance for overall needling experience. No meaningful floor or ceiling effects were observed. The Persian NPREM appears to provide a valid and reliable measure of needling experiences among older adults undergoing hemodialysis. It appears suitable for routine patient-reported experience assessment, quality improvement initiatives, and intervention research, pending further validation in broader and more diverse populations.