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

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.