# Development and validation of a questionnaire for the knowledge assessment and management of PLADO diet in kidney and healthy population in Cyprus

## TL;DR

This paper introduces a new questionnaire to assess knowledge and perceptions of plant-based diets for kidney health in Cyprus.

## Contribution

The study presents a validated, culturally tailored questionnaire for assessing dietary perceptions related to kidney health in Cypriot populations.

## Key findings

- The questionnaire achieved high expert agreement and acceptable internal consistency across subscales.
- Pilot testing revealed knowledge gaps and uncertainty about plant-based protein sustainability among CKD patients.
- The tool includes educational content to evaluate baseline knowledge and learning outcomes.

## Abstract

Chronic kidney disease (CKD) requires dietary strategies that balance protein restriction, nutritional adequacy, and sustainability. As plant-dominant dietary models gain prominence in renal nutrition, understanding public perceptions of protein sources and their health impacts is increasingly critical. However, no validated assessment tool exists to evaluate such perceptions within the Cypriot population. This study presents the development and validation of a novel questionnaire designed to assess perceptions of sustainability, nutritional value, and health impacts of plant- and animal-based proteins, with a focus on kidney health. The instrument was developed through literature review, expert input (n = 10), cognitive pretesting, and pilot testing (n = 120). Validation included content validity indexing (I-CVI), Modified Kappa statistics, internal consistency via Cronbach's alpha, and exploratory factor analysis (EFA). Expert agreement was high, with an S-CVI/Ave of 0.89 and 93% of items achieving I-CVI ≥ 0.83. Internal consistency across subscales ranged from α = 0.71 to 0.82. EFA supported construct validity, explaining 36% of the variance. The final 42-item questionnaire covers eight domains, including sustainability beliefs, dietary behavior, and protein knowledge. A unique feature is its embedded educational content—glossary terms, visuals, and explanatory prompts—designed to evaluate baseline knowledge and learning outcomes. Pilot results revealed knowledge gaps and uncertainty about the sustainability of plant-based proteins among CKD respondents. This validated tool fills a significant gap in renal nutrition education and research and offers a reliable, culturally relevant means to assess dietary perceptions. It supports patient education, public health interventions, and clinical practice in promoting sustainable, kidney-friendly diets. Broader application and cross-cultural adaptation are recommended to enhance global utility.