Abstract
<title>Abstract</title> <p>Background Social determinants of health significantly influence hemodialysis patients; yet culturally adapted assessment tools are limited in Iran. This study evaluated the psychometric properties of the Persian version of the Steps to Better Health Questionnaire in hemodialysis patients. Methods A cross-sectional study was conducted in 2024 using a census approach across all nine dialysis centers in Qazvin Province. The 16-item STBH-Q, assessing five SDH domains, was translated using the Forward-Backward method. Validity was assessed through face, content, discriminant, and construct analyses, and reliability via test-retest with Intraclass Correlation Coefficient. Statistical analyses were performed using STATA version 17. Results The study included 435 hemodialysis patients with a 98% participation rate. The Persian STBH-Q demonstrated strong validity, with Impact Scores > 1.5 for face validity, CVR ≥ 0.75, CVI > 0.79 per item, and total CVI of 0.94 for content validity. Discriminant and construct validity were confirmed through significant item-domain correlations and subgroup differences (P < 0.001), respectively. Reliability was high, with domain ICC 0.82–0.94 and total ICC 0.94 (P < 0.001). Conclusion The Persian STBH-Q is a valid and reliable tool for assessing SDH in Iranian hemodialysis patients, facilitating targeted interventions and informing health policy. Further studies in other Iranian regions are recommended to enhance generalizability.</p>