Participants in this arm will undergo a two-phase educational intervention with a total duration of six hours. In the first phase, patients will access an interactive video series on end-stage renal disease (ESRD) and its treatment options via an online platform. The series consists of ten 30-minute sessions delivered daily. The videos include interactive elements such as pop-up questions and multiple-choice assessments, with responses monitored by an instructor. All participants will receive prior training on how to use the system. In the second phase, patients will attend a one-hour instructor-led group discussion to review and consolidate key concepts.

Participants in this arm will receive a two-phase educational intervention lasting a total of six hours. In the first phase, patients will access a series of conventional (non-interactive) educational videos on end-stage renal disease (ESRD) and treatment options via an online platform. The series consists of ten 30-minute sessions delivered daily. In the second phase, patients will participate in a one-hour instructor-led group discussion to review the video content, explore key concepts, and consolidate their understanding. Discussions will be facilitated by an experienced instructor familiar with the video content.

Participants in this group will receive the standard educational care provided at their respective centers. This typically includes nurse-delivered patient education, distribution of educational pamphlets, and follow-up by the unit's assigned nurse educator.

Phase 1 - Interactive Video-Based Training (10 sessions of 30 minutes each):

Patients will access the platform via the website https://spotplayer.ir/ and watch a comprehensive interactive video related to end-stage renal disease (ESRD) and its replacement therapies. This video consists of ten 30-minute sessions, uploaded at the rate of one session per day. During the viewing, pop-up questions will appear, which patients are required to answer. Different response options will lead to the presentation of different educational scenarios. In addition, multiple-choice questions related to the content will be included throughout the video, and patients must record their answers in the system. The instructor will be able to review these responses through a management dashboard. It is worth noting that all patients will have previously received the necessary training to use the interactive videos, including Q&A sessions designed to ensure sufficient skill acquisition in utilizing the interact

Patient activation refers to an individual's knowledge, skills, confidence, and willingness to manage their own health and healthcare. In this study, patient activation is considered a primary behavioral outcome, as the educational intervention is designed to empower participants to take a more active role in managing their dialysis treatment and overall health. The Patient Activation Measure (PAM), developed by Hibbard and colleagues, consists of 13 items and is a valid and reliable tool for assessing patient activation in the field of nephrology. Responses are recorded using a five-point Likert scale ("Strongly disagree" = 1, "Disagree" = 2, "Agree" = 3, "Strongly agree" = 4, and "Not applicable" = no score). The raw total scores range from 13 to 52, with lower scores indicating lower activation levels and higher scores indicating higher activation levels (41).

The End-Stage Renal Disease Adherence Questionnaire (ESRD-AQ) is a self-report instrument consisting of 46 items across five domains, designed to assess patient adherence to treatment in four areas: attendance at hemodialysis sessions, medication adherence, fluid restrictions, and dietary recommendations. The first section of the questionnaire collects general information about patients' knowledge of ESRD and their history of renal replacement therapy (5 items). The subsequent four sections assess adherence to hemodialysis attendance (14 items), medication use (9 items), fluid restriction (10 items), and dietary recommendations (8 items), respectively. Responses are recorded using a combination of Likert scales, multiple-choice questions, and yes/no formats. The total score ranges from 0 to 1200, with higher scores indicating greater adherence to treatment (43). The reliability of this instrument was confirmed by Rafiei et al. (2014), with a Cronbach's alpha of 0.91 and a test-retest