It is estimated that 30% to 40% of approximately 42,000 Americans with renal disease who require hemodialysis to maintain life fail to comply to dietary (food and water intake) restrictions crucial for sustaining that life. No controlled studies have been reported which have investigated intervention(s) for increasing dietary compliance of chronic hemodialysis patients. The long-term objectives of the research being proposed are (1) to provide a model intervention approach for facilitating dietary compliance; (2) reduction in medical costs made necessary by diet abuse--costs which the disproportionately high percent of poor blacks cannot pay; and (3) prolongation of healthy life on hemodialysis.
The specific aims are to test the effects of three treatment packages (A, B, & C) on measures of fluid and food intake compliance--interdialysis fluid weight gain and serum potassium level, respectively. Each treatment package consists of three components (I, II & III) introduced in a serial manner in order to determine any significant individual component effect(s), 2-component (I + II) effects or 3-component (I + II + III) effects of treatment packages. Components of Treatment A are self-monitoring (I) + continued self-monitoring (II) + teaching self-reinforcement for maintenance (III). Treatment B is the same as A but adds teaching behavioral control to self-monitoring in component II. Treatment C is the same as B but adds family support to all its components (I, II & III). Treatments B and C are behavioral medicine social learning theory based approaches. Self-monitoring involves having patients keep records of fluid intake between treatments with reinforcements for weight gain reduction/improvement. Behavioral control involves graphically plotting reported fluid intake and fluid weight gain between treatments and showing their relationship, giving feedback about self-monitoring accuracy and reinforcements for weight gain reduction/improvement. The research methodology will be to assign 120 patients (30 each) to Group I (Treatment A), Group II (Treatment B), Group III (Treatment C), or Group IV (Control group). A stratified sampling method will be used for group assignment controlling for three factors: race, years on dialysis, and level of fluid restriction. The dependent measures will be taken across baseline, treatment and follow-up. A multivariate ANOVA using a partially balanced incomplete design with repeated measures will be used to determine immediate, maintenance, and generalization (to food intake compliance) effects of nurse implemented treatments designed to improve fluid intake compliance.
| Tucker, C M (1989) The effects of behavioral intervention with patients, nurses, and family members on dietary noncompliance in chronic hemodialysis patients. Transplant Proc 21:3985-8 |
