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Theses Doctoral

Study of Compliance Behavior of Hemodialysis Patients

Sherwood, Roger J.

This research project was designed to identify variables within the dialysis patients' ecological field associated with behaviors. The import of this study lies in the fact that dialysis patients' health and levels of social functioning are affected by the degree to which they are able to comply with their prescribed medical and dietary regimen.

Five measures of compliance were selected as the dependent measures for this study. Serum phosphorous, serum potassium, and between dialysis weight gains constituted three objective measures. An Overall Objective Compliance Index was created by standardizing and summing the patient's scores on the three objective measures.The fifth dependent measure was based upon the patients' self-reports of their compliance. We found this measure to be the least reliable and negatively correlated with the objective measures. Independent variables were grouped into five domains, demographic, intra-personal, inter-personal, health delivery system and environmental factors.

A random sample of 60 patients was selected from the 131 patient population at the Brooklyn Kidney Center for this cross-sectional descriptive study. Fifty-five patients were interviewed and five patients refused to be interviewed. The interviewed sample was predominantly male (66%), Black (73%). with less than a high school education (52%), had a mean age of 46 and had been on dialysis an average of four years. A structured interview format was utilized to collect data; information was also abstracted from a review of the medical charts. Each patient was interviewed while they were being dialyzed.

Less educated, married, female patients new to dialysis reported
experiencing the greatest impact from renal failure and dialysis treatments. However, when we correlated the overall degree of impact of the illness with the five dependent measures, there were no statistically significant associations. In other words, while these patients experienced the greatest impact, there was no relationship between their subjective experience and the compliance measures.

The findings between the demographic characteristics and compliance
measures indicate that some patients are at higher risk of experiencing
social role disruptions. A demographic profile of the patients most at
risk in being non-compliant shows that they were older males, with less education, of lower socio-economic status, unemployed, born in the New York City area and new to dialysis.

The patients' coping activities and the availability of a neighbor were the only independent variables which emerged as being associated with all four objective measures of compliance. Patients who tended to reach out to others and did not solely rely on themselves and who continued to think about the current crisis were more compliant with respect to all four objective measures. Patients who had a neighbor to call upon when in need of help were also more compliant. Families that lacked organization, internal support, or tended toward either of the extremes of over involvement or disengagement from the patient appeared to increase the likelihood that the patients would have problems with compliance.

Patients with lower objective knowledge scores and who experienced barriers to following their medical and dietary instructions such as the lack of cash to purchase medications when needed, feeling depressed, being too busy, etc., were less compliant. Contrary to expectations, patients who reported higher levels of satisfaction with the dialysis staff and quality of care were also less compliant. This was attributed to the patients' use of denial and fear of staff's criticisms.

A recommended program for increasing dialysis patients' compliance
levels is presented in which more reliance is placed on a comprehensive psychosocial evaluation and the initiation of family and group services. Future research projects are discussed noting the importance of utilizing longitudinal type designs.

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More About This Work

Academic Units
Social Work
Thesis Advisors
Fanshel, David
Degree
Ph.D., Columbia University
Published Here
April 28, 2015
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