Graduate Program

Clinical Psychology

Degree Name

Master of Arts (MA)

Semester of Degree Completion

1999

Thesis Director

Russell E. Gruber

Abstract

Patient adherence with prescribed medical regimens is vital in promoting the health of patients. Complex medical regimens are difficult for patients to follow and it is therefore important to understand what causes patients not to follow their prescribed treatment recommendations. Hemodialysis (HD) is one such complex medical regimen that requires patients to follow strict restrictions in their diet. One area of the HD regimen that is particularly hard for patients to adhere to is restrictions in the amount of fluid they can safely consume. Research has shown that noncompliance to fluid restrictions is pervasive, with patients stating that adherence to their fluid restrictions is one of the most difficult aspects of their treatment. Researchers have investigated the role patient health beliefs play in adherence to medical treatments. Health locus of control (HLC) is one construct of health beliefs investigated that involves what the patient perceives as controlling their health. Research has focused on a direct link between HLC and patient adherence behaviors, however recent work has suggested that HLC functions as a moderator in patient adherence. A self-efficacy model has also arisen in the research attempting to predict adherence. Perceived health competence (PHC) is a health-specific measure of self-efficacy that taps the level of control and influence a patient believes they have over their overall health. Few studies have investigated the moderating role of HLC combined with a measure of the patient's perceived health competence. This study attempts to assess what effect HLC and PHC have on a patient's adherence to their fluid restrictions.

HD patients (N = 108) from two Midwestern HD centers owned and operated by Gambro Healthcare, Inc. were asked to volunteer to take part in the study with fifty-one consenting to participate. Each subject was given three health belief measure questionnaires, Form C of the Multidimensional Health Locus of Control Scale (Wallston, K. A , Wallston, B. S., & Devellis, R, 1978), the Perceived Health Competence Scale (Smith, M. S., Wallston, K. A., & Smith, C. A., 1995), and the Illness Effects Questionnaire (Greenberg, G.D., & Peterson, R. A , 1984), along with a demographic questionnaire. Their medical charts were also reviewed in order to obtain data pertaining to their fluid adherence behaviors.

The study did not find any significant relationships between the health measures and fluid adherence behaviors. Age was the only significant predictor of fluid adherence behaviors with older patients being more likely to have better adherence to their fluid restrictions than their younger counterparts. When comparing subjects based on degree of adherence, there were no further significant differences found.

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