Intervention strategies to improve compliance with medical regimens by ambulatory hemodialysis patients

Abstract

This research examined the relative efficacies of three intervention strategies designed to increase compliance to medical regimens in a group of ambulatory hemodialysis patients. The interventions examined included behavioral contracting (with or without the involvement of a family member or friend) and weekly telephone contacts with patients. Compliance was assessed with regard to following dietary restrictions and limiting fluid intake. Data were collected from 116 patients drawn from two outpatient clinics. Within clinics, patients were randomly assigned either to an intervention program or to a control group. The study employed a pretest-posttest control group design. Patients were interviewed before the intervention programs began (T1), after a 6-week intervention period (T2), and 3 months after completion of the intervention period (T3). Results showed that the interventions achieved substantial reductions in patients' serum potassium levels and in weight gains between dialysis treatments between T1 and T2. In general, however, these program effects tapered off to preintervention levels between T2 and T3. The findings thus indicate a need for long-term intervention programs.

Strategies to improve dietary, fluid, dialysis or medication adherence in patients with end stage kidney disease on dialysis: A systematic review and meta-analysis of randomized intervention trials

“…In fifteen studies (42%), theoretical models of behaviour relevant to treatment adherence formed the basis of the trialled intervention. The health belief model [27, 32, 41, 45] was the most commonly used, while self-efficacy theory [7, 45, 46], social cognitive theory [30, 47], self-affirmation theory [48, 49], trans-theoretical models (TTM) [35, 37], self-regulation theory [34], King’s theory of goal attainment [12] and the ABC (Antecedents, Behaviour, Consequences) model relevant to rational emotive therapy [33] were also invoked. Six out of seven studies, where the interventionist was a psychologist, had a theoretical behavioural underpinning.…”

“…The dominant category was assigned by consensus, with guidance when necessary from the senior psychologist among the authors. Eleven studies evaluated educational or cognitive interventions, four had behavioural or counselling interventions [6, 12, 27, 45], four had psychological or affective interventions [33, 39, 48, 49] and fourteen studies had elements of different categories in the trialled intervention (refer to Table 1).…”

“…The comparator included attention control [25], placebo support and discussion control conditions [34], provision of matching health information without prior reaffirmation activity [48, 49], use of a daily activity monitoring application [47], and health education which was different from the trialled intervention [13, 28]. Four studies [7, 25, 27, 35] included in this review also had two or more active (partial or alternative) intervention arms in addition to the main intervention and control arms (refer to Table 1).…”

Reporting of Telehealth-Delivered Dietary Intervention Trials in Chronic Disease: Systematic Review

“…A total of 37 trials were included ( Figure 1 ) [ 2 ], of which 49 were experimental interventions and 37 were comparison interventions. Of the 37 trials, 29 evaluated one experimental intervention [ 7 , 8 , 14 , 28 - 53 ], 4 trials evaluated two experimental interventions [ 54 - 57 ], and 4 trials evaluated three experimental interventions [ 58 - 61 ]. Trials were published from 1981 and 2016 and conducted in patients with cardiovascular disease or heart failure (n=13) [ 7 , 8 , 29 , 31 , 36 - 40 , 42 , 56 , 57 , 62 ], hypertension (n=11) [ 14 , 32 - 34 , 43 , 44 , 54 - 56 , 59 , 60 ], diabetes (n=10) [ 14 , 28 , 30 , 35 , 45 - 50 , 56 , 61 ], kidney disease (n=3) [ 51 , 52 , 58 ], and obesity (n=3) [ 32 , 53 , 57 ].…”

Psychometric Validation of the Self-Efficacy for Restricting Dietary Salt in Hemodialysis Scale

“…13–20 The basic premise underlying self-efficacy theory is that the expectations of personal mastery and success (efficacy expectation) influence the likelihood of an individual engaging in a particular behavior. In essence, an individual’s behavior is influenced by personal characteristics, beliefs about the consequences of a particular behavior, and the confidence in one’s ability to achieve that behavior.…”