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Article Excerpt
Fluid control in patients on dialysis is an important determinant of outcome. A large change in weight during a dialysis session is related to lower effectiveness of dialysis (Sharp, Wild, & Gumley, 2005), exacerbation of hypertension (Inrig et al., 2007; Lopez-Gomez, Villaverde, Jofre, Rodriguez-Benitez, & Perez-Garcia, 2005; Rahman, Fu, Sehgal, & Smith, 2000; Sherman, Daniel, & Cody, 1993), pulmonary edema (Abuelo, 1998), and a higher risk for death (Leggat, 2005; Saran et al., 2003). Nevertheless, fluid control is one of the more difficult restrictions affecting adherence (Newmann & Litchfield, 2005), with findings showing prevalences of nonadherence in patients on hemodialysis of 10% to 60%, depending on the definition of fluid control adherence (Denhaerynck et al., 2007).
While previous studies of this issue have explored associations with nonmodifiable demographic characteristics, such as sex (Cummings, Becker, Kirscht, & Levin, 1982), age (Bame, Petersen, & Wray, 1993), educational status (Morduchowicz et al., 1993), and income (Bame et al., 1993), more recent efforts have focused on the modifiable variables of psychosocial factors; in particular, much attention is now focused on social support as an important psychosocial factor related to fluid control adherence in patients on dialysis (Heaney & Israel, 2002). Social support is defined as support by social and interactional activities (Cassel, 1976; Heaney & Israel, 2002; House, Landis, & Umberson, 1988) from sources such as family, friends, colleagues, and medical staff (Kovac, Patel, Peterson, & Kimmel, 2002).
The patient's perception of family support is associated with not only lower levels of interdialytic weight gain, but also survival (Kara, Caglar, & Kilic, 2007; Patel, Peterson, & Kimmel, 2005; Thong, Kaptein, Krediet, Boeschoten, & Dekker, 2007). Although the regularity and extended duration of each treatment episode provides patients on dialysis a greater chance of receiving support from dialysis staff than those with other chronic diseases, few studies have clarified the relationship between staff support and fluid control adherence in these patients (Kovac et al., 2002). Further, the degree to which dialysis staff support is associated with fluid control adherence compared with that of other psychosocial components of the Health Belief Model (HBM) is also unknown, notwithstanding the HBM's status as one of the most widely used conceptual frameworks in health behavior (Janz, Champion, & Strecher, 2002).
The authors investigated the relationship between patients' perceptions of dialysis staff encouragement (Kidney Disease Quality of Life subscale instrument--KDQOL) and fluid control adherence. They also examined the relationship between the psychosocial factors of the HBM and fluid control adherence in comparison with that of dialysis staff encouragement.
Subjects and Methods
Study Design and Subjects
The study was conducted under a cross-sectional design from January 2007 to April 2007 in 72 participants from a public hospital (52 patients) and a dialysis clinic (20 patients) in a single district in northeast Honshu, Japan. Inclusion was restricted to outpatients 20 years of age or older undergoing hemodialysis (HD) treatment for end stage renal disease (ESRD) for at least six months before entry.
Background Data
Demographic characteristics, including gender, age, education, marital status, living situation, job, and income, were collected using a self-reported questionnaire. Information on the primary cause of kidney failure, diabetes, diuretic use, duration of dialysis, frequency of dialysis per week, and body mass index (BMI) was obtained from the dialysis staff. Laboratory values for serum hematocrit, albumin, normalized protein catabolic rate (nPCR), potassium, phosphate, and Kt/V were collected from January 2007 to April 2007. Average values were calculated from 11 samples for mean serum hematocrit, 3 to 6 for albumin (depending on the hospital), 3 for nPCR, 14 for potassium, and 11 for phosphate.
Assessment of Fluid Control Adherence
The outcome measure was intradialytic weight loss (IWL) to dry weight (DW), defined as the amount of weight lost during an HD session. Mean IWL from January 24, 2007, to April 10, 2007, was used, while mean dry weight was from January 2007 to March 2007. In accordance with the cutoff defined by Leggat et al. (1998), nonadherence was defined as an IWG of more than 5.7% of dry weight (Hecking et al., 2004; Leggat et al., 1998).
Dialysis Staff Support
Dialysis staff support was measured using the dialysis staff encouragement subscale (DSE) of the KDQOL-SF[TM] (Green et al., 2001). Development and validation of the KDQOL-SF have been described elsewhere (Green et al., 2001).
The DSE contains two statements: (1) the dialysis staff encouraged me to be as independent as possible, and (2) the dialysis staff supported me in coping with my kidney disease. For each statement, subjects were asked to choose one of the following responses: definitely true (1 point), mostly, true (2 points), don't know (3 points), mostly false (4 points), and definitely false (5 points). The score was computed by summing the scores from each question item and then transforming the raw scores into a to 100-point scale (Green et al., 2001), with a higher score reflecting greater staff encouragement.
Serf-Efficacy
Dietary self-efficacy was measured using the dietary management self-efficacy scale (DMSES), a 9-item scale whose development and validation have been described elsewhere (Oka & Chaboyer, 2001; Oka, Tomura, Munakata, & Tsuchiya, 1996). The DMSES contains the following two series of statements.
I have confidence in my ability to manage my diet:
* When irritated.
* When I eat out.
* When hungry.
* When dining out or at a party.
* When feeling unpleasant.
* When I feel a constant need to have something in my mouth.
* In a reasonable way.
I have confidence in my ability to avoid a favorite food which caused a bad result on my blood test:
* Even when...
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