The Effect of a Patient Self-Monitoring Tool Upon Adherence in Patients Receiving Hemodialysis

Abstract

OBJECTIVE: To assess the effectiveness of a self-monitoring tool and behavioral contracting upon perceptions of self-efficacy, health beliefs, and adherence in patients receiving hemodialysis. Forty patients (mean age = 49: range 26–78 years: 25 males/15 females) with end-stage renal disease on chronic hemodialysis for 2 months or greater with a history of non-compliance with phosphorus (≥6.0 mg/dl) and/or fluid restrictions (interdialytic gains ≥ 3 kg/week and/or 4 kg/weekend) for 1 or more months, were randomly assigned to a control (n=10) or treatment group (n=30). The design was quasi-experimental with monthly intervention using a pretest/posttest over a 6 month period. Both groups were given surveys at baseline and month 6 to measure perceptions of self-efficacy for performing specific health behaviors, assess health beliefs, and test renal diet knowledge. The treatment group also received monthly self-monitoring patient reports and behavioral contracting. Results were analyzed using two-sample t tests, ANOVA repeated measures design, and chi-square tests. Overall, no significant improvements in adherence existed between the groups, although the treatment group had a significant decrease in mean phosphorus levels ( p=.005) from baseline to month 3, but was a trend and not statistically significant as it was not maintained. The only significant finding between the two groups was an increase in posttest knowledge scores in the treatment group ( p=.008). This was a significant increase from baseline ( p=.002). This intervention showed the patient self-monitoring process was effective in encouraging active patient participation and increasing interest in health. It may have resulted in increased patient adherence had the study continued for a longer period of time with more frequent patient interaction.