Date of Award

1982

Degree Type

Dissertation

Degree Name

Ph.D.

Department

Psychology

Keywords

Psychology, Clinical.

Rights

CC BY-NC-ND 4.0

Abstract

Nonadherence to hemodialysis fluid restrictions is a particularly difficult and dangerous problem for chronic dialysis patients. Review of noncompliance studies suggests that enmeshment in a stable supportive family and peer network is predictive of improved compliance. The network model and mapping techniques, used to study how people adapt to different life stresses, provides a useful means to evaluate the relationship between support network characteristics and dialysis compliance. Forty chronic hemodialysis patients were recruited from three metropolitan dialysis units in southeastern Michigan. Noncompliance was defined as 3-month mean interdialysis weight gains one standard deviation above the population mean. Twenty noncompliant patients were demographically matched pairwise with twenty compliant patients. Network predictor variables, determined through a structured interview, were: size, density, homogeneity, multiplexity, staff and family percentage, duration, frequency, proximity, reciprocity, dialysis awareness, influence, change, and level of desired interaction, value simularity, concern, trust, and assistance. Results showed that compliant patients had larger, more spread out and long-standing networks, with fewer staff and more multiple-role relationships. Compliant patients appeared to also have more dense networks consisting of more family members. Information from all the variables was used to correctly classify 85 percent of noncompliant and 95 percent of compliant patients. Factor analysis produced six factors: Change, Family Enmeshment, Size, Medical Status Awareness, Support, and Reachability. Size and Family Enmeshment demonstrated significant associations with compliance, accounting for 30 percent of individual compliance variance. The findings of more dense, family oriented networks for compliant patients is interpreted as partial confirmation of the importance of emotional support, empathy and stable sense of self identity for compliance. The negative findings for direct measures of relationship support, using the five scales--assistance, concern, trust, value similarity and desired interaction--are interpreted as an indication of response bias, present in the hemodialysis population, towards denial of any problems in their personal lives. The outcome of this study is taken as (1) further evidence of the utility of the network model and network mapping techniques, and (2) as additional support for the hypothesized relationship between compliance and emotional support. Implications for clinical intervention with noncompliant patients are drawn, along with suggestions for future research.Dept. of Psychology. Paper copy at Leddy Library: Theses & Major Papers - Basement, West Bldg. / Call Number: Thesis1982 .B844. Source: Dissertation Abstracts International, Volume: 43-03, Section: B, page: 0865. Thesis (Ph.D.)--University of Windsor (Canada), 1982.

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