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The social ecological approach of Moos (1979) was applied to the study of compliance with treatment regimen by hemodialysis patients. A total of 180 hemodialysis patients from six dialysis units in the Metropolitan Detroit, Michigan area participated in this research. These patients responded to two questionaires and provided background information about themselves. This information provided data on three variable groups as designated by the social ecological approach: person, environment, and mediating variables. Compliance data, the fourth variable group used in this research, was obtained from patient medical charts. The data were analyzed to determine the following; (1) Is there support for considering person, environment, and mediating variables as unique groups of variables as suggested by the social ecological approach? (2) What is the relationship that exists among the different compliance measures? Is compliance a unitary factor or is it multidimensional? (3) Can compliance be predicted using measures of environment, person and mediating variables?

The results of this research supported the social ecological concept that measures of person and environment were unique. The mediating variables were not found to be independent of measures of the person. In examining the relationship among the different measures of compliance, it was found that they could be summarized by four compliance factors: (1) Leaving Treatment Early, (2) Phosphorus Levels, (3) Potassium Levels, and (4) Weight Gains. There was no support available for consideration of compliance as a unitary factor or concept. This raises serious questions about the meaning of previous compliance research which has used different measures of compliance interchangeably. It was possible to predict a modest but significant amount of variance in the four compliance factors using measures obtained of person, environment, and mediating variables. Additional support for the finding of discrete compliance factors was obtained in the different pattern of variables found to be predictive of the four compliance factors. The results of this research were discussed in terms of implications for the social ecological approach, future dialysis research, and application to dialysis treatment.