BURGHER, PETER L.; PHD
                         UNIVERSITY OF WINDSOR (CANADA), 1982

                         PSYCHOLOGY, CLINICAL (0622)

                         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.


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