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.
Social
Systems Simulation Group
P.O. Box 6904 San Diego, CA 92166-0904 Roland Werner, Principal Phone/FAX (619) 660-1603 |