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Evidence of improved fluid management in patients receiving haemodialysis following a self-affirmation theory-based intervention: A randomised controlled trial

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Objective: Haemodialysis patients are at risk of serious health complications; yet, treatment non-adherence remains high. Warnings about health risks associated with non-adherence may trigger defensive reactions. We studied whether an intervention based on self-affirmation theory reduced resistance to health-risk information and improved fluid treatment adherence.

Design: In a cluster randomised controlled trial, 91 patients either self-affirmed or completed a matched control task before reading about the health-risks associated with inadequate fluid control.

Outcome measures: Patients’ perceptions of the health-risk information, intention and self-efficacy to control fluid were assessed immediately after presentation of health-risk information. Interdialytic weight gain (IDWG), excess fluid removed during haemodialysis, is a clinical measure of fluid treatment adherence. IDWG data were collected up to 12¬†months post-intervention.

Results: Self-affirmed patients had significantly reduced IDWG levels over 12 months. However, contrary to predictions derived from self-affirmation theory, self-affirmed participants and controls did not differ in their evaluation of the health-risk information, intention to control fluid or self-efficacy.

Conclusion: A low-cost, high-reach health intervention based on self-affirmation theory was shown to reduce IDWG over a 12-month period, but the mechanism by which this apparent behaviour change occurred is uncertain. Further work is still required to identify mediators of the observed effects.
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Keywords: adherence; behaviour change; dialysis; fluid control; interdialytic weight gain; self-affirmation

Document Type: Research Article

Affiliations: 1: School of Psychology, University of Hertfordshire, Hatfield, UK 2: Health Psychology Section, Department of Psychology, Institute of Psychiatry, King’s College London, London, UK 3: Manchester Centre for Health Psychology, School of Psychological Sciences, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK 4: East & North Herts NHS Trust, Renal Unit Lister Hospital, Stevenage, UK 5: UCL Centre for Nephrology, Royal Free, London, UK 6: UCL School of Pharmacy, London, UK 7: Southend University Hospital NHS Foundation Trust, Westcliff-on-Sea, UK

Publication date: January 2, 2016

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