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Cynical hostility, powerful others control expectancies, and patient adherence in hemodialysis
A J Christensen1, J S Wiebe, W J Lawton
1Department of Psychology, University of Iowa, Iowa City 52242, USA. AlanChristensen@uiowa.edu
Insights
Cynical hostility negatively impacts adherence to dialysis regimens, particularly when patients believe external factors, not their own actions, control health outcomes. This highlights the need to assess both hostility and health expectancies in chronically ill patients.
Area of Science:
- Nephrology
- Psychology
- Health Behavior
Background:
- Chronic illness management requires patient adherence to complex treatment regimens.
- Hemodialysis patients face challenges adhering to fluid restrictions and dietary phosphorus limits.
- Psychological factors, such as hostility and locus of control, may influence adherence.
Purpose of the Study:
- To investigate the combined influence of cynical hostility and powerful others health locus of control on adherence in hemodialysis patients.
- To determine if these psychological factors predict adherence to specific components of the dialysis regimen.
Main Methods:
- Forty-eight hemodialysis patients completed the Cook-Medley Hostility Scale and the Powerful Others Health Locus of Control (PHLC) scale.
- Regimen adherence was measured by interdialysis weight gain and serum phosphorus levels.
- Hierarchical regression analysis was used to examine the relationships between variables.
Main Results:
- Higher hostility was significantly associated with elevated serum phosphorus levels, indicating poorer adherence to dietary and medication recommendations.
- The negative impact of hostility on adherence was more pronounced in patients with a high PHLC, suggesting they rely less on healthcare providers' advice.
- Neither hostility nor PHLC significantly predicted adherence to fluid restrictions, as measured by interdialytic weight gain.
Conclusions:
- Assessing both cynical hostility and health locus of control expectancies can help identify hemodialysis patients at risk for adherence difficulties.
- These psychological assessments may aid in tailoring interventions to improve regimen compliance in chronically ill populations.
Objective:
The present study examined the joint role of cynical hostility and powerful others health locus of control expectancies in predicting regimen adherence in a sample of center hemodialysis patients.
Method:
Forty-eight hemodialysis patients completed the Cook-Medley Hostility (Ho) Scale and the Powerful Others Health Locus of Control (PHLC) scale. Adherence to the fluid-restriction and phosphorus reduction components of the treatment regimen was assessed by examining patients' interdialysis session weight gains and serum phosphorus (P) levels.
Results:
In a hierarchical regression analysis, higher hostility was associated with significantly higher serum P levels indicating poorer dietary and medication adherence. The main effect for hostility was qualified by the interaction of hostility and PHLC. This pattern indicated that the deleterious effect of hostility on adherence was most pronounced among patients possessing the expectancy that positive health outcomes are not strongly contingent on the actions or advice of powerful others (eg. health care providers). Similar analyses failed to show significant effects for hostility or PHLC in the prediction of interdialytic weight gain.
Conclusions:
The present findings suggest that jointly assessing hostility and health-related expectancies may be useful in identifying chronically ill patients who are potentially at risk for difficulties in performing a prescribed regimen.