The effect of a self-monitoring tool on self-efficacy, health beliefs, and adherence in patients receiving hemodialysis.

OBJECTIVE: Assess the effectiveness of a self-monitoring tool on perceptions of self-efficacy, health beliefs, and adherence in patients receiving hemodialysis. DESIGN: A monthly intervention using a pretest, posttest design over a 6-month period. Both the treatment and control groups were randomly selected and received surveys to assess health beliefs, perceptions of self-efficacy for performing specific healthful behaviors, and renal diet knowledge at baseline, before intervention, and 6 months later. The treatment group also received monthly feedback of monthly phosphorus levels and interdialytic weight gains. SETTING: A university hospital-based 43-chair ambulatory dialysis center. SUBJECTS: Forty patients with end-stage renal disease (25 men and 15 women, age 26 to 78 years), on chronic hemodialysis for at least 2 months and with a history of noncompliance with phosphorus and/or fluid restrictions for 1 or more months. MAIN OUTCOME MEASURES: Self-efficacy, health beliefs, knowledge, biochemical, and demographic variables were analyzed. Analysis of variance tests of repeated measures were used to examine relationships between adherence with phosphorus and fluid restrictions to health beliefs and perceptions of self-efficacy after training in self-monitoring. RESULTS: Overall, there were no significant improvements in adherence with phosphorus and fluid restrictions between the two groups, although a comparison within the groups revealed the treatment group had a statistically significant decrease in mean phosphorus levels of 7.14 to 6.22 mg/dL (P = .005) from baseline to month 3. However, because this value was not maintained, it was not statistically significant. No significant differences existed between the two groups for health beliefs and perceptions of self-efficacy. Knowledge scores in the treatment group, however, improved significantly as compared to the control group (P = .008) and was a significant increase from baseline (P = . 002). In the control group, all scores fell slightly but this difference was not significant. CONCLUSIONS: The benefits of patient self-monitoring and behavioral contracting upon adherence in patients on hemodialysis are inconclusive, as serum phosphorus and interdialytic weight gains did not differ between the two groups. The interventional tools also appeared to have little effect on perceptions of self-efficacy and health beliefs. Trends of improvement, however, did exist for phosphorus within the treatment group and subjects in this group had a statistically significant increase in knowledge scores over time. Additional research using repeated measures design is needed to explore the effects of increased frequency and duration of an intervention on the attainment of patient clinical outcome measures.

My guardian angel: a learning exercise for adolescent AIDS education.

This article describes the methods to conduct a simple role-play exercise. The purpose of the exercise is to practice skills to prevent HIV infection and AIDS, including peer communication about personal health decisions among high school and college students. With guidance from the instructor, each student individually prepares a written Personal Prevention Plan for actions they intend to prevent AIDS. Following completion of the Plan, two pairs of students role play using a prepared scenario. The scenario includes a dilemma about a dating couple choosing to have sexual intercourse and the reactions of their closest friends. Other students in the class observe the interactions of their peers. After the role play, all of the students discuss factors that influence dating and intimate behaviors including peer attitudes and beliefs. Students volunteer ideas to counter perceived peer pressure for sexual intercourse.

Lesions in ventromedial hypothalamus or amygdala do not affect naloxone's suppression of water consumption.

Rats received lesions in the ventromedial hypothalamus (VMH) or amygdala, or were sham operated, and then were tested for two-hour intake of water after injections of naloxone (2 mg/kg), MIF-1 (2, 4, or 8 mg/kg), or diluent. There was a significant effect of test compound, with naloxone reducing consumption relative to the diluent control and the largest dose of MIF-1. Although MIF-1 tended to suppress drinking, the effect did not reach significance. There was no main effect for lesions, indicating that the amygdala and the VMH do not play a critical role in the effect of naloxone or MIF-1 on water consumption. A significant lesion by time interaction occurred, however, with amygdala-lesioned rats drinking the most in the first 30 min but much less after that. The VMH rats drank the most in the 30-60 min interval, but there were no differences in groups after 60 min. Thus, it appears that the intact VMH and basolateral amygdala are not necessary for naloxone's suppression of water consumption in the rat.