Date of Award


Degree Name

Doctor of Philosophy



First Advisor

Dr. Malcolm Robertson

Second Advisor

Dr. Paul Mountjoy

Third Advisor

Dr. Chris Koronakos

Fourth Advisor

Dr. Bill Carlson


Seventeen adult, chronic hemodialysis out-patients were assessed on measures of: Compliance, beliefs about their health, and depression. The Multidimensional Health Locus of Control Scale was used to assess Internal Locus of Control (LOC), Chance LOC, or Powerful Other LOC. An assessment instrument was developed by the author using the Health Belief Model, and was administered to all subjects. This was designed to give a numerical value to patients' beliefs about the severity of their illness, beliefs about their susceptibility to the consequences of noncompliance, beliefs about the benefits of compliance, beliefs about the barriers that might stand in the way of compliance, and a measure of general health-related motivation. The Beck Depression Inventory was used to measure depression. Fluid compliance was measured by comparing performance over several months with criteria established specifically for each subject. Nine subjects fit the operational definition of noncompliance and were given self-management training that consisted of self-monitoring and cognitive restructuring. A single subject design was used, comparing each person's performance after the intervention with his or her performance before the intervention. Significant results were obtained with four subjects. However, uncontrolled sources of variability may have accounted for some of the apparent effects of the independent variable. Several other clinically significant results were of interest. Noncompliant patients were found to be significantly more depressed than compliant patients. The technique of operationally defining the population at risk was useful and was recommended as a standard procedure to give the staff a more accurate assessment of patient performance. The use of the Health Belief Model appears to have some consistency and may have predictive value. However, the sample was too small for claims of significance. The model proved to be clinically useful. Some patients took interest in the training in self-monitoring, and for some persons this appears to be an effective strategy to improve compliance. Also, the technique was successful in discriminating those who were accurate estimators of their fluid intake from those who were not accurate estimators. Finally, a clinically significant finding was that several noncompliant subjects were fully aware of the consequences of fluid overloading, the severity of their illness, and the benefits of compliance, and still chose to overload on fluids. They were articulate in their awareness of the fact that, for them, the value of the short-term reinforcer outweighed the ultimate punisher.

Access Setting

Dissertation-Open Access