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UC Irvine UC Irvine Electronic Theses and Dissertations UC Irvine UC Irvine Electronic Theses and Dissertations Title Working for the Weekend: The Effect of Cognitive Functioning, Social Support, and the Interdialytic Interval on Disease Self-Management Among Patients on Hemodialysis Permalink https://escholarship.org/uc/item/3bw6q3dr Author Henry, Shayna L. Publication Date 2014 Peer reviewed|Thesis/dissertation eScholarship.org Powered by the California Digital Library University of California UNIVERSITY OF CALIFORNIA, IRVINE Working for the Weekend: The Effect of Cognitive Functioning, Social Support, and the Interdialytic Interval on Disease Self-Management Among Patients on Hemodialysis DISSERTATION submitted in partial satisfaction of the requirements for the degree of DOCTOR OF PHILOSOPHY in Psychology and Social Behavior by Shayna Lynn Henry Dissertation Committee: Professor Larry Jamner, Chair Professor Madeleine Pahl Associate Professor Ilona Yim 2014 © 2014 Shayna Lynn Henry ii for adale, the first and the second ii TABLE OF CONTENTS Page LIST OF TABLES v LIST OF FIGURES vii ACKNOWLEDGEMENTS viii CURRICULUM VITAE x ABSTRACT OF THE DISSERTATION xx CHAPTER ONE: INTRODUCTION 1 The behavioral demands of hemodialysis 4 Issues related to the assessment of nonadherence to ESRD treatment 8 Demographic factors associated with adherence to ESRD treatment 10 Psychosocial & environmental determinants of adherence to treatment & 11 disease self-management Social support and ESRD 13 Cognitive demands of hemodialysis treatment 20 Cognitive dysfunction and the interdialytic interval 23 Family support, cognitive function, and treatment adherence 25 Ecological Momentary Assessment: Using experience sampling to measure 28 health behaviors The present investigation 33 CHAPTER TWO: METHOD 37 Participants 37 Participant recruitment 37 Procedures 38 Study instruments 42 Design considerations 60 Data analyses 62 CHAPTER THREE: RESULTS 65 Characteristics of the sample 65 Enrollment and retention 65 Description of the selected subsample 65 Data preparation 66 iii Descriptive findings 66 Hypothesis 1: Relationships between social support and adherence 75 Hypothesis 2: Relationships between momentary reports of cognitive 79 functioning and the interdialytic interval Hypothesis 3: Relationships between cognitive functioning and adherence 82 Hypothesis 4: Effects of cognitive functioning on discrepancies between 85 objective and subjective adherence Hypothesis 5: Mediating effect of cognitive function on the relationship 86 between the interdialytic interval and treatment adherence Hypothesis 6: Interactions between cognitive functioning, treatment adherence, 88 and social support Exploratory findings: Associations between personality factors, individual 88 psychological experiences, and health locus of control and cognitive functioning, social support, and adherence Summary of the results 92 CHAPTER FOUR: DISCUSSION 94 Social support and ESRD: The unique influence of disease-specific support 96 Cognitive dysfunction and the interdialytic interval: Does cognitive 101 impairment increase or decrease as a function of time since dialysis? Cloudiness, forgetfulness, and inattention: Cognitive dysfunction and 104 adherence to treatment Time since dialysis, and adherence to treatment: Does cognitive dysfunction 107 account for the relationship between adherence and the length of the interdialytic interval? Social support, cognitive functioning, and adherence: Does support buffer the 108 influence of cognitive dysfunction on behaviors of disease self-management? Explorations of personality factors, individual psychological experiences, and 110 health locus of control and study factors Assessing disease self-management in real time: The potential of mobile 113 technologies Study limitations 119 Conclusions 123 REFERENCES 125 APPENDIX 194 iv LIST OF TABLES Table 1 Study measures 161 Table 2 Self-reported disease burden 162 Table 3 DSSQ subscale ratings 163 Table 4 Personality characteristics of the present sample 164 Table 5 Kidney disease-specific health locus of control 165 Table 6 Mean levels of neurocognitive function 166 Table 7 Average mood ratings in the electronic diary 167 Table 8 Rates of receipt of momentary disease-specific social support and control 168 Table 9 Associations between interview and diary measures of disease-specific support 169 Table 10 Rates of diary-reported ESRD-related health behaviors 170 Table 11 Mean levels of momentary cognitive dysfunction across days 171 Table 12 Correlations between RABQ scores and diary reports of adherence behaviors 172 Table 13 Relationship between social support and mean interdialytic weight gain 173 Table 14 Relationship between social support and phosphorus and potassium levels 174 Table 15 Comparison of clinical and diary measures of cognitive functioning 175 Table 16 Correlations between diary- and interview-based assessments of reaction time, 176 trouble thinking, and confusion Table 17 Relationship between diary- and interview-based assessments of reaction time, 177 trouble thinking, and confusion Table 18 Relationships between clinical measures of neurocognitive functioning and 178 average interdialytic weight gain across 6 months Table 19 Relationships between clinical measures of neurocognitive functioning and 179 phosphorus and potassium levels across 6 months Table 20 Relationships between momentary measures of neurocognitive functioning and 180 mean interdialytic weight gain across 6 months v Table 21 Relationships between momentary measures of neurocognitive functioning and 181 phosphorus and potassium levels across 6 months Table 22 Mean values and ranges for discrepancies between objective and subjective 182 treatment adherence Table 23 Associations between cognitive dysfunction and discrepancies in objective and 183 subjective adherence Table 24 Relationships between length of the interdialytic interval and markers of 184 treatment adherence Table 25 Enhancing effect of slowed reaction time on the relationship between IDI length 185 and good diet behavior Table 26 Effects of momentary reports of stress on concomitant reports of cognitive 186 dysfunction vi LIST OF FIGURES Figure 1 The present study 187 Figure 2 Sample timeline for one participant 188 Figure 3 Participant enrollment and retention 189 Figure 4 Momentary mood ratings on dialysis vs. non-dialysis days 190 Figure 5 Types of fluids consumed 191 Figure 6 Mediating effects of cognitive dysfunction on IDI length and adherence 192 vii ACKNOWLEDGEMENTS A debt of gratitude is owed my committee chair and advisor, Larry Jamner, for his encouragement and guidance throughout my graduate training and his contributions to this dissertation. True to his word, he never told me what to do, but provided me with the tools and resources to develop an expertise in social behavior and its consequences. I am enormously grateful for the experiences I have had working for Professor Jamner and I know they will be echoed in my future work. I would also like to thank my remaining committee members, Sarah Choi, Ilona Yim, and especially Karen Rook and Madeleine Pahl. Each of them has brought a different perspective to the current project and I am thankful for the opportunity to work with this interdisciplinary team toward this culminating research effort. A huge thanks to Professor Rook, whose encouragement to reach out to faculty in medicine, feedback in the early phases of the project, and support in the drafting of the dissertation proposal were critical in the development of this study. Finally, my heartfelt appreciation to Dr. Pahl, who took the time to answer an email from some graduate student she didn’t know in a department she had never worked with, and set in motion an invaluable collaborative relationship. Dr. Pahl’s enthusiasm for this project and my work has been heartening and her willingness to offer up her clinical resources and expertise was critical in the success of this project. Additionally, I would like to thank the staff of the UC Irvine Medical Center Hemodialysis Unit, especially Miguel Hernandez, Karen Luker, and Pat Croft, who graciously gave of their tables and chairs, their keys, their records room, and endless other resources, as well as the patients and their families, who kindly volunteered their time and without whom this effort would not have been possible. Thanks also to the faculty and fellows of the UC Irvine Division of Nephrology and Hypertension for being kind to myself and our team as we repeatedly got in their way, even though we probably never adequately explained how we are different from social workers. Another big thanks to David Busse, who went above and beyond the call of duty as a colleague and was enormously influential in the development of this project. His input and perspective were hugely helpful as we got the study out of the lab and into the clinic. Finally, I am tremendously grateful for the support and encouragement of my husband, Brad, and my daughter, Adale, who have suffered and celebrated right along with me throughout my training and who did their best to accommodate the demands of my work and the dissertation project. I know it took more than a couple of years (sorry honey) and I know my friends will not call me doctor but they are my biggest champions and I am hugely thankful for their confidence in me and my career. viii Generous financial support for this dissertation was provided by the UC Irvine Institute for Clinical and Translational Sciences Dean’s Triumvirate Award, via the National Center for Research Resources and the
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