title: Evidence that self-affirmation improves phosphate control in hemodialysis patients: a pilot cluster randomized controlled trial.
abstract: BACKGROUND
  Hemodialysis patients are at risk of serious health complications, yet treatment non-adherence remains high.
  
  
  OBJECTIVE
  Warnings about health risks associated with non-adherence may trigger defensive reactions. We studied whether an intervention based on self-affirmation theory (Steele 1988) reduced patients' resistance to health-risk information and improved adherence.
  
  
  METHODS
  One hundred twelve patients either self-affirmed or completed a matched control task before reading about the risks associated with a lack of phosphate control. Serum phosphate was collected from baseline up to 12 months.
  
  
  RESULTS
  Self-affirmed patients had significantly reduced serum phosphate levels at 1 and 12 months. However, contrary to the predictions derived from self-affirmation theory, self-affirmed participants and controls did not differ in their evaluation of the health-risk information, behavioural intention or self-efficacy.
  
  
  CONCLUSIONS
  A low-cost, high-reach health intervention based on self-affirmation theory was shown to reduce serum phosphate over a 12 month period. Further work is required to identify mediators of the observed effects.
authors.affiliation: School of Psychology, University of Hertfordshire, Hatfield, UK, v.a.wileman@herts.ac.uk.
authors.forename: Vari
authors.initials: V
authors.lastname: Wileman
authors.forename: Ken
authors.initials: K
authors.lastname: Farrington
authors.forename: Joseph
authors.initials: J
authors.lastname: Chilcot
authors.forename: Sam
authors.initials: S
authors.lastname: Norton
authors.forename: David M
authors.initials: DM
authors.lastname: Wellsted
authors.forename: Michael K
authors.initials: MK
authors.lastname: Almond
authors.forename: Andrew
authors.initials: A
authors.lastname: Davenport
authors.forename: Gail
authors.initials: G
authors.lastname: Franklin
authors.forename: Maria Da Silva
authors.initials: Mda S
authors.lastname: Gane
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Armitage
mesh_terms: D005260:Female; D015438:Health Behavior; D006801:Humans; D054559:Hyperphosphatemia / Q000209:etiology / Q000517:prevention & control* / Q000523:psychology; D007676:Kidney Failure, Chronic / Q000523:psychology / Q000628:therapy; D008297:Male; D055118:Medication Adherence / Q000523:psychology; D008875:Middle Aged; D010349:Patient Compliance / Q000523:psychology* / Q000706:statistics & numerical data; D010353:Patient Education as Topic / Q000379:methods; D010710:Phosphates / Q000097:blood; D010865:Pilot Projects; D006435:Renal Dialysis / Q000009:adverse effects / Q000523:psychology*; D012649:Self Concept; D016903:Drug Monitoring
chemical_list: D010710:Phosphates