title: Evidence of improved fluid management in patients receiving haemodialysis following a self-affirmation theory-based intervention: A randomised controlled trial.
abstract: OBJECTIVE
  Haemodialysis patients are at risk of serious health complications; yet, treatment non-adherence remains high. Warnings about health risks associated with non-adherence may trigger defensive reactions. We studied whether an intervention based on self-affirmation theory reduced resistance to health-risk information and improved fluid treatment adherence.
  
  
  METHODS
  In a cluster randomised controlled trial, 91 patients either self-affirmed or completed a matched control task before reading about the health-risks associated with inadequate fluid control.
  
  
  METHODS
  Patients' perceptions of the health-risk information, intention and self-efficacy to control fluid were assessed immediately after presentation of health-risk information. Interdialytic weight gain (IDWG), excess fluid removed during haemodialysis, is a clinical measure of fluid treatment adherence. IDWG data were collected up to 12 months post-intervention.
  
  
  RESULTS
  Self-affirmed patients had significantly reduced IDWG levels over 12 months. However, contrary to predictions derived from self-affirmation theory, self-affirmed participants and controls did not differ in their evaluation of the health-risk information, intention to control fluid or self-efficacy.
  
  
  CONCLUSIONS
  A low-cost, high-reach health intervention based on self-affirmation theory was shown to reduce IDWG over a 12-month period, but the mechanism by which this apparent behaviour change occurred is uncertain. Further work is still required to identify mediators of the observed effects.
authors.affiliation: a School of Psychology , University of Hertfordshire , Hatfield , UK.|b Health Psychology Section, Department of Psychology , Institute of Psychiatry, King's College London , London , UK.
authors.forename: Vari
authors.initials: V
authors.lastname: Wileman
authors.affiliation: b Health Psychology Section, Department of Psychology , Institute of Psychiatry, King's College London , London , UK.
authors.forename: Joseph
authors.initials: J
authors.lastname: Chilcot
authors.affiliation: c Manchester Centre for Health Psychology, School of Psychological Sciences, Manchester Academic Health Science Centre , University of Manchester , Manchester , UK.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Armitage
authors.affiliation: d East & North Herts NHS Trust, Renal Unit Lister Hospital , Stevenage , UK.
authors.forename: Ken
authors.initials: K
authors.lastname: Farrington
authors.affiliation: a School of Psychology , University of Hertfordshire , Hatfield , UK.
authors.forename: David M
authors.initials: DM
authors.lastname: Wellsted
authors.affiliation: b Health Psychology Section, Department of Psychology , Institute of Psychiatry, King's College London , London , UK.
authors.forename: Sam
authors.initials: S
authors.lastname: Norton
authors.affiliation: e UCL Centre for Nephrology , Royal Free , London , UK.
authors.forename: Andrew
authors.initials: A
authors.lastname: Davenport
authors.affiliation: d East & North Herts NHS Trust, Renal Unit Lister Hospital , Stevenage , UK.
authors.forename: Gail
authors.initials: G
authors.lastname: Franklin
authors.affiliation: d East & North Herts NHS Trust, Renal Unit Lister Hospital , Stevenage , UK.
authors.forename: Maria
authors.initials: M
authors.lastname: Da Silva Gane
authors.affiliation: f UCL School of Pharmacy , London , UK.
authors.forename: Robert
authors.initials: R
authors.lastname: Horne
authors.affiliation: g Southend University Hospital NHS Foundation Trust , Westcliff-on-Sea , UK.
authors.forename: Mike
authors.initials: M
authors.lastname: Almond
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005440:Fluid Therapy / Q000523:psychology*; D005500:Follow-Up Studies; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D033182:Intention; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance / Q000523:psychology*; D011582:Psychological Theory; D006435:Renal Dialysis; D020377:Self Efficacy; D016896:Treatment Outcome; D015430:Weight Gain
keywords: adherence; behaviour change; dialysis; fluid control; interdialytic weight gain; self-affirmation