The use of stages of change to improve adherence with interdialytic weight gain recommendation in hemodialysis patients

Elaine Marie Fontenot Molaison


Stages of change is a behavioral theory used to aid in understanding behavior change and plan interventions. By placing individuals in one of five stages of readiness to change, nutrition education interventions can be planned according to individual needs to produce more positive outcomes. The purpose of this experimental study was to evaluate the effects of a 12-week nutrition education intervention based on the stages of change model to promote participants readiness to change fluid intake habits and increase knowledge of appropriate interdialytic weight gain in hemodialysis patients. Stage of readiness to change, knowledge of appropriate interdialytic weight gain, and mean weight gain before, during, and after the study were obtained from dialysis patients in five intervention and five control dialysis units. Semi-stage specific education material was presented to the intervention group via bulletin boards, handouts, and dietitian feedback. Both groups were equally divided by gender, containing approximately 80% African Americans. The average age of the participants was just over 50 years, mean length on dialysis was between three and five years and mean years of education was just under 12 years. Intervention participants had a greater progression in stage ( p < .001), and had significantly more participants in the maintenance stage and significantly less in precontemplation at the end of the 12 weeks (p = .001) than the control group. Knowledge scores significantly increased in the intervention group, and scores were significantly higher than the control group scores at the two follow-up periods (p < .001). Interdialytic weight gains did not decrease in either group. For the intervention group age and length of time on dialysis were negative predictors of weight gain and stages of change (p < .05). Females tended to have lower average weight gains than males (p < .001). The increased knowledge without subsequent behavior change is common in dietary behavior research. The use of an algorithm with a more definite description of fluid intake behaviors may have aided in placing individuals in a more appropriate stage of readiness to change. Behavior change results may have been more positive if the intervention were based on individualized, stage specific education material. Nutritionists can use the information gathered in this study to plan and implement interventions for other chronic diseases requiring dietary modification. Once the stage of readiness to change is evaluated, the intervention can be aimed at the individual readiness to change. If this method is found to produce lasting behavioral change, the stages of theory can be used in the everyday wellness setting.