Behavioral Contracting With a Monetary Incentive Program to Improve Fluid Compliance of Hemodialysis Patients

Date of Award


Degree Type


Degree Name

Doctor of Philosophy (PhD)



First Advisor

James G. Hollandsworth

Advisor Department



This study investigated the effectiveness of a unit-wide behavioral contracting program that utilized monetary reinforcers to improve fluid compliance of hemodialysis patients. Sixty end-stage renal disease patients receiving dialysis at Kidney Care, Inc. in Jackson, Mississippi participated in the study. The clinical setting in which the study was conducted necessitated the use of a quasi-experimental design since subjects could not be randomly assigned to treatment conditions. Subjects who consented to participate in the study signed a contract that specified the reward for complying with fluid restrictions. Subjects who achieved fluid compliance earned the right to participate in a monetary incentive program. Weekly drawings were held for four consecutive weeks. After 4 weeks treatment conditions were reversed and the waiting list control subjects participated in the monetary incentive program. Visual inspection of graphed data was inconclusive. A two groups by four weeks analysis of covariance with repeated measures revealed no differences between groups, within groups, nor any interaction of groups and weeks. No salient differences of those subjects who did achieve criterion during the intervention phase were identified. Recommendations for future research include increasing the length of the intervention and standardizing the amount of the monetary reinforcer. Other recommendations include offering more individualized treatment programs to those patients who demonstrate serious noncompliance to fluid restrictions and using peer influence to shape behavior. In addition, the issue of alcohol and drug dependency should be addressed as such behavior may significantly affect intersession weight gain.