Christensen A J, Wiebe J S, Lawton W J
Department of Psychology, University of Iowa, Iowa City 52242, USA.
Psychosom Med. 1997 May-Jun;59(3):307-12. doi: 10.1097/00006842-199705000-00013.
The present study examined the joint role of cynical hostility and powerful others health locus of control expectancies in predicting regimen adherence in a sample of center hemodialysis patients.
Forty-eight hemodialysis patients completed the Cook-Medley Hostility (Ho) Scale and the Powerful Others Health Locus of Control (PHLC) scale. Adherence to the fluid-restriction and phosphorus reduction components of the treatment regimen was assessed by examining patients' interdialysis session weight gains and serum phosphorus (P) levels.
In a hierarchical regression analysis, higher hostility was associated with significantly higher serum P levels indicating poorer dietary and medication adherence. The main effect for hostility was qualified by the interaction of hostility and PHLC. This pattern indicated that the deleterious effect of hostility on adherence was most pronounced among patients possessing the expectancy that positive health outcomes are not strongly contingent on the actions or advice of powerful others (eg. health care providers). Similar analyses failed to show significant effects for hostility or PHLC in the prediction of interdialytic weight gain.
The present findings suggest that jointly assessing hostility and health-related expectancies may be useful in identifying chronically ill patients who are potentially at risk for difficulties in performing a prescribed regimen.
本研究考察了愤世嫉俗敌意和对有权势他人健康控制源的预期在预测中心血液透析患者样本的治疗方案依从性方面的联合作用。
48名血液透析患者完成了库克-梅德利敌意（Ho）量表和对有权势他人健康控制源（PHLC）量表。通过检查患者透析间期体重增加和血清磷（P）水平，评估对治疗方案中液体限制和磷减少部分的依从性。
在分层回归分析中，较高的敌意与显著较高的血清P水平相关，表明饮食和药物依从性较差。敌意的主效应因敌意与PHLC的相互作用而有所不同。这种模式表明，对于那些预期积极健康结果不太强烈依赖于有权势他人（如医疗保健提供者）的行动或建议的患者，敌意对依从性的有害影响最为明显。类似的分析未能显示敌意或PHLC在预测透析间期体重增加方面有显著影响。
目前的研究结果表明，联合评估敌意和与健康相关的预期可能有助于识别那些在执行规定治疗方案时可能面临困难风险的慢性病患者。
