Date of Award


Degree Type


Degree Name

Master of Science



Major Professor

Mary Nelle Traylor

Committee Members

Jane R. Savage, William D. Barber


Four 10-13 minute color video-tape cassettes were developed and used as a self instructional program. The cassettes were designed to reinforce the initial one-to-one therapeutic diet instruction which is routinely given by the hospital dietitian to maintenance hemodialysis patients. The tapes were shown to the subjects used in this study while they were receiving dialysis therapy in The University of Tennessee Artificial Kidney Center.

One cassette each was prepared pertaining to the dietary adjustments for protein, sodium and fluids, potassium and kilocalories. The content of the tapes was primarily directed to the needs of the educationally disadvantaged, thus obviating the use of printed words in both the information presented and the self test which was built into each tape. Graphics, cartoon characters with dialogue, food models, actual food examples, live demonstrations and line drawings for the self tests were coordinated with appropriate narration in order to emphasize important components of the diet prescription.

Sixteen subjects were randomly selected to participate in the study. Grades completed in school by these subjects ranged from second grade through the junior year in college. This population sample provided an educational and socioeconomic cross-section of the 29 patients who were currently undergoing maintenance hemodialysis in the Center. In order to assess the efficacy of the instructional program toward increasing adherence to the diet prescription, identical information and behavioral tests were administered both before the presentation of the video-tapes and one month following the presentation.

Results of the study revealed a statistically significant (P<0.001) increase in the informational recall scores of all participants following instruction by the audio-tutorial program. As was expected, the less educated group effected the greater improvement.

To ascertain the change in dietary adherence, a 24-hour recall of food intake was recorded for each patient at both pretesting and post-testing. While the dietary recall method lacks precision, the unaccountable errors in estimation of food ingested were considered to be similar at each testing period. Significant changes in percentages of adherence to the diet prescription were observed for kilocalories, sodium and water. The change in protein ingestion was positive for all subjects, but non-significant. The better educated group effected a significant, positive change in kilocalorie intake. Both groups showed an understanding of the importance of restricting sodium intake, but need additional reinforcement to achieve the prescribed level. Water was the only dietary variable which approximated the diet prescription at pretesting. The less educated subjects exhibited a significant decrease in water intake, while the better educated group decreased water intake only slightly.

These changes suggest that diet prescriptions designed to achieve more desirable biochemical profiles are realistic, and with adequate reinforcement, improved behavior should follow.

It was concluded that: (a) the audio-tutorial program was a successful technique for teaching information to the hemodialysis patients participating in this study, regardless of educational background; and (b) further reinforcement measures are required to achieve sufficient application of the information learned in order to attain the desirable adherence to the diet prescription.

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Nutrition Commons