Cognitive and personality factors in the delay of gratification of hemodialysis patients.

On the basis of Mischel's (1984) social learning analysis of the process of delay of gratification in children and in line with Bandura's (1977) self-efficacy theory, we developed a model of delay of gratification in adults and tested it on dialysis patients who were continuously required to comply with a stringent regimen of fluid-intake to keep alive. We hypothesized that patients' self-evaluations of their past compliance and their efficacy expectations would be associated with their actual delay behavior. Underlying these process-regulating cognitions would be stable competencies, such as learned resourcefulness (i.e., one's self-control skills). Fifty-three dialysis patients self-evaluated their fluid intake compliance, their efficacy expectations, and their health beliefs. Resourcefulness was assessed by Rosenbaum's Self-Control Schedule. Actual fluid-intake compliance was reliably assessed by the mean body weight increase between dialyses during the 3-month period prior to the study and during two follow-up periods. The results supported the model. On the one hand, self-efficacy expectations were related to persistence with the fluid diet and on the other hand to subjects' self-evaluation of their past adherence behavior as well as to their resourcefulness. Although the path model suggested a causal pattern, the correlational nature of the study precluded any conclusions on cause-effect relationship.