No description available.

Asthma management in school-aged children, particularly controller medication use, is best conceptualized as parent-child shared management. Controller medication nonadherence is common, and leads to higher disease morbidity such as cough, sleep disruption, poor activity tolerance, and asthma exacerbation. The purpose of this study was to describe asthma illness representations of both school-aged children (6-11 years) with persistent asthma and their parents, and to examine their interdependence. The Common Sense Model of Self-regulation, modified to include Parent-Child Shared Regulation, provided the framework for this descriptive, cross-sectional study. Thirty-four parent-child dyads independently reported on asthma control, controller medication adherence, and asthma illness representations by completing the Childhood Asthma Control Test, Medication Adherence Report Scale for Asthma, Brief Illness Perception Questionnaire, and Beliefs about Medicines Questionnaire. Using intraclass correlations, moderate agreement was evident between the parent and child timeline (perceived duration) illness representation domain (ICC= .41), and there was a weak association between the parent and child symptoms domain (ICC = .13). The remaining controllability and consequences domains showed no agreement. Hierarchical regression analyses were used to test parent and child illness representation domain variables as predictors of parent or child estimates of medication adherence. With parent-reported medication adherence as the dependent variable, regression models used parent illness representation variables followed by the corresponding child variable. Parent beliefs about medication necessity versus concerns was a significant predictor of parent-reported treatment adherence (β = .55, p < .01). Child-reported treatment control was also predictive of parent-reported treatment adherence (β -.50, p < .01). When child-reported medication adherence was the dependent variable, the child illness representation variable was entered first followed by the parent variable. Child beliefs about medication necessity versus concerns was the only significant predictor of child-reported adherence (child β .50, p < .01), none of the parent variables reached significance. Findings from this study indicate that although there are similarities between parent and child asthma illness representations, parental illness representations do not predict children's estimation of controller medication adherence. These findings indicate that school-aged children develop illness representations somewhat independent from their parents and, therefore, are critical participants in both asthma care as well as research.

Aims: This study aims to explore the experience of osteoarthritis (OA) in older adults, drawing on concepts from the literature on chronic illness including social-cognition models (e.g. Self-Regulatory Model) and cognitive concepts (e.g. self-schema). Design and Participants: A qualitative research design and Phenomenological Interpretative Analysis Methodology were used. Sixteen participants were interviewed. Ten were recruited from an orthopaedic surgical waiting list source and six from a GP source: age ranged from 67 to 79 years, and history of osteoarthritis ranged from one to 35 years. Measures: A semi-structured interview schedule was designed and piloted, based on the research literature. Results: Analysis identified the following themes: Demands of OA (pain, impact on activity, and impact on mood); Perceptions ofOA (onset/deterioration, cause, label, seriousness, prognosis); Strategies to manage OA (use of health services, changes in behaviour, psychological strategies, appraisal of strategies); Perception of Self (compared to past/future/others) and Contextual factors (age, co-morbidity, waiting list). Links between themes were reciprocal, and a tentative model ofOA is presented. Implications: A comprehensive model of the experience of chronic illness could provide a framework to guide interventions for direct clinical interventions (e.g. adjustment to chronic illness, pain management, identification of psychological comorbidity) and indirect interventions (e.g. consultancy with other health professionals).

Prior research has indicated that laypeople construct mental representations of physical symptoms in order to attempt to understand illness (e.g., Leventhal, Safer, Panagis, 1983; Leventhal & Contrada, 1987; Lau, Bernard, & Hartman, 1989). These "illness representations" are influenced by prior experience with and prior knowledge about illness as well as efforts to seek additional information through social channels or media. More and more, the internet is a prominent source of health information, especially for older adults (aged 50 year and up). Yet, few studies have systematically examined how older adults search for health information online. Similarly, recent trends in healthcare such as health consumerism assume that patients will be more empowered if they have access to more information. However, little has been done to investigate whether patients, in fact, feel more empowered after acquiring online health information. The current study examined the online health information seeking of older adults (N = 79) in order to determine the cognitive and diagnostic processes that older adults use to acquire information. Older adults read a vignette which depicted one of two common illnesses and then were asked to "think-aloud" while they attempted to diagnose the illness. Older adults then diagnosed the illness using either a traditional search engine (Google) or popular self-diagnosis tool (WebMD Symptom Checker), and answered questions about illness representations, cognitive effort, web interactivity, and feelings of empowerment after the search. Quantitative results showed inconsistent change in illness representations. Plausible reasons for a lack of findings are discussed. Participants who used WebMD perceived greater cognitive effort while using the computer program than those who used Google, and participants who were inaccurate in their diagnosis perceived greater cognitive effort of diagnosing than those who were accurate. Accuracy was unrelated to perceived interactivity, age, or search method. Participants 50-64 years old found a new version of WebMD to be less interactive than Google. In contrast, participants 65 years or older perceived no difference in interactivity depending upon search method. In terms of empowerment, participants who used Google perceived greater choice than WebMD. There were no differences in feelings of competence depending upon search method. Qualitative results showed that participants spent the majority of time navigating the computer and processing health information. Most participants diagnosed the illness by eliminating diseases whose symptoms did not match the symptoms of the illness vignette. Participants tended to visit commercial health websites such as Everyday Health and begin their information search by typing a vignette symptom into the search bar. Participants who were 65 years or older were less confident about their diagnosis than 50-64 year old participants. Finally, participants who used Google to diagnose were more likely to comment about the credibility of the information found when compared to those who used WebMD. The current study found no change in illness representations after an online information search. However, this produces questions as to the amount of time in which the layperson constructs his/her illness representation. In addition, few differences in interactivity, accuracy, or empowerment were found between an online health information search conducted with a search engine as compared to a self-diagnosis tool. However, individual differences suggest that different age cohorts may prefer information to be presented in different ways which could influence web design. Further studies in human-computer interaction and health cognition may be able to answer the questions that arose.

The purpose of this study was to evaluate Leventhal, Nerenz, and Steele’s (1984) self-regulation model of adaptation to chronic illness when applied to children with asthma and their parents. The self-regulation model posits that illness representations influence coping, and via coping, adaptive outcomes. In the adult literature, illness representations or perceptions of symptoms, cause, time-line, consequences and control of illness have been found to be important determinants of coping and adjustment. No study, however, has examined illness representations in relation to coping and adjustment in children with a chronic illness or their parents. A second goal was to examine the influence of parents on the coping processes of their children. One hundred and twenty-eight children (7-13 years) with asthma and their 120 primary caregivers (96% mothers) were individually interviewed regarding their illness representations, and completed self-report questionnaires of coping and psychological adjustment. For both children and parents, illness representations had a direct association with psychological adjustment that was not mediated by coping. Children and parents who considered the child’s asthma to be a serious condition with frequent symptoms and serious consequences reported poor psychological adjustment, over and above any effect of the clinical severity of the illness itself. Parental illness representations and adjustment were significantly related to these same variables for children. However, after controlling for relevant demographic/asthma variables in regression analyses, only children’s illness representations remained significantly associated with parental illness representations. Children who demonstrated more negative illness representations had parents who also held more negative beliefs about asthma. These findings suggest illness representations to be an important target for psychological interventions.

No description available.

Yes / The Self-Regulation Model (SRM) identifies that the beliefs people hold about an illness can influence their responses to that illness. Although there are generic measures of illness representations, there is a need for a brief tailored measure to use with people with dementia. The aim of this study was to develop and validate a brief measure called the Representations and Adjustment to Dementia Index (RADIX). The RADIX contains questions on the SRM elements: Identity, Cause, Timeline, Control, and Consequences. The RADIX validation was conducted with a sample of 385 community-dwelling people with mild to moderate dementia who were taking part in the IDEAL cohort study. Test-retest reliability was conducted over a 4-week period with a separate sample of 20 people with dementia. The validation process resulted in a reduction in the number of items in the Timeline, Control, and Consequences items. The resulting RADIX demonstrated good acceptability, internal reliability, and test-retest reliability. All the RADIX items had low missing data, indicating good acceptability. The factor analysis confirmed that the Consequences items formed two subscales (practical and emotional consequences) that had Cronbach's α of 8 and 0.91 respectively. Test-retest reliability indicated that the Identity, Timeline, and Control items had moderate reliability and the practical and emotional consequences scales had good reliability. The RADIX demonstrates acceptable psychometric properties, proves to be a useful measure for exploring people's beliefs about dementia, and could aid the provision of tailored information and support to people with dementia.

Depression is a substantial psychopathology encountered in the dialysis population yet its association with potentially modifiable psychological antecedents are not well known. Of these potential antecedents, individual’s perception of their condition are likely to play an important role in how they adjust to their illness (Leventhal, Brissette, & Leventhal, 2003). The Common Sense Model suggests that illness representations guide the self-regulation of illness (Leventhal, Meyer, & Nerenz, 1980; Leventhal, Nerenz, & Steele, 1984). The model posits that the interpretation of illness (illness perceptions) influence the response and procedures adopted in order to regulate the illness threat. The overarching aim of the work here is to examine whether illness perceptions predict depression and its trajectory in End-Stage Renal Disease (ESRD) patients, and to establish if depression and illness perceptions are associated with adverse clinical outcomes in these patients. In order to achieve these aims it was first important to establish how best to assess depression and illness representations in the context of ESRD. A pilot study investigated whether the Beck Depression Inventory (BDI) and the Revised Illness Perception Questionnaire (IPQ-R) could be administered to haemodialysis patients (HD) while actively on dialysis. Patients completed the BDI and IPQ-R while on-dialysis and again at a time when off-dialysis (n=40). Level of agreement revealed no discernable difference between BDI and IPQ-R scores across the two conditions, although there was a slight bias with regards to scoring on somatic items of the BDI while on-dialysis. Given these data, on-dialysis assessments were employed in the studies reported. Furthermore the BDI was compared against a diagnostic standard for Major Depressive Disorder (MDD) in order to define an adjusted BDI cut-off score that would indicate potential depressive cases. The data revealed that a BDI≥16 had optimal sensitivity and specificity for MDD. This cut-off score was employed to define patients with “probable” depression. The factor structure of the BDI was the focus in the following chapter. BDI data from two larger studies (reported later in the thesis) were pooled in order to conduct confirmatory factor analysis, testing several proposed structures of the BDI. The analysis revealed that two and three factor solutions had relatively poor fit to the data. A relatively novel bi-factor model proposed by Ward (2006) had the best fit. In this model there is a general depression factor that loaded onto all of the 21 BDI items, and two smaller orthogonal cognitive and somatic factors. These factors collectively explained 91% of the total variance in BDI-II total scores, suggesting that the BDI provides a good overall measure of global depressive symptoms. The first study to examine the association between illness representations and depression was a cross-sectional study of established HD patients (n=215). Nearly 30% of the sample were depressed (BDI≥16), highlighting the extent of depressive symptoms in this patient group. Significant differences between depressed and non-depressed patients with regards to illness perceptions were evident. In logistic regression illness coherence, perceived consequences and treatment control perceptions predicted depression. Interestingly clinical variables including co-morbidity were unrelated to depression. This suggests that it is not disease severity or extra-renal co-morbidity per se that are vulnerabilities for depression, rather it is the interpretation of the disease that appears to be important. The proceeding chapter extended this cross-sectional investigation by examining the trajectory of depression (i.e. change in depression) over the first year of dialysis therapy in relation to illness representations. An incident cohort of dialysis patients (n=160) were seen at a point soon after dialysis initiation and followed up 6 and 12 months thereafter. In particular, differences between patients who start dialysis via planned route (i.e. those with progressive renal failure who had been “worked-up” to dialysis) vs. those who started dialysis suddenly (unplanned starters) were sought. Unplanned starters were more depressed than the planned patients and held different illness perceptions. Structural equation modelling of the baseline data revealed that illness perceptions predicted depression, and that path to dialysis had an indirect effect on depression as mediated through illness perceptions. Over time, depression and illness perceptions appeared to remain relatively stable although there was some evidence of a non-linear decline in depression scores over the follow-up period. In addition, illness identity decreased over time, while illness coherence (understanding) increased. Clinical and demographic factors were not associated with the trajectory of depression as assessed using Latent Growth Models. However several illness perceptions were associated with a change in depression over time, suggesting that patient’s illness representations assist in the regulation (or under-regulation) of mood. The first of two clinical oriented chapters examined the utility of illness representations in explaining fluid non-adherent behaviour. HD patients were categorised as either fluid adherent or non-adherent based upon Inter-dialytic Weight Gain (IDWG). Patients in the upper quartile of percent weight gain were defined as non-adherent (IDWG≥3.21% dry weight). The data revealed that non-adherent patients had lower timeline perceptions as compared to adherent patients. Logistic regression models were evaluated in order to identify predictors of fluid non-adherence. After several demographic and clinical variables had been controlled, lower consequence perceptions predicted non-adherence. This data points to the utility of understanding dialysis patient’s personal illness representations in relation to maladaptive health care behaviour. Finally, the potential association between depression, illness representations and short term survival in incident dialysis patients was evaluated. Patients were followed up for a mean of 545 (±271) days in which there were 27 deaths (16.9%). Patients were censored if they were lost to follow-up, transplanted or recovered renal function. In Cox survival models after controlling for several co-variates including co-morbidity, depression significantly predicted mortality. Furthermore, survival models including illness perceptions revealed that treatment control perceptions were also predictive of mortality. These results suggest that depression and beliefs surrounding treatment control contribute to the survival of dialysis patients. Possible explanations regarding these associations are presented. In conclusion the empirical investigations offered here support the thesis that illness perceptions predict depression in dialysis patients. Moreover there is evidence that illness representations are associated with maladaptive health behaviour (non-adherence) in dialysis patients. Depression and illness representations also predict short-term survival in incident patients after adjusting for important co-variates. Recent studies have shown that altering maladaptive illness perceptions via psychological intervention can have a positive influence upon outcomes (Petrie, Cameron, Ellis, Buick, & Weinman, 2002). Given the evidence presented in this thesis, testing interventions that target maladaptive illness representations in order to improve clinical and psychological outcomes seem highly relevant in this setting.

Patients’ beliefs about their illness are known to influence their experiences of illness, its psychological impact, their health behaviours, and overall health outcomes. Research into illness beliefs has typically involved written or oral methods, yet recent studies have suggested that patients’ beliefs about their illness may be embodied in visual form, in their mental images of the disease. Beliefs embedded in mental images may not be captured via traditional modes of assessment, and thus far the possible significance of this kind of ‘visual knowledge’, has been largely overlooked. Studies using visual methods to explore patients’ mental images suggest this is a viable and useful approach which may provide additional insights into their illness beliefs. Research of this kind is in its infancy however, and there are several fundamental questions concerning the existence and nature of mental images, how best to access such images, and their relationship to illness beliefs, which are as yet unanswered. This thesis employed qualitative methods to address these issues and explore the significance of mental images within the context of head and neck cancer. It consists of three empirical phases – a methodological pilot study, a qualitative meta-synthesis, and a longitudinal study. The findings indicate that many patients do generate a mental image of their cancer, and this is significant in terms of their understanding of both the disease and its treatments. Images appear to enhance patients’ comprehension of what is going on inside their bodies, and may both reflect and influence illness beliefs. In this thesis these findings are considered with reference to the methodological issues intrinsic to researching mental images, and the implications for future research and clinical practice.

Objectives This thesis aimed to explore psychological factors associated with walking behaviour in patients with Peripheral Arterial Disease, within the framework of Leventhal et al’s (1998) Common-sense Model of Self-regulation of Health and Illness. The objective was to identify psychological factors which could be modified to increase walking behaviour in these patients. Method A series of three studies were conducted to achieve these aims. The first study was an exploratory qualitative study, to explore the illness and treatment beliefs and walking behaviour of patients with intermittent claudication. The second study was a cross-sectional postal questionnaire to a cohort of patients with intermittent claudication, which tested the influence of the psychological factors identified in the qualitative study, in a larger sample. The final study was a randomised controlled trial of a brief psychological intervention designed to modify the illness and walking beliefs of patients with intermittent claudication, in order to increase walking behaviour. Results Beliefs about intermittent claudication, and beliefs about walking were both found to be associated with walking behaviour in the qualitative study. The results from the cross-sectional postal questionnaire confirmed this relationship – taken as a set, illness and walking beliefs accurately predicted adherence to minimum walking levels for 93.4% of the sample. The brief psychological intervention successfully modified illness and treatment beliefs and increased walking behaviour in patients newly diagnosed with intermittent claudication. Conclusion This thesis highlights the importance of illness and walking beliefs to the walking behaviour of patients with intermittent claudication. The thesis has added to the body of knowledge about intermittent claudication, and the findings of this thesis have implications for the treatment of patients with intermittent claudication within the health service. Theoretical and clinical implications of this research are discussed.