How do Patients Understand their Illness Common Sense Models of Illness and their Effects on their H

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How do Patients Understand their Illness? Common
Sense Models of Illness and their Effects on
their Health

• Sara Joice
• Health Psychology Course Level 1 21.11.05

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Aims

• Describe Leventhals Self Regulation Model (SRM)
• Present examples of qualitative evidence
• Present examples of quantitative evidence
• Application of the model
• Summary

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Lecture Plan

• Overview of last week
• The model
• Evidence including your representations
• Applications
• Summary

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Last week

• Patients in the video described their illness in
  terms of identity, time, control and consequence
• Biased sample because very positive about their
  recovery
• There are people with chronic illness who are not
  so positive

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Why try and understand?

• Why is it that people with the same chronic
  condition respond differently to their illness?
• What is it in those who respond in a positive
  manner that differentiate them from those who
  respond in a negative manner?

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Leventhals Self Regulation Model
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Culture, Language, Institutional Roles etc.
Self system Identity Time-line
Self control Cause
Consequences
Source of attributes i.e. Future
Selves Procedural Beliefs (Conservation, Exercise
to strengthen etc.)
Representation of danger
Coping procedures
Appraisal
Situational stimuli inner outer
Representation of fear
Coping procedures
Appraisal
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Headache - 5 domains

• Identity my head hurts
• Cause too much beer
• Time - last night and the headache is not going
  away
• Consequence this lecture is droning on
• Control go to sleep

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Coping

• zzzzzzzzzzzzzz

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Headache - 5 domains reappraisal

• Identity my head still hurts
• Cause not taking a paracetamol
• Time - its been over an hour now
• Consequence this lecture is still droning on
  but I need to listen cos of exams
• Control take a paracetamol after lecture

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History

• Health Beliefs Model
• Patients perception of severity and
  vulnerability to a health threat would motivate a
  change in health-related behaviour.

• Drive Reduction Theory, if actions failed to
  remove (fear and) danger avoidant denial and
  unrealistic reassurances would remove fear while
  leaving danger intact

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Leventhal et al (1965)

• 2x2 design
• Gp 1 Letter low threat action plan
• Gp 2 Letter hi threat no action plan
• Gp 3 Action plan only
• Gp 4 Neither letter or action plan
• Results Action plan increased uptake of
  immunisation regardless of threat level

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Therefore

• Fear itself does not change behaviour !

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Meyer et al (1985)

• Design qualitative structured interviews
• Gp 1 ( n50) normotensives
• Gp 2 (n65) newly treated
• Gp 3 (n50) continuing treatment
• Gp 4 (n65) re-entry

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Results

• 92 patients in continuing treatment group could
  tell when their blood pressure was up
• 80 agreed with the statement that you cannot
  tell when your blood pressure is up
• 40 of newly diagnosed believed their
  hypertension to be acute
• 64 of re-entry believed it to be chronic
• 80 had reasons for why they had hypertension

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Lau and Hartman (1983)

• Design qualitative
• Time 1 (n257) measures of performance of
  health behaviours and health locus of control
• Time 2 to think about the last time they were
  unwell and write down the reasons for why they
  had gotten sick on that occasion

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Results

• Reasons for getting sick fell into two groups
  external factors and internal factors
• 40 offered multiple reasons
• Reasons for recovering passive, external factors
  and internal factors
• If a person believes it was there fault of
  getting the disease they were more active in
  their recovery

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Representation of danger
Coping procedures
Appraisal

Situational stimuli
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Coping procedures

• Cognitive and behavioural actions we take to
  enhance recovery
• Or do not take!
• They are numerous and illness specific
• Self efficacy and belief in effectiveness of
  plans

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Evidence for coping

• Heijmans 1999 negative coping associated with
  with chronicity and low control
• Earll et al 1993 positive coping associated with
  greater identity and consequences

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Appraisal

• Revises the illness representations the
  individual holds
• Difficult to operationalise
• One suggestion has been satisfaction outcomes

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Five properties

• Illness representations and action plans define
  behaviour
• It defines 5 specific domains
• The 5 domains are bi-level abstract and
  concrete
• Separate cognitive and affective systems interact
• Contextual factors are assumed

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Revised Illness Perception Questionnaire (IPQ-R)
Moss-Morris R Weinman J Petrie K et al (2002)

• items response
• Identity (symptoms) 14 yes/no
• Time-acute 6
• cyclical 4
• Consequence 6 5 point
• Control-personal 6 scale
• treatment 5

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Cause

• items response
• - psychological 6
• - risk factors 7 5 point
• - immunity 3 scale
• - accident/chance 2

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Identity
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Illness representations
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Comparing illness representations
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Possible Causes
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Cause
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Identified first factor cause
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Identified third factor cause
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Applications (Petrie et al 2002)

• RCT
• 65 MI patients received an intervention based on
  own illness representations
• Results showed a positive change in patients
  attitudes to MI
• Better prepared on discharge
• Returned to work quicker
• Reported lower rates of angina

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Summary

• Leventhals Self Regulation Model (SRM) has been
  described
• Qualitative evidence from Meyer et al and Lau and
  Hartman
• Quantitative evidence from yourselves and Moss
  Morris et al
• Applications by Petrie et al

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The SRM

• Contextual factors
• Dynamic
• 5 domains
• It is continually being developed and tested

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• The end

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References

• Meyer, D, Leventhal, H and Gutman, M. (1985)
  Common-sense Models of Illness The example of
  hypertension Health Psychology 4 2 115 - 135
• Leventhal, H., Meyer, D. Nerenz, D. (1980) The
  Common Sense of illness danger . In S.Rachman
  (ed) Contributions to Medical Psychology (Vol.
  II p 7 30) NewYork Permagon Press.
• Cameron, L.D. Leventhal, H. (eds) (2003) The
  Regulation of Health and Illness Behaviour
  Routledge, London
• Moss-Morris, R. Weinman, J. Petrie, K. Horne, R.
  Cameron S.D., Buick, D. (2002) The Revised
  Illness Perception Questionnaire (IPQ-R).
  Psychology and Health 17 11-16
• Weinman, J. (1998) Health Care. In (Eds.) D.W.
  Johnston and M. Johnston Health Psychology, Vol.
  8 of (Eds.) A.S. Bellack and M. Hersen,
  Comprehensive Clinical Psychology, Oxford,
  Permagon

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References

• Petrie, K.J., Cameron, L.D., Ellis, C.D., Buick
  D., Weinman, J. (2002) Changing Illness
  Perceptions After Myocardial Infarction An Early
  Intervention Randomized Control Trial.
  Psychosomatic Medicine 64 (4) 580 586
• Heijmans, M. (1999) The Role Of Patients Illness
  Representations In Coping And Functioning With
  Addisons Disease. British Journal Of Health
  Psychology 4 137 - 149
• Earll, L. Johnston, M. Mitchell, E. (1993) Coping
  With Motor Neurone Disease An Analysis Using
  Self-Regulation Theory. Palliative Medicine 7,
  (supp 2) 21-31
• Lau, R.R., Hartman, K.R. (1983) Common Sense
  Representations Of Common Illnesses. Health
  Psychology, 2, 167 185.
• Leventhal, H., Singer, R. and Jones, S. (1965)
  Effects Of Fear And Specificity Of
  Recommendations Upon Attitudes And Behaviour.
  Journal of Personality and Social Psychology 6
  313 321.
• Brownlee, S., Leventhal, H., Leventhal, E. A.
  (2000) Regulation, Self-Regulation and
  Construction of the Self in the Maintenance of
  Physical Health. In M. Boekartz, P.R. Pintrick
  and M. Zeidner (Eds.) Handbook of
  Self-Regulation, San Diego, CA Academic Press.