Abstract
BackgroundPRISM (the Pictorial Representation of Illness and Self Measure) is a novel, simple visual instrument. Its utility was initially discovered serendipitously, but has been validated as a quantitative measure of suffering. Recently, new applications for different purposes, even in non-health settings, have encouraged further exploration of how PRISM works, and how it might be applied. This review will summarise the results to date from applications of PRISM and propose a generic conceptualisation of how PRISM works which is consistent with all these applications.MethodsA systematic review, in the form of a qualitative evidence synthesis, was carried out of all available published data on PRISM.ResultsFifty-two publications were identified, with a total of 8254 participants. Facilitated by simple instructions, PRISM has been used with patient groups in a variety of settings and cultures. As a measure of suffering, PRISM has, with few exceptions, behaved as expected according to Eric Cassell’s seminal conceptualisation of suffering. PRISM has also been used to assess beliefs about or attitudes to stressful working conditions, interpersonal relations, alcohol consumption, and suicide, amongst others.DiscussionThis review supports PRISM behaving as a visual metaphor of the relationship of objects (eg ‘my illness’) to a subject (eg ‘myself’) in a defined context (eg ‘my life at the moment’). As a visual metaphor, it is quick to complete and yields personally salient information. PRISM is likely to have wide applications in assessing beliefs, attitudes, and decision-making, because of its properties, and because it yields both quantitative and qualitative data. In medicine, it can serve as a generic patient-reported outcome measure. It can serve as a tool for representational guidance, can be applied to developing strategies visually, and is likely to have applications in coaching, psychological assessment and therapeutic interventions.
Highlights
There are frequently circumstances in medicine and in the social sciences when it can be useful to gather personally salient attitudes or attributions from an individual or a group
A 2009 editorial commenting on the use of Pictorial Representation of Illness and Self Measure (PRISM) in dermatology [9] was sceptical, commenting ‘who knows what the parabola [the space encompassing the disks] means for each individual, and who knows what this distance means?’
The consistent results of PRISM as a measure of suffering suggest that it has the potential in healthcare and social science to further elucidate the nature and associations of suffering
Summary
There are frequently circumstances in medicine and in the social sciences when it can be useful to gather personally salient attitudes or attributions from an individual or a group. Gathering and aggregating personally salient data can be difficult and time consuming. Nomothetic methods, for example generic questionnaires, can elicit information about known and/or frequent attitudes. Such methods are very unlikely to access the full range of individual attitudes within any group. Idiographic methods such as personal narratives and interviews have the potential to elicit the full range of attitudes in any given group, but such methods can be difficult to apply in practice because they are time-consuming and because aggregating data from individual informants can be difficult [1]. This review will summarise the results to date from applications of PRISM and propose a generic conceptualisation of how PRISM works which is consistent with all these applications
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