Abstract
According to the common-sense model of self-regulation, individuals form lay representations of illnesses that guide coping procedures to manage illness threat. We meta-analyzed studies adopting the model to (a) examine the intercorrelations among illness representation dimensions, coping strategies, and illness outcomes; (b) test the sufficiency of a process model in which relations between illness representations and outcomes were mediated by coping strategies; and (c) test effects of moderators on model relations. Studies adopting the common-sense model in chronic illness (k = 254) were subjected to random-effects meta-analysis. The pattern of zero-order corrected correlations among illness representation dimensions (identity, consequences, timeline, perceived control, illness coherence, emotional representations), coping strategies (avoidance, cognitive reappraisal, emotion venting, problem-focused generic, problem-focused specific, seeking social support), and illness outcomes (disease state, distress, well-being, physical, role, and social functioning) was consistent with previous analyses. Meta-analytic path analyses supported a process model that included direct effects of illness representations on outcomes and indirect effects mediated by coping. Emotional representations and perceived control were consistently related to illness-related and functional outcomes via, respectively, lower and greater employment of coping strategies to deal with symptoms or manage treatment. Representations signaling threat (consequences, identity) had specific positive and negative indirect effects on outcomes through problem- and emotion-focused coping strategies. There was little evidence of moderation of model effects by study design, illness type and context, and study quality. A revised process model is proposed to guide future research which includes effects of moderators, individual differences, and beliefs about coping and treatment. (PsycINFO Database Record
Highlights
This review indicates that relations between patients’ illness beliefs and important illnessrelated outcomes across studies are accounted for by sets of coping strategies
Based on the foregoing review and critique we aim to test a process model derived from Leventhal et al.’s common-sense model based on a meta-analytic synthesis of findings from studies measuring illness representations, coping strategies, and illness outcomes in patient groups with chronic illnesses or conditions2
To test the sufficiency of the model, we propose a generalized hypothesis in which the illness representation dimensions have statistically significant non-zero total indirect effects on each illness outcome mediated by the coping constructs with no direct effects of the representations on outcomes
Summary
This review indicates that relations between patients’ illness beliefs and important illnessrelated outcomes (reducing disease progression, improving functioning, promoting wellbeing, allaying distress) across studies are accounted for by sets of coping strategies (avoidance, cognitive reappraisal, emotion venting, problem-focused coping, seeking social support). It is necessary to understand the individual’s cognitive and emotional representations of the threat that initiate subsequent coping procedures directed at threat and emotion management. These two parallel processes together represent a self-regulatory system with significant implications for illness outcomes such as disease, functional state, and psychological distress that are independent of the pathological markers of illness. Whereas research on the common-sense model of self-regulation has indicated that cognitive and emotional representations of illness are related to coping procedures adopted to manage illness threat and distress, and to illness-related outcomes such as recovery or symptom management There have been previous tests of the process model in participants with particular chronic illnesses (e.g., Brewer, Chapman, Brownlee, & Leventhal, 2002; Gould, Brown, & Bramwell, 2010; Gray & Rutter, 2007; Rutter & Rutter, 2002), there has been no systematic test of a full process model adopting multiple representation, coping, and outcome variables based on a cumulative synthesis of data across research on the common-sense model in chronic illness
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