Illness Perception Research Articles

Pattern of Non-prescription Drug Use in Febrile children Prior to Outpatient Visit in a Semi Urban Tertiary Hospital

Background: Use of drugs without any prior medical consultation is a common practice in lower and middle income countries which causes health hazards and misuse or overuse of drugs. Fever is a common symptom for which parents seek medical care according to their knowledge and ability. Objective: To observe the patterns of drug use, source of drugs, and identify the factors associated with the use of non-prescription drugs in febrile children. Methods: This is a hospital based observational cross sectional study conducted over a period of four months in the Ashulia Women and Children Hospital (AWCH). Study population was the febrile children attending paediatric out patient department. Data was collected from parents/caregiver through a pretested questionnaire. Result: Among 614 study children 77.2% had fever for less than 5 days and out of them 544(90.7%) children were treated with different types of drugs. Out of them 90.1% children had drugs without any prescription mostly from drug retailers (54.8%). Commonly used drug was antipyretic (99.3%) followed by antibiotic (49.1%) and antihistamine (31.9%) and 73.16% children were treated with multiple drugs. Cefixime (40.8%) was found to be a widely used antibiotic. Perception of mild illness (53.3%) was reported predominantly as a cause of using drugs without medical advice. Conclusion: This study reveals use of multiple drugs including antibiotics for treating febrile illness of children prior to medical consultation and treatment was most commonly taken from drug retailers. BANGLADESH J CHILD HEALTH 2023; VOL 47 (1) : 39-42

Media Coverage of Sports Concussion: An Experimental Study of Framing Effects on Community Injury Perceptions

The media portrayal of sports concussion (SC) contributes to community understanding of injury. However, this could be hampered by inaccurately framed (minimising) SC coverage. 157 volunteers were randomly allocated to one of six online survey conditions. The conditions used a brief written news sports report with a non-serious (MI) or serious (MA) SC frame. Additional conditions varied the injured player’s sex (male or female) or the sport (unnamed or basketball). Standardised measures were administered, including the Illness Perceptions Questionnaire-Revised, and a custom-measure of perceptions of SC seriousness (SISI). A series of one-way ANOVA’s revealed one statistically significant framing effect for the SISI ( p < .05, large effect). Post-hoc pairwise comparisons found higher SISI scores for MA compared to MI conditions. There was no difference in the player sex or sport variants. No differences were found on other outcome measures. This study replicated a MA versus MI framing effect on the SISI, however wider effects were not seen. The framing effect on community perceptions of SC may be more circumscribed than previously suggested. While this requires further investigation, minimising frames should still be avoided as per existing recommendations.

Using word clouds to reveal patients' perceptions about their arthritis.

Patients' perceptions about their illness have the power to influence health outcomes. However, existing illness belief measures can be burdensome. Using word clouds to illustrate patients' experiences is potentially a novel solution, but research is lacking in this area. This study aimed to explore whether word clouds illustrate patients' perceptions about their illness and to determine commonalities and differences in experiences of rheumatic diseases. A cross-sectional study was conducted with 323 patients with rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, or gout in New Zealand. Participants reported two words describing their inflammatory arthritis experience and completed the Brief Illness Perception Questionnaire. Word clouds were generated from participants' responses, and analysis of variance models were used to explore perceptions between groups. Eleven themes were identified, with each constituting a percentage of total word occurrence and weighting in word clouds. Symptom/sensation was the most prominent theme across all conditions (35%-61%), followed by affect/emotional experience (16%-25%). Theme prevalence varied across word clouds for each condition. Social impact was more prevalent for gout, and burden/intrusion was more prominent for ankylosing spondylitis. Functioning was less prevalent in the gout word cloud than in other conditions. There was moderate overlap between word cloud themes and illness perception domains. Word clouds uniquely identified themes related to burden/intrusion, functioning, opportunity, and social impact of illness. This study supports using word clouds as a low-burden method of examining the experiences of patients with inflammatory arthritis and could be tested with other patient groups. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Remote monitoring of rheumatoid arthritis (REMORA): study protocol for a stepped wedge cluster randomized trial and process evaluation of an integrated symptom tracking intervention

BackgroundManagement of rheumatoid arthritis (RA) relies on symptoms reported by patients during infrequent outpatient clinic visits. These reports are often incomplete and inaccurate due to poor recall, leading to suboptimal treatment decisions and outcomes. Asking people to track symptoms in-between visits and integrating the data into clinical pathways may improve this. However, knowledge on how to implement this into practice and its impact on services and outcomes remains scarce in RA. Therefore, we evaluate the comparative effectiveness and cost-effectiveness of integrated symptom tracking in people with RA over and above usual care, while generating insights on factors for successful implementation.MethodsIn this superiority stepped wedge cluster-randomized controlled trial with continuous recruitment short exposure design, 16 rheumatology outpatient departments (clusters) recruit a total of 732 people with active RA. They initially offer clinic visits according to standard of care before switching in pairs to visits with integrated symptom tracking. Clusters switch in randomized order every 3 weeks. Integrated symptom tracking consists of (1) a mobile app for patients to track their symptoms daily and other RA aspects weekly/monthly, and (2) an interactive dashboard visualizing the app data, which healthcare professionals access from their electronic health record system. Clinic visits happen according to usual practice, with tracked symptom data only reviewed during visits. Our primary outcome is a difference in marginal mean disease activity score at 12 ± 3 months between standard of care and integrated symptom tracking, after accounting for baseline values, cluster, and other covariates. Secondary outcomes include patient-reported disease activity, quality of life and quality-adjusted life-years, medication/resource use, consultation and decision-making experience, self-management, and illness perception. We also conduct interviews and observations as part of a parallel process evaluation to gather information on implementation.DiscussionOur trial will generate high-quality evidence of comparative and cost-effectiveness of integrated symptom tracking compared to standard of care in people with RA, with our process evaluation delivering knowledge on successful implementation. This optimizes the chances of integrated symptom tracking being adopted more widely if we find it is (cost-) effective.Trial registrationRegistered 4-Jun-2024 on https://www.isrctn.com/, ISRCTN51539448.Trial open science framework repositoryhttps://osf.io/sj9ha/.

Pain in Biologic-Treated Rheumatoid Arthritis Patients: The Role of Illness Perception Before and After the COVID-19 Pandemic.

We aimed to assess the role of the COVID-19 pandemic in the association of clinical, physical, and psychological factors with pain in Rheumatoid Arthritis (RA) patients. We included 103 RA patients (81.6% females; mean age 56.1±13.8years). Patients filled out the VAS-pain, GAD-7, PHQ-9, MFI-20, and B-IPQ. Paired sample t-tests, correlations, and multiple regression analyses were used to analyse the data. Our results showed significantly worsened pain in the data collected post-pandemic (p≤0.05). Pre-pandemic, the final regression models showed an association between functional disability (β=0.24; p≤0.05), illness perception (β=0.34; p≤0.05) and pain. In post-pandemic models, significant associations were found between fatigue (β=0.33; p≤0.01) and illness perception (β=0.36; p≤0.01) with pain. Positive illness perception was able to alleviate the associations between fatigue and depression with pain before and after the pandemic. Findings indicate that patients with RA may have been negatively affected by the COVID-19 pandemic given their vulnerability. Even though pharmacological treatment was not interrupted, post-pandemic results showed significantly higher levels of experienced pain. Therefore, in addition to biological therapy, non-pharmacological interventions, including psychological support aimed at diminishing negative illness perception, may be beneficial in reducing RA-related pain, especially when dealing with a crisis.

Community perception towards mental illness and help-seeking intention in Southwest Ethiopian Peoples Regional State.

Community perception of mental illness is a collective belief system and attitude about mental disorders; it affects the availability of services, the level of stigma, and the help-seeking intention. This study assessed community perceptions towards mental illness and help-seeking intentions in Southwest Ethiopia. A community-based analytical cross-sectional study was done in Southwest Ethiopian People's Regional State (SWEPRS), from March 1st to June 30th, 2021. All adult individuals >18 years old living in the region were the source population, while all adult >18 years old living in the selected household were the study population. The calculated sample size was 1028. Participants were selected using a multistage sampling technique. A structured, interview-based questionnaire was used to collect the data. The data were entered into Epidata Manager and exported to SPSS for analysis. The response rate for this study was 95.4%. The prevalence of poor perception and unfavorable help-seeking intention of mental illness were 45.8%, 95% CI (42.6, 48.9), and 49.5%, 95% CI (46.4, 52.7) respectively. Being rural [AOR = 1.94 (95% CI:(1.41, 2.66)]c, lack of information [AOR = 4.82(95% CI: (3.39,6.83)], exposure to mental illness [AOR = 4.11(95% CI:(2.64,6.38)] were significantly associated with poor perception of mental illness. Also, gating mental illness information [AOR = 0.40 (95% CI: (0.19, 0.83)], and being exposed to mental illness [AOR = 0.56 (95% CI: (0.41, 0.79)] were significantly associated with unfavorable help-seeking intentions for mental illness. The high prevalence of poor perceptions and unfavorable help-seeking intentions for mental illness can be minimized through providing tailored information regarding the cause, type, and severity of the problem, particularly in the rural areas.

Path analysis of illness perception, medication beliefs, family support on inhaler adherence in elderly COPD patients: Based on triadic reciprocal determinism

ObjectiveThis study aimed to explore the pathways through which personal factors (demographic characteristics, illness perception, medication beliefs) and environmental factors (family support) influence adherence to inhaler therapy among Chinese elderly patients with chronic obstructive pulmonary disease (COPD) based on the triadic reciprocal determinism. MethodsA cross-sectional survey was conducted from June 2022 to December 2023 using the Test of Adherence to Inhalers (TAI), the Beliefs about Medicines Questionnaire (BMQ), the Brief Illness Perception Questionnaire (B-IPQ) and the Family Support Scale to investigate 305 elderly COPD patients (mean age 70.96 years, 213 males) from the Department of Respiratory Medicine of a comprehensive hospital in Anhui, China mainland. Path analysis was performed using AMOS 22.0. ResultsPath analysis showed that illness perception, necessity beliefs, concerns beliefs and family support all had direct effects on inhaler adherence, while age had an indirect effect on adherence. Additionally, necessity beliefs and concerns beliefs exhibited significant mediating effects between illness perception and inhaler adherence. Family support respectively mediated the relationships between necessity beliefs, concerns beliefs and inhaler adherence. ConclusionA multidimensional approach targeting cognitive, belief and family factors holds promise for substantially improving inhaler adherence among elderly COPD populations. Practice ImplicationsThis study provided new perspectives for improving inhaler adherence in COPD patients. Healthcare providers should emphasize improving patients' illness perception and medication beliefs, considering the important impact of family support on inhaler adherence.

Adverse Drug Reactions and Predictors of Medication Adherence in Patients with Prostate Cancer.

Adherence to therapy with prostate cancer medicines is critical for delaying the progression of disease and enhancing health outcomes. To determine patients' medication adherence, the predictors of adherence, and the frequency and types of adverse drug reactions (ADRs) in persons with prostate cancer. A serial entry-point cross-sectional study of patients with prostate cancer was conducted in 3 cancer hospitals in Nigeria over a 12-month period (January 7, 2022, to January 3, 2023). Data on medication adherence were self-reported by patients, and data on ADRs were obtained from hospital records. Descriptive and inferential statistical analyses were performed, and p less than 0.05 was considered statistically significant. Of the 133 study participants, most 112 (84.2%) reported high medication adherence. The cost of drugs was the most frequently reported potential barrier to adherence (n = 63, 47.4%). Adherence was significantly dependent on family history of cancer (df = 3, F = 4.557, p = 0.005) and health-related quality of life (HRQOL) (ß = 0.275, T = 2.170, p = 0.032) but not illness perception (ß = 0.046, T = 0.360, p = 0.72). Adverse events were observed in 36 participants (27.1%) and were deemed to be "possible ADRs" (n = 19, 53%) or "probable ADRs" (n = 17, 47%); all were nonpreventable and expected (100%), and most (n = 31, 86%) were within the level 1 category of severity. Loss of erection and low libido was the most frequently reported ADR (n = 14, 39%). In this study, medication adherence was high, with cost being a potential barrier to adherence. Family history of cancer and HRQOL significantly predicted medication adherence. The medications were well tolerated, and observed ADRs had minor severity. Policies targeting the reduction of cost-related factors for prostate cancer medications are essential.

Effectiveness of a peer-to-peer, self-management intervention for young people with depression and anxiety in Denmark: an observational study and a propensity score-matched comparison.

This study investigated the effectiveness of a 7-weeks peer-to-peer program for young people aged 15 to 25 years with depression or anxiety symptoms in Denmark. A total of 483 participants (72% women) participated in the program and the evaluation. The participants completed questionnaires at baseline, postintervention, and at 5-month follow-up to assess changes in depression symptoms (using Beck's Depression Inventory-II), anxiety symptoms (using Spielbergers State-Trait Anxiety Inventory for Adults) and self-efficacy in controlling or managing the illness (using the personal control subscale from the Illness Perception Questionnaire-Revised). Analyses were done using repeated measures mixed linear regression models. Moreover, a register-based matched comparison group was derived as a comparison to assess changes in being in education and employment at 8-month follow-up. Within the intervention group, both depression and anxiety scores declined across the 5-month follow-up compared to baseline (b = -9.6, 95% CI: -11.2, -8.1 for depression symptoms). The self-efficacy score increased from baseline to post-intervention (b = 1.4, 95% CI: 1.0, 1.8) and this level was maintained at follow-up. More than half of the participants were in education at baseline while 24% received social transfer payments. Compared with matched comparison group, a lower proportion of the intervention group remaining in education (71% vs. 80%). Among participants who were employed at baseline, a higher proportion of the intervention group were enrolled in education (27% vs. 19%) and were unemployed (14% vs. 4%) compared to the matched comparison group. This study supports the effectiveness of a peer-to-peer intervention for depression and anxiety symptoms, and self-efficacy in symptom control. However, mixed effects on education and employment were observed, indicating a negative impact on education among those initially enrolled and a higher proportion of employed participants starting education.

Translation and psychometric properties of the Hebrew version of Patient Enablement Instrument for Back Pain (PEI-BP)

BackgroundLow back pain (LBP) is a widespread cause of disability worldwide. Self-management is a significant factor impacting an individual's ability to cope with LBP. The Patient Enablement Instrument for Back Pain (PEI-BP) assesses the ability of people with LBP to self-manage their illness. ObjectiveThis study aimed to translate and culturally adapt the PEI-BP into Hebrew and evaluate the reliability, validity, and responsiveness. DesignCross-sectional study with a nested prospective sub‐sample. MethodsThe PEI-BP was translated and culturally adapted into Hebrew using recommended guidelines. We included 188 LBP patients. The psychometric properties of the PEI-BP were evaluated according to the COSMIN methodology. For construct validity, the Ronald Morris disability questionnaire, the Brief Illness Perception Questionnaire, the Fear-Avoidance Beliefs Questionnaire-physical activity, the 12-item Short‐Form Health Survey mental health, and the Numerical pain rating scale were included. To assess reliability, a sub-sample of participants (n = 50) completed the PEI-BP again after one week and after six weeks (n = 50) to evaluate responsiveness. ResultsThe PEI-BP demonstrated good internal consistency (Cronbach's α = 0.821) and test-retest reliability (ICC = 0.77). For construct validity, four out of the five hypothesized correlations were confirmed. Responsiveness showed a Receiver Operating Characteristic curve area of 0.81 (95% CI 0.67–0.93); the minimal detectable change was 14.5. A potential significant ceiling but no floor effects were observed (17.5% and 6.4%, respectively). ConclusionsThe translation and validation of the PEI-BP suggest that it is a feasible, reliable, valid, and responsive instrument for evaluating 'patient enablement' with LBP in the Hebrew-speaking population.

Qualitative Exploration of Experiences of Mental Illness and Stigma Management Strategies Among University Students in Lahore

Current literature on student mental health offers ample evidence of a worldwide increase in the prevalence of mental health issues among university students. However, there is limited literature from a social constructionist approach within Pakistan examining the student perception of mental illness, stigma, stigma management, and barriers to help-seeking. This study attempts to bridge the gap by conducting a descriptive qualitative study using the social constructionist framework to understand the perception of mental illness and its corresponding stigma in a fluid, non-canonical fashion. Semi-structured interviews with 11 university students reveal the personalized meanings given to the critical terms within the study. Intersectional dimensions of gender, class, and level of education are extensively explored, considering the student’s perceptions. The reflexive thematic analysis identifies perceived determinants of mental illnesses, the perceived relationship between mental illness and stigma, stigma management strategies employed by respondents, and perceived coping mechanisms. In Pakistan, where mental illness is not only prevalent but highly stigmatized, this research hopes to be a valuable addition to scholarly research on mental health and illness among young people in higher education institutes.

Opioid Misuse by Adults with Chronic Pain: The Impact of Illness and Medication Beliefs.

Why do some adults with chronic pain misuse their prescription opioids when others do not? Based on the extended Common-Sense Model, the study evaluated whether adults' beliefs about their pain have an indirect effect on risk of opioid misuse through beliefs about opioids when controlling for depression. The sample included 297 adult participants in the U.S. recruited from Prolific, an online crowdsourcing website. Study measures included the Illness Perception Questionnaire-Revised (IPQ-R; protective and threat-related illness beliefs about chronic pain), the Beliefs about Medicines Questionnaire-Specific subscale (BMQ-Specific; concern and necessity medication beliefs about prescription opioids), and the Current Opioid Misuse Measure (COMM; risk of current opioid misuse). This cross-sectional parallel mediation analysis was conducted using MPlus. After controlling for depression, the indirect effect of protective illness beliefs on opioid misuse risk through concern medication beliefs (b = -0.01, 95% CI (-0. 038, -0.001), and the indirect effect of threat-related illness beliefs on opioid misuse risk through necessity medication beliefs (b = 0.02, 95% CI (0.004, 0.036) were significant. The full model explained 35% of the variance of opioid misuse risk. Adults with chronic pain with stronger protective beliefs about pain were less likely to have concerns about their opioids and were at lower risk for opioid misuse, while those with greater threat-related beliefs about pain were more likely to believe that their opioids were necessary and be at greater risk for opioid misuse. Results have implications for medical and mental health providers and future research.

Correlation between illness perceptions and self-reported degree-of-worry in somatic ill patients in emergency care: a Danish cross-sectional study.

The study aimed to investigate the correlation between illness perceptions and self-reported degree-of-worry (DOW) in patients presenting to the emergency department with acute somatic illness. A cross-sectional survey study collected data from a survey on DOW, the Brief-illness Perception Questionnaire (B-IPQ) and demographics. An emergency department at a university hospital in the Capital Region of Denmark. 944 patients (≥18 years) presenting to the emergency department with acute somatic illness. Data collection was conducted during day and evening shifts on weekdays from 13 January to 19 December 2020. Correlations between B-IPQ scores and DOW, including (1) the total B-IPQ score, (2) emotional representations (emotion and illness concern combined) and (3) the single items, respectively. Secondary analysis: linear relationships between the single B-IPQ items and DOW. Analyses included the variables sex, age, reason for contact, self-reported comorbidity, employment, highest educational attainment, cohabitation status and region of origin. The study found moderate correlations between the total illness perceptions score and DOW of 0.47 (95% CI 0.42 to 0.52) and emotional representations and DOW of 0.57 (95% CI 0.52 to 0.61). Linear regression showed the largest and most significant changes in DOW with an increasing score of the B-IPQ items for consequence, illness concern and emotion. Illness perceptions overall and perceptions of consequences of symptoms, illness concern and emotional representations are correlated with patients' DOW, with increasing DOW related to more negative illness perceptions. This finding contributes to insight into how illness perceptions are related to illness worry when presenting to the emergency department. Incorporating the novel DOW scale may aid triage and clinical encounters in the emergency department. ClinicalTrails.gov reference: NCT04226040.

A feasibility study of a couple-based illness perception intervention for couples coping with colorectal cancer

PurposeAs a special psychological variable, illness perception significantly affects the cancer adaptions of colorectal cancer couples. No studies focus on facilitating cancer adaption by targeting the illness perception in colorectal cancer couples. This research attempted to explore the feasibility, acceptability, and potential effectiveness of an illness perception intervention program designed for couples with colorectal cancer, guided by a self-regulation common sense model. MethodsA single-group pilot study including pre- and post-testing was carried out with Chinese couples having colorectal cancer. Six sessions were delivered consecutively by researchers via in-person or telephone for couples. By calculating the rates of recruitment and retention, the feasibility of the intervention was analyzed. Intervention acceptability was evaluated by analysis of the post-intervention quantitative and qualitative data. Outcomes were described as illness perception, cancer-related communication problems, dyadic coping, quality of life, anxiety and depression, and benefit finding. Effect sizes were computed to assess the preliminary program effects. ResultsThe feasibility was confirmed by the recruitment (67.6%) and retention (82.6%) rates. The acceptability was endorsed by the reported participant satisfaction. Validating the program’s preliminary effectiveness, the intervention program has moderate effect sizes (Cohen’s d: 0.33-0.79) that boost illness perception and major cancer adjustment results for patients and their spousal caregivers. ConclusionsThe research proved that the couple-based illness perception intervention among colorectal couples was feasible, acceptable, and initially effective. To investigate this intervention program more thoroughly and apply it to a wider range of disease backgrounds, an extensive randomized controlled experiment is necessary.

How illness perception congruence between patients with cancer and caregivers affects their anxiety and depression levels

Abstract Background: This study aimed to investigate the similarities or discrepancies in illness perception between patients with cancer and their primary caregivers by examining the predictive effect of illness congruence on anxiety and depression in both patients and caregivers. Methods: A total of 106 patients with cancer with outpatient chemotherapy aged 18–65 years (M = 49.60; SD = 11.35; 60.4% female) and 106 caregivers aged 18–65 years (M = 42.97; SD = 12.51; 50.9% female) participated in the study, which was conducted at the outpatient chemotherapy unit of a large public hospital. Data were collected through convenience sampling using a cross-sectional design. Depression and anxiety levels were measured using the Hospital Anxiety and Depression Scale, whereas illness perception was measured using the Brief Illness Perception Scale. Results: Multiple hierarchical regression analysis determined that higher illness perception congruence significantly predicted higher anxiety levels in patients with cancer after controlling for demographic variables. Conclusion: The results revealed that higher illness perception congruence between patients and their caregivers was associated with increased anxiety in patients with cancer. Both patients and caregivers perceiving the illness negatively might have accounted for the higher anxiety levels of the patients. Furthermore, the findings demonstrate and emphasize the vital role of further dyadic investigations, in which family members are also involved.

Effects of Mobile Application-Based Cognitive Behavioral Therapy on Psychological Outcomes in Women Treated for Breast Cancer: A Randomized Controlled Pilot Trial in Germany.

Breast cancer has a strong impact on the mental state of those affected. Cognitive behavioral therapy (CBT) is one effective approach to reduce disease burden. This randomized controlled pilot trial aimed to assess the effect of the digital CBT-based application Living Well on psychological outcomes in a German female breast cancer population. Female breast cancer patients (n=70) with ongoing or finished oncological treatment that is who were receiving or had received any type of oncological treatment were included in the study and randomized to an intervention group (IG, n=32) receiving Living Well in addition to care as usual, and a control group (CG, n=38) receiving care as usual only. Participants completed standardized questionnaires at baseline and after 2, 4, 8, and 12weeks to assess anxiety and depression (HADS) as primary outcomes, distress (DT), health-related quality of life (HRQoL, AQoL-8D), and illness perception (B-IPQ) as secondary outcomes. After 12weeks, significant (p<0.05) higher improvements in the IG could be observed in anxiety levels, HRQoL, and illness perception, when compared to the CG. Age and time since diagnosis were found to be relevant covariates for anxiety levels. In distress levels, the IG showed a clinically relevant and nearly significant reduction compared to the CG (p=0.057). No effects could be observed in depression levels. The results demonstrate the potential of Living Well to improve psychological outcomes of female breast cancer patients and encourage further studies evaluating the effectiveness of the digital application. The trial has been registered in the German Clinical Trials Register (DRKS00029918).

Value of the central sensitisation inventory in patients with axial spondyloarthritis.

In many patients with axial spondyloarthritis (axSpA), pain persists despite anti-inflammatory medication. Quantitative sensory testing (QST) indirectly assesses altered somatosensory function, though its clinical practicality is limited. The Central Sensitisation Inventory (CSI) could be an alternative in the initial assessment of central sensitisation (CS). This study aimed to investigate the value of the CSI in evaluating CS in patients with axSpA by (1) assessing somatosensory function related to CS with QST and (2) exploring associations between CSI, QST, patient and disease characteristics and pain-related psychosocial factors. Consecutive outpatients from the Groningen Leeuwarden AxSpA cohort underwent QST, including pressure pain threshold (PPT), temporal summation (TS) and conditioned pain modulation (CPM). Participants completed questionnaires assessing CS (CSI), illness perception (Revised Illness Perception Questionnaire, IPQ-R), pain-related worrying (Pain Catastrophising Scale, PCS), fatigue (Modified Fatigue Impact Scale, MFIS), anxiety/depression (Hospital Anxiety and Depression Scale, HADS) and coping. QST measurements were stratified for CSI≥40. 201 patients with axSpA were included; 63% male, 64% radiographic axSpA, median symptom duration 12 years (IQR 5-24), mean Axial Spondyloarthritis Disease Activity Score 2.1±1.0. Patients with CSI≥40 had significantly lower PPTs and higher TS than CSI<40 (p<0.004). No significant differences in CPM were observed. In multivariable linear regression, sex, PCS, IPQ-R Identity, MFIS and HADS anxiety were independently associated with CSI (78% explained variance). In this large cross-sectional study in patients with axSpA, the CSI appears as a useful initial CS assessment questionnaire. When CSI scores indicate CS, considering pain-related psychosocial factors is important. These results emphasise the need for a biopsychosocial approach to manage chronic pain in patients with axSpA.

The integrated behavioral model of mental health help seeking (IBM-HS): A health services utilization theory of planned behavior for accessing care.

This article introduces the integrated behavioral model of mental health help seeking (IBM-HS), a theoretical model for understanding the constructs (e.g., systemic, predisposing, and enabling factors; mental health literacy; illness perceptions; perceived need; stigma; shame; perceived benefits, motivation) that influence people's decision making around seeking professional mental health care and their ultimate access to formal treatment. The IBM-HS is a help-seeking-specific adaptation of the empirically supported integrated behavioral model and integrative model, which are themselves evolutions of the theory of planned behavior and theory of reasoned action. The IBM-HS posits that help-seeking determinants (e.g., structural forces; cultural influences; past help-seeking experience; evaluated need; mental health perceptions, knowledge, and skills; social support) influence help-seeking beliefs (i.e., outcome beliefs, experiential beliefs, beliefs about others' expectations, beliefs about others' behavior, logistical beliefs), which in turn determine their respective help-seeking mechanisms (i.e., attitude, perceived norm, personal agency). These mechanisms collectively influence help-seeking intention, which drives prospective help-seeking behavior, subject to the moderating effects of determinants. Finally, prospective behavior has reciprocal feedback loop effects on certain determinants and beliefs. This article describes the need for the IBM-HS, the model's constructs and their interrelations, measurement considerations, and how the model can be used by scholarly and applied users to systematically understand people's intention to seek professional mental health care services and what helps or hinders them from utilizing this care. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Treatment adherence: A Concept Analysis Using the Walker & Avant Method.

To clarify the meaning of treatment adherence and identify its attributes, antecedents, consequences, and empirical referents. A concept analysis. Walker and Avant's method was used to analyze treatment adherence. PubMed, Web of Science, Wiley Online Library, and EBSCO databases were searched from 2013 to 2023. The PRISMA 2020 checklist was used. Seventeen studies were included in this analysis. The defining attributes were the ability to comply with the treatment, consistency in the treatment plan, communication with the healthcare provider, and willingness to treat. Antecedents included multiple medicines, lifestyle changes, illness perceptions and beliefs, and long-term treatment. The outcomes included treatment success, improved long-term treatment, and improved clinical outcomes. Treatment adherence is a positive reaction of a patient to have the ability to comply with the treatment, consistency in the treatment plan, communication with the healthcare provider, and willingness to treat. This study proposes a detailed definition, attributes, antecedents, consequences, and empirical referents for treatment adherence. It is instructive to clinical nursing of treatment adherence, can be extended to various diseases, helps to improve clinical nursing practice regarding treatment adherence, and contribute to improving human health.

Examining the relationships between pain, activities of daily living, and perceptions of overall health in older adults with breast cancer: Results from a brief geriatric screening.

273 Background: Geriatric assessment has been identified as an essential component to caring for patients with cancer who are over 65 years old. Prior research suggests that physical pain and illness perceptions each impact important health behaviors. This retrospective study utilized a brief geriatric screen to examine the relationships between pain levels, activities of daily living (ADLs), and perceptions of overall health for older adults with breast cancer. Implications for methods to improve the patient experience for this population are considered. Methods: The Senior Adult Oncology Program (SAOP) screening tool was administered to 429 patients age 65 or older at a breast oncology clinic. A total ADL score was computed by summing patient-reported responses to 13 ADL items, such as ability to dress oneself, feed oneself, and remember to take medications. A higher ADL score indicates greater difficulty with these responsibilities. Pain was assessed using a 10-point scale; scores were dichotomized to form a low-pain group (scores 0-4) and high-pain group (scores 5-10). Overall Health was assessed on a 1-10 scale, with higher scores indicating perceptions of greater health. Demographic and medical information was abstracted from patients’ electronic health records. Independent samples t-tests examined differences between the high-pain and low-pain groups in total ADL score and self-assessed Overall Health. Results: The average age of the sample was 76 years old (range = 65-89 years). Approximately half of the sample identified as White (48%); 20% identified as Black. In comparing the high-pain and low-pain groups, the high-pain group reported significantly greater difficulty with ADLs (M score = 3.25, 1.41, respectively; p=.026). Additionally, patients endorsing high pain levels reported significantly worse Overall Health as compared to patients endorsing low levels of pain (M= 7.50, 6.11, respectively; p=.001). Conclusions: Older adults with breast cancer experiencing high levels of pain demonstrated greater difficulty with ADLs and worse perceptions of overall health. It is critical that pain is assessed early and often for older adults with breast cancer. Early identification of high pain levels in this population could allow those in need to receive pharmacological and/or behavioral treatments for pain, which may maintain stability or promote improvement in ADLs and perceptions of one’s health. Incorporating brief pain assessments into future geriatric screening tools could improve the process of aging during and after breast cancer.