Perceptions Of Personal Control Research Articles

A Prospective Examination of Disease Management Program Use by Complex Cardiac Outpatients

BackgroundThe use of disease management programs (DMPs) by patients with cardiovascular disease (CVD) is associated with improved outcomes. Although rates of cardiac rehabilitation (CR) use are well established, less is known about other DMPs. The objectives of this study were to describe the degree of DMP utilization by CVD outpatients, and examine factors related to use. MethodsThis study represents a secondary analysis of a larger prospective cohort study. In hospital, 2635 CVD inpatients from 11 hospitals in Ontario Canada completed a survey that assessed factors affecting DMP utilization. One year later, 1803 participants completed a mailed survey that assessed DMP utilization. ResultsOne thousand seventy-three (59.5%) participants reported using at least 1 DMP. Overall, 951 (52.7%) reported participating in cardiac rehabilitation, and among participants with a comorbid indication, 212 (41.2%) reported attending a diabetes education centre, 28 (25.9%) attended stroke rehabilitation, 35 (12.9%) used a heart failure clinic, and 13 (11.7%) attended a smoking cessation program. A multinomial logistic regression analysis showed that compared with no DMP use, participants that attended 1 or multiple programs were younger, married, diagnosed with a myocardial infarction, less likely to have had a percutaneous coronary intervention and had higher perceptions of personal control over their heart condition. There were few differences between participants that used 1 vs multiple DMPs, however, having diabetes or comorbid stroke significantly increased the likelihood of multiple DMP use. ConclusionsApproximately 40% of CVD outpatients do not access DMPs. An integrated approach to vascular disease management appears warranted.

Perception of control, coping and psychological stress of infertile women undergoing IVF

The study aimed to examine: (i) the association between perception of infertility controllability and coping strategies; and (ii) the association between perception of infertility controllability and coping strategies to psychological distress, applying multivariate statistical techniques to control for the effects of demographic variables. This cross-sectional study included 137 women with fertility problems undergoing IVF in a public hospital. All participants completed questionnaires that measured fertility-related stress, state anxiety, depressive symptomatology, perception of control and coping strategies. Pearson’s correlation coefficients were calculated between all study variables, followed by hierarchical multiple linear regression. Low perception of personal and treatment controllability was associated with frequent use of avoidance coping and high perception of treatment controllability was positively associated with problem-focused coping. Multivariate analysis showed that, when controlling for demographic factors, low perception of personal control and avoidance coping were positively associated with fertility-related stress and state anxiety, and problem-appraisal coping was negatively and significantly associated with fertility-related stress and depressive symptomatology scores. The findings of this study merit the understanding of the role of control perception and coping in psychological stress of infertile women to identify beforehand those women who might be at risk of experiencing high stress and in need of support.Infertility and its treatment are severe stressors and many women undergoing fertility treatment experience significant emotional distress. The existing literature indicates that several factors may influence emotional reactions to infertility and fertility treatment, including coping strategies and sense of controllability. This study showed that low perception of controllability was associated with avoidance coping. In addition, the study demonstrated that perception of infertility controllability and coping strategies were related to psychological stress. Therefore, healthcare professionals should enhance the implementation of interventions and support services for infertile women undergoing fertility treatment in order to enhance sense of control and alter coping skills of those women believed to be at risk.

Labor Participation Among Patients with Inflammatory Bowel Disease

The aims of the present study are twofold. First, to describe labor participation rates of people with inflammatory bowel disease (IBD) in the Netherlands compared with the total Dutch population and to people with chronic illness in general. Second, to explore differences in labor participation among IBD patients and assess the potential impact of a number of characteristics of IBD patients on labor participation. Data were obtained from a nationwide survey of individuals with IBD in the Netherlands. In all, 1115 respondents completed the survey. Univariate, bivariate, and multinomial logistic regression analysis were conducted to identify factors predicting the number of hours worked by IBD patients. People with IBD do not participate less often in the labor market compared with the total Dutch population age 15 to 64. However, male patients age 45 to 64 less often have a fulltime job compared with age- and gender-matched reference groups from the general population. People with IBD are more likely to participate in the labor market than people with chronic illness in general. Gender, age, duration of illness, having a stoma or pouch, comorbidity, vitality, pain, and perceived personal control appear to be significant predictors of the number of hours worked. People with IBD in the Netherlands are as often employed as the general population, but among some gender/age categories fewer people work fulltime. Besides sociodemographic and illness characteristics, the perception of personal control over the illness explains differences in the number of hours worked. Strengthening IBD patients' control perceptions deserves attention.

Associations between knowledge, illness perceptions, self-management and metabolic control of type 2 diabetes among African and European-origin patients

abubakari a-r, jones mc, lauder w, kirk a, anderson j & devendra d (2011) Journal of Nursing and Healthcare of Chronic Illness3, 245–256Associations between knowledge, illness perceptions, self-management and metabolic control of type 2 diabetes among African and European-origin patients Aims. Using Leventhal’s Common-sense self-regulation model, this study investigated associations between illness perceptions, self-management and metabolic-control outcomes for diabetes among European and African-origin patients with type 2 diabetes. Background. Compared to the general populations of their host countries, African-origin populations in the diaspora are disproportionately affected by diabetes and its microvascular complications. However, comparatively little is known about how African-origin patients with type 2 diabetes perceive about their condition and whether such perceptions influence their self-management behaviours. Design. Cross-sectional design. Methods. Participants were recruited from diabetes clinics in London. Illness perceptions and adherence to self-management recommendations were assessed using questionnaires and data for metabolic-control outcomes were obtained from patient records. Associations between variables were investigated using correlations and multiple-regression techniques. Data collection for the study was conducted between February and June 2008. Results. In all, 359 patients participated in the study. The results indicated that perceiving diabetes with severe consequences was associated with poor self-management in both African-origin (black-African and black-Caribbean) and European-origin (white-British) patients with type 2 diabetes. However, personal control perceptions were associated with better self-management in African-origin patients. In multivariate analysis, illness perceptions explained significant proportions of the variations in self-management behaviours in both European-origin and African-origin patients. Perceived personal control over diabetes was a main determinant of the variations in self-management among European and African-origin patients. Other dimensions of illness perceptions, including consequences and emotional representations contributed to variations in self-management among African-origin patients. After controlling for demographic/disease characteristics, self-management of diabetes did not predict any metabolic-control outcome for diabetes in any ethnic group. Conclusion. Illness perceptions are important determinants of self-management among African-origin patients. Relevance to clinical practice. Illness perception-based interventions may be used to promote self-management among African-origin patients. Healthcare professionals should consider using patients’ illness perceptions to inform service delivery.

Schools as Complex Host Environments: Understanding Aspects of Schools that May Influence Clinical Practice and Research

Schools as Complex Host Environments: Understanding Aspects of Schools that May Influence Clinical Practice and Research

Perceived autonomy and self-esteem in Dutch dialysis patients: The importance of illness and treatment perceptions

Compared to healthy people, end-stage renal disease (ESRD) patients participate less in paid jobs and social activities. This study explored the perceived autonomy, state self-esteem and labour participation in ESRD patients on dialysis, and the role illness and treatment perceptions play in these concepts. Patients completed questionnaires at home or in the dialysis centre (N = 166). Data were analysed using bivariate and multivariate analyses. Labour participation among dialysis patients was low, the average autonomy levels were only moderate, and the average self-esteem level was rather high. On the whole, positive illness and treatment perceptions were associated with higher autonomy and self-esteem, but not with labour participation. Multiple regression analyses demonstrated that illness and treatment perceptions explained 18 to 27% of the variance in autonomy and self-esteem. Perceptions of personal control, less impact of the illness and treatment, and less concern were important predictors. Our results indicate that dialysis patients’ beliefs about their illness and treatment play an important role in their perceived autonomy and self-esteem. Stimulating positive (realistic) beliefs and altering maladaptive beliefs might contribute to a greater sense of autonomy and self-esteem, and to social participation in general. Interventions focusing on these beliefs may assist patients to adjust to ESRD.

Can personal control over the physical environment ease distractions in office workplaces?

The purpose of this study was to investigate whether perception of control over aspects of the physical environment reduces the previously documented negative effects of distraction in office workplaces on perceived job performance. This study analysed 384 questionnaires collected from employees in the corporate offices of three manufacturing companies in Michigan, USA. The role of a sense of personal control over physical environment features as a mediating influence between work attitudes and work outcomes was explored using structural equations modelling. The results showed that workers' sense of control over physical aspects of their work environment mediated the relationship between perceived distractions and perceived job performance. These results suggest that increasing perceptions of personal control over features of the physical work environment may serve to link work attitudes and work outcomes. Statement of Relevance: Open-plan offices are common throughout the world, making this study relevant for researchers and practitioners alike. These results suggest that if employees can adjust aspects of their office work environment, this may increase their sense of personal control, reducing the effects of distractions, a frequent complaint in open offices.

Illness Perceptions After Myocardial Infarction

: Health-related quality of life (HRQoL) is impaired in patients after a myocardial infarction (MI), and fatigue and depression are common health complaints among these patients. Patients' own beliefs about their illness (illness perceptions) influence health behavior and health outcomes. The aim of the present study was to examine illness perception and its association with self-reported HRQoL, fatigue, and emotional distress among patients with MI. : The sample consisted of 204 patients who had had MI and who completed the questionnaires during the first week in the hospital and 4 months after the MI. The questionnaires used were the Illness Perception Questionnaire, Multidimensional Fatigue Inventory, Hospital Anxiety and Depression Scale, and the Short Form Health Survey (SF-36). : Patient's illness perception changed over time from a more acute to a more chronic perception of illness, and beliefs in personal and treatment control of MI had decreased. Furthermore, these negative beliefs were associated with worse experiences of fatigue and lowered HRQoL. : Patients' illness perceptions influence health outcomes after an MI. Supporting MI patients in increasing their perception of personal control could be a primary nursing strategy in rehabilitation programs aimed at facilitating health behavior, decreasing experiences of fatigue, and increasing HRQoL.

Distinctiveness of psychological obstacles to recovery in low back pain patients in primary care

Many psychological factors have been suggested to be important obstacles to recovery from low back pain, yet most studies focus on a limited number of factors. We compared a more comprehensive range of 20 factors in predicting outcome in primary care. Consecutive patients consulting 8 general practices were eligible to take part in a prospective cohort study; 1591 provided data at baseline and 810 at 6months. Clinical outcome was defined using the Roland and Morris Disability Questionnaire (RMDQ). The relative strength of the baseline psychological measures to predict outcome was investigated using adjusted multiple linear regression techniques. The sample was similar to other primary care cohorts (mean age 44years, 59% women, mean baseline RMDQ 8.6). The 20 factors each accounted for between 0.04% and 33.3% of the variance in baseline RMDQ score. A multivariate model including all 11 scales that were associated with outcome in the univariate analysis accounted for 47.7% of the variance in 6months RMDQ score; rising to 55.8% following adjustment. Four scales remained significantly associated with outcome in the multivariate model explaining 56.6% of the variance: perceptions of personal control, acute/chronic timeline, illness identify and pain self-efficacy. When all independent factors were included, depression, catastrophising and fear avoidance were no longer significant. Thus, a small number of psychological factors are strongly predictive of outcome in primary care low back pain patients. There is clear redundancy in the measurement of psychological factors. These findings should help to focus targeted interventions for back pain in the future.

Physicians’ decision-making style and psychosocial outcomes among cancer survivors

Objective We evaluated pathways linking physicians’ decision-making style with cancer survivors’ health-related quality of life (HRQOL). Methods We analyzed survey data from 623 survivors diagnosed with leukemia, colorectal, or bladder cancer in Northern California, 2–5 years prior to the study. Of these, 395 reported making a medical decision in the past 12 months and were asked about their physician's decision-making style. We evaluated the association of physician style with proximal communication outcomes (trust and participation self-efficacy), intermediate cognitive outcomes (perceived control and uncertainty), and distal health outcomes (physical and mental HRQOL). Results Overall, 54% of survivors reported a sub-optimal decision-making style for their physician. With the exception of physical health, physician style was associated with all proximal, intermediate, and distal outcomes ( p ≤ 0.01). We identified two significant pathways by which a participatory physician style may be associated with survivors’ mental health: (1) by increasing survivors’ participation self-efficacy and thereby enhancing their perceptions of personal control ( p < 0.01); (2) by enhancing survivors’ level of trust and thereby reducing their perceptions of uncertainty ( p < 0.05). Conclusion A participatory physician style may improve survivors’ mental health by a complex two-step mechanism of improving survivors’ proximal communication and intermediate cognitive outcomes. Practice implications Physicians who adopt a participatory decision-making style are likely to facilitate patient empowerment and enhance patients’ HRQOL.

Altered Perceptions of Personal Control About Retained Weight and Depressive Symptoms in Low-Income Postpartum Women

Postpartum weight retention and depressive symptoms have a high prevalence among low income women. This qualitative study describes low-income women's experiences of weight changes and depressive symptoms during the late postpartum period. Women (n = 25) who were either overweight or had depressive symptoms, or both, at 12 months postpartum participated in an ethnically-congruent focus group. Women's experiences indicated altered personal control related to retained postpartum weight and depressive feelings. Retained weight negatively affected self-esteem and family functioning. Depression left women feeling isolated yet reluctant to seek help. These findings could provide the basis for health promotion interventions relevant to this population.

Users' Perceptions of Personal Control of Environmental Conditions in Sustainable Buildings

As part of a broader assessment of the performance of a worldwide set of sustainable buildings, the authors investigated the users' perceptions of personal control of internal environmental conditions. The main aims were to determine the amount of personal control building users had over heating, cooling, ventilation, lighting, and noise; and whether they considered it to be important. A questionnaire survey, in which respondents rated these various aspects on a 7-point scale, was the principal instrument used. For this set of buildings it was found that the users' perceived the amount of personal control they had of lighting to be reasonable, but that for heating, cooling, ventilation, and (particularly) noise was relatively low. Around 30% of respondents see it as important to have this control. Some of the findings suggest that the better the users' perceptions of their environmental conditions, the less their apparent need for personal control, a line of enquiry possibly meriting further pursuit. A number of findings reinforced the conclusion that noise problems remain a real concern.

Racial/ethnic variation in the relationship between physical limitation and fear of crime: an examination of mediating and moderating factors

This study has four objectives. First, we confirm the previously observed association between physical limitations and fear of crime. Second, we assess the role of age in this relationship. Third, we identify factors that mediate this relationship. Fourth, we assess whether this relationship is observed across racial/ethnic groups. Adjusting for perceptions of personal control and disability-related stigma reduces the magnitude of this relationship to non-significance for black and white respondents, but not for Hispanics. Also, we find that age is inversely related to fear of crime for blacks and whites.

God and the government: Testing a compensatory control mechanism for the support of external systems.

The authors propose that the high levels of support often observed for governmental and religious systems can be explained, in part, as a means of coping with the threat posed by chronically or situationally fluctuating levels of perceived personal control. Three experiments demonstrated a causal relation between lowered perceptions of personal control and the defense of external systems, including increased beliefs in the existence of a controlling God (Studies 1 and 2) and defense of the overarching socio-political system (Study 4). A 4th experiment (Study 5) showed the converse to be true: A challenge to the usefulness of external systems of control led to increased illusory perceptions of personal control. In addition, a cross-national data set demonstrated that lower levels of personal control are associated with higher support for governmental control (across 67 nations; Study 3). Each study identified theoretically consistent moderators and mediators of these effects. The implications of these results for understanding why a high percentage of the population believes in the existence of God, and why people so often endorse and justify their socio-political systems, are discussed.

Wake up! Your PDQ is due!

1. Lori A Woeste, EdD MT (ASCP)[⇑][1] 1. is assistant professor, Clinical Laboratory Science Program, Illinois State University 2. Beverly J Barham, PhD MPH MT(ASCP) 1. is associate professor, Clinical Laboratory Science Program, Illinois State University 1. Address for correspondence: Lori A Woeste EdD MT (ASCP), assistant professor, Clinical Laboratory Science Program, Department of Health Sciences, 332 Felmley Hall Campus Box 5220, Illinois State University, Normal IL 61790-5220 (309) 438-8810, (309) 438-2450 (fax). lawoest{at}ilstu.edu. BACKGROUND Student engagement in the classroom can often be an elusive goal. We as faculty in a four-year university-based clinical laboratory science program were noticing a trend of more students coming to class unprepared. In an effort to increase student engagement in two different pre-professional practice clinical laboratory science (CLS) courses, the pre-discussion quiz (PDQ) was implemented as a curricular component for enhancing student engagement. This was done as an active learning strategy to motivate students to read the material and respond to a series of questions in preparation for discussion before they came to class. A review of educational literature suggests intrinsically motivated learning enhances the learning process. It is suggested this intrinsic motivation is linked to such factors as the perception of personal control, self-efficacy, and the perception of relevance.1 These instructional strategies should give the learner some control over sequence of instruction and pace,2 and some even believe they should not be optional.3 The use of incentive-based preparation exercises has been found to significantly improve student engagement and provide an effective means of assessment.4 OVERVIEW The pre discussion quizzes (PDQs) were delivered via WebCT® in undergraduate CLS immunology and chemistry courses. Each course was 16 weeks long, met twice a week at 8:00 AM during the fall semester, and included 24 in the student cohort. Most students were at junior status with a few seniors and an occasional sophomore. The cohort included both native students, e.g., those students who began their post secondary experience at this institution,… ABBREVIATIONS: CLS = clinical laboratory science; PDQ = pre discussion quiz. [1]: #corresp-1

Perceived Control and Negative Affect Predict Expected and Experienced Acute Clinical Pain: A Structural Modeling Analysis

Risk factors for elevated levels of clinical and experimental pain have been shown to be independently predicted by the individual's perception of personal control, negative emotional states, and pain expectancy. In this study we examine the mutual simultaneous association of these factors in the experience of dental extraction pain. Using structural equation modeling we examined the relationship between desired and predicted personal control, negative emotional state and the expectation of pain to predict worst treatment pain. A convenience sample of 381 patients receiving walk-in emergency dental treatment were enrolled. Half of the patients were randomly selected for generating the measurement model, the hold-out subsample was used to confirm the model. Overall fit indices were adequate for both models [chi(2)/df > or = 1.37, Comparative Fit Index (CFI) > or = 0.96, Standardized Root-Mean-Square Residual (SRMR) < or = 0.05, Root Mean Square Error of Approximation (RMSEA) < or = 0.06], coefficients of determination were meaningful (R(2) > or = 0.14), and factor loadings (beta's) were significant (P's < 0.001) for each step in both models. A sequential pathway was revealed wherein patients' desire for control over the aversiveness of treatment and their prediction of having control over those events (whether desired or not) facilitated a negative emotional state. Negative emotional state in turn influenced expected treatment pain and subsequently the level of treatment pain actually experienced. We conclude that the perception of personal control is a clinically important and cognitively-mediated factor that influences the level of acute pain experienced during stressful clinical procedures.

Perceptions of Parental Communication Orientation, Perfectionism, and Disordered Eating Behaviorsof Sons and Daughters

This study investigated the influence of perceived parental communication orientation and individual perfectionism on late adolescent offspring's maladaptive eating behaviors using a nonclinical sample (N = 424). College students' perceptions of their communication patterns with parents, self- and parentally prescribed perfectionism, and perceptions of personal control were measured to explore possible associations among these variables and whether they, in combination, predicted maladaptive eating. Results revealed that 23% of the sample participated in maladaptive eating behaviors; in addition, a father–child conformity communication pattern and paternally prescribed perfectionism predicted maladaptive eating within this sample when controlling for individual factors such as offspring's perfectionism and perceived loss of personal control. These findings suggest that father–child communicative interaction that emphasizes conformity to high paternal standards may increase offspring's risk of developing maladaptive eating behaviors.

Cognitive adaptation theory and breast cancer recurrence: Are there limits?

Relations of the components of cognitive adaptation theory (self-esteem, optimism, control) to quality of life and benefit finding were examined for 70 women (91% Caucasian) diagnosed with Stage I, II, or III breast cancer over 5 years ago. Half of these women experienced a recurrence within the 5 years; the other half remained disease free. Women were matched on age, race, stage of disease, and intervention condition. Baseline perceptions of personal control over illness, but not general self-esteem or optimism, were associated with women's reports of worse physical functioning, worse mental functioning, and less benefit finding 5 years later for recurrent women but not disease-free women. These findings highlight the notion that there may be boundary conditions on the adaptiveness of perceived control.

Changes in personal control as a predictor of quality of life after pulmonary rehabilitation

Objective Perceptions of mastery and self-efficacy may be related to better outcomes in pulmonary rehabilitation in patients with chronic obstructive pulmonary disease (COPD). This study examined (1) whether patients with COPD improved during a rehabilitation programme with respect to quality of life (QoL) and perceptions of self-efficacy and mastery, and (2) whether increased perceptions of mastery and self-efficacy contributed to a higher QoL after rehabilitation. Methods Thirty-nine consecutive COPD patients (aged 60.5 ± 9.0) were included from a rehabilitation centre and completed self-report questionnaires assessing symptoms, QoL, and perceptions of personal control. Results COPD patients improved during rehabilitation in overall QoL and self-efficacy, although no significant changes were found in QoL domains and mastery. Changes in self-efficacy during rehabilitation contributed to the explanation of the social and psychological functioning QoL domains. Conclusion Even in seriously impaired COPD patients in advanced stages of illness, positive changes in self-efficacy and overall well-being can be established during rehabilitation. Changes in self-efficacy were related to a better QoL, suggesting the importance of personal control in the adjustment to COPD. Practice implications Focussing more explicitly on the enhancement of perceptions of personal control in COPD patients may be an important aim of pulmonary rehabilitation.

Emotional comfort: The patient's perspective of a therapeutic context

Background Comfort is a word that is frequently used to describe both physical and emotional aspects of the hospital experience. A number of definitions exist in the literature and there is a lack of clarity in understanding this concept. Objectives This paper describes the therapeutic context of emotional comfort that was identified in a qualitative study that sought to explain the perceived therapeutic effect of interpersonal interactions that were experienced by patients during hospitalisation. Design Grounded theory. Settings Public and private hospitals situated in Perth, Western Australia. Participants 40 patient participants from a variety of settings, and 32 nurse participants. All participants were over the age of 18 and spoke English. Methods Formal and informal interviews, field observations. Results Patients interpreted the interpersonal interactions that they experienced during hospitalisation in terms of their experience of emotional comfort or discomfort. A central feature of emotional comfort was the patient's perception of personal control. Conclusions This study provides a greater understanding of the concept of comfort from the perspective of hospitalised patients. It highlights that patients approach their illnesses or injuries perceiving that a connection exists between the mind and the body.