Sense Model Of Illness Representations Research Articles

Experience of a tertiary-level urology center in the clinical urological events of rare and very rare incidence. III. Psychourological events: 2. Phobia of renal failure due to loin pain

BackgroundEnd-stage renal disease and loin pain are prevalent nephrourological topics with unfavorable reputations among populations. We aimed to present our center’s experience with the cases of phobia of renal failure in relation to loin pain.MethodsIt is a retrospective study of phobia of renal failure among the patients who presented with loin pain to our center between July 1991 and June 2017. Description of perception of renal failure risk was guided by the modified Common Sense Model of Illness Representation.ResultsOf more than 64, 000 patients who presented with loin pain, only 78 patients (0.12%) had phobia of renal failure. Mean age ± SD (Range) was 41.12 ± 9.58 (23–60) years. Sixty-four patients (82.1%) expressed directly fear of renal failure. Physical examination and investigations revealed no risks of renal failure in all patients. High percentages of phobia of renal failure were associated with the female gender (73.1%), the presence of a relative patient with renal failure (83.3%), and low socioeconomic levels: education (89.7%), residential (75.6%), and economic status (88.5%) levels. The modified Common Sense Model of Illness Representation revealed predominant emotional representations and unreal cognitive domains with altered perception of renal failure risk.ConclusionsPhobia of renal failure is very rare. It is a consequence of the altered perception of risk of renal failure due to unconscious attribution of loin pain to renal failure. Female gender, the presence of a relative with renal failure, and low socioeconomic levels could be suggested as risk factors for phobia of renal failure.

Causal explanations for lack of pregnancy applying the common sense model of illness representation to the fertility context

Objectives: The current study explored causal explanations for lack of pregnancy and association with help-seeking behaviour. Differences based on gender and country Human Development Index were examined.Design: A mixed method design was used.Main outcome measures: Data were drawn from the International Fertility Decision-Making Study, a cross-sectional study of 10,045 individuals (1690 men; 8355 women) from 79 countries. Respondents rated to what extent they believed their lack of pregnancy was due to something they or their partner had done/not done or other factors and described their reasons for making this rating.Results: Respondents were aged 18–50 (M = 31.83) years, partnered and had been trying to achieve a pregnancy/father a child for over six months (M = 2.8 years). Men and women primarily believed their lack of pregnancy was due to medical problems or chance/bad luck. Thematic analysis of textual responses from 29.7% of the sample found that respondents focused on their personal experience or a salient life event when describing the cause of their lack of pregnancy. Women expressed more regret and helplessness about causes than men. Significant country differences were observed.Conclusions: Individuals may develop inaccurate causal explanations based on their personal experiences. Access to accurate information is necessary to facilitate timely help-seeking.

More than just side-effects: The role of clinical and psychosocial factors in non-adherence to tamoxifen.

Tamoxifen non-adherence is apparent in up to half of breast cancer survivors and is associated with increased risk of recurrence and reduced quality of life. However, factors contributing to non-adherence in this population are currently poorly understood. This study explored the relationship between key components of the Common Sense Model of Illness Representations (CSM)/the Theory of Planned Behaviour (TPB) and intentional and unintentional non-adherence in a large sample of women prescribed tamoxifen following primary breast cancer. Cross-sectional questionnaire study (n=777). Women were eligible if they were over 18, had been diagnosed with primary breast cancer, and had been prescribed tamoxifen. Participants were recruited in clinic or online and completed questionnaires assessing illness perceptions, treatment beliefs, adherence, quality of life, social support, distress, and the key TPB components. Logistic regressions were conducted to test elements from each model and to identify correlates of intentional and unintentional non-adherence. Patients were classified as non-adherent based on Medication Adherence Rating Scale scores; 44% of the population were non-adherent; 41% reported unintentional non-adherence, and 9% reported intentional non-adherence. Study variables accounted for more variance in intentional (Nagelkerke R2 =46%) than unintentional non-adherence (Nagelkerke R2 =17%). Intentional non-adherence was best explained by a combination of TPB and CSM variables, but these variables did not contribute significantly to unintentional non-adherence. The TPB and the CSM provide a useful framework for understanding intentional tamoxifen non-adherence. Elements from both models should be considered when designing interventions to increase adherence rates. Statement of contribution What is already known about this subject? Non-adherence to tamoxifen is common and is associated with poor clinical outcomes. Few modifiable predictors of tamoxifen non-adherence have been identified. What does this study add? Unintentional non-adherence is reported much more frequently than intentional non-adherence. Elements from the CSM and TPB provide a useful framework for understanding non-adherence to tamoxifen. Unique correlates were found for intentional and unintentional non-adherence.

Abstract A55: Assessing the applicability of leventhal's common sense model of illness representation to explain african american prostate cancer survivors' disease experiences and disease Management Strategies

Abstract Background: Culture has a major influence on many aspects of health in general, and cancer prevention and control in particular. Culture influences the receptiveness of consensus and evidence-based risk reduction strategies across the continuum of care. Culture also provides men with templates for interacting with clinicians and the health care system. Over the past two decades, medical and public health practitioners have devoted a great deal of attention to understanding how African American culture influences the multi-level processes that create or maintain prostate cancer treatment disparities. The current study adds to this growing body of literature by exploring the usefulness of Leventhal's Common Sense Model (CSM) of Illness Representation to explain the content and structure of African American prostate cancer survivors' narratives of their disease process and disease management strategies. Narrative structure was evaluated using the five illness representation domains of the CSM (i.e., cause, control/cure, consequences, identity, and, timeline). Narrative content was explored using investigator created sub-themes representing each illness representation domain. Methods: A purposive sample of prostate cancer survivors was recruited via cancer registries, word-of-mouth and newspaper advertisements in New York and Georgia from 2013 to 2014. Survivors were eligible to participate if they were diagnosed with localized prostate cancer (T1 or T2), able to speak and understand English, and self-identified as African American. Each participant completed a semi-structured, in-depth interview with a graduate trained interviewer. All men provided written informed consent and received a $50 incentive for their participation. Each interview was audiotape recorded, transcribed verbatim by a professional transcriptionist and entered into MAXQDA12 software for data management and analysis. All transcribed interviews were coded independently by a three-member team until a minimum of 80% coding agreement was reached. Results: A total of 15 men completed in-depth interviews. All interviews lasted between 30 - 90 minutes. With regard to narrative structure, survivors provided descriptions characterizing all five of the illness representation domains. More survivors provided descriptions relating to causes and consequences, while fewer provided descriptions related to the timeline domain. With regard to coping, many interviewees reported that it was challenging to simultaneously develop a treatment care plan while managing their emotions. Most descriptions of the consequences centered around concerns men had related to treatment rather than having the disease. Several interviewees expressed concerns about limitations placed on their personal and social relationships as a result of treatment complications. With regard to emotional coping, men reported a variety of adaptive and maladaptive strategies including acceptance, avoidance, humor, religion, and shared decision-making with family members and significant others. Despite these concerns, most men were grateful to be alive and were optimistic about their prognosis. Conclusion: The results of this research suggest that the CSM can be used to explain African American prostate cancer survivors' experiences with treatment care planning and coping. Future research should elucidate culturally acceptable strategies to help men simultaneously develop treatment plans and deal with the emotional aspect of having this disease. Future research should also focus on identifying similarities and differences between African American and White survivors using the CSM to determine if unique or one-size-fits all interventions are sufficient. Citation Format: Jarrett Johnson, Sarbesh Pandeya, Ahmed Kabore, Levi Ross. Assessing the applicability of leventhal's common sense model of illness representation to explain african american prostate cancer survivors' disease experiences and disease Management Strategies. [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr A55.

Cancer-related fatigue in post-treatment cancer survivors: application of the common sense model of illness representations.

BackgroundCancer-related fatigue (CrF) is a common and disruptive symptom that may be experienced during and after cancer. Research into the subjective experience of fatigue in this group is required. The common sense model of self-regulation of health and illness (SRM) addresses personal beliefs or mental representations—whether medically sound or unsubstantiated— that a person holds about a health issue. The current study assesses if the SRM could be used as a theoretical framework for organizing the experiences of people with CrF, with a view to identifying methods to address fatigue in cancer survivors.MethodFour focus groups were held with a total of 18 cancer survivors who reported they experienced ‘significant fatigue or reduced energy.’ A thematic analysis was conducted within the framework of the SRM.ResultsFindings were aligned with the SRM, with participants discussing fatigue with reference to representation, coping, and appraisal of symptoms. In particular, the wider social context of CrF was frequently addressed. Perceived inadequacies in support available to those with lingering fatigue after the completion of cancer treatment were highlighted by the participants.ConclusionThis study explored the subjective experience of fatigue after cancer using the SRM. CrF should be approached as a complex psychosocial issue and considered from the patient perspective to facilitate better understanding and management of symptoms. The SRM is an applicable framework for identifying modifiable factors that could lead to improved coping with CrF in post-treatment cancer survivors.

Illness Perceptions and Health Behaviors of Black Women

The Common Sense Model of Illness Representations proposes that representations or perceptions of illness drive health behaviors. The purpose of this study was to explore the relationships between hypertension representations, exercise, and dietary behaviors in hypertensive black women (N = 204, aged 18-65 years). Regression results revealed that perceiving hypertension as chronic and perceiving it a result of environmental causes were inversely related to moderate-intensity physical activity (β = -.15 [P = .05] and β = -.25 [P = .05], respectively). Having more emotional responses to hypertension (β = .23, P = .05) was related to moderate-intensity physical activity and more fruit and vegetable consumption (β = .28, P = .05). These findings suggest that hypertension representations can interfere with recommended lifestyle changes among black women. Assessing hypertension representations and implementing measures to clarify misperceptions of hypertension among black women may lead to better blood pressure control and health outcomes.

Predicting Self-Management Behaviors in Familial Hypercholesterolemia Using an Integrated Theoretical Model: the Impact of Beliefs About Illnesses and Beliefs About Behaviors.

Patients with familial hypercholesterolemia (FH) are at markedly increased risk of coronary artery disease. Regular participation in three self-management behaviors, physical activity, healthy eating, and adherence to medication, can significantly reduce this risk in FH patients. We aimed to predict intentions to engage in these self-management behaviors in FH patients using a multi-theory, integrated model that makes the distinction between beliefs about illness and beliefs about self-management behaviors. Using a cross-sectional, correlational design, patients (N = 110) diagnosed with FH from a clinic in Perth, Western Australia, self-completed a questionnaire that measured constructs from three health behavior theories: the common sense model of illness representations (serious consequences, timeline, personal control, treatment control, illness coherence, emotional representations); theory of planned behavior (attitudes, subjective norms, perceived behavioral control); and social cognitive theory (self-efficacy). Structural equation models for each self-management behavior revealed consistent and statistically significant effects of attitudes on intentions across the three behaviors. Subjective norms predicted intentions for health eating only and self-efficacy predicted intentions for physical activity only. There were no effects for the perceived behavioral control and common sense model constructs in any model. Attitudes feature prominently in determining intentions to engage in self-management behaviors in FH patients. The prominence of these attitudinal beliefs about self-management behaviors, as opposed to illness beliefs, suggest that addressing these beliefs may be a priority in the management of FH.

Illness representations and psychological distress in Indian patients with cancer: does being aware of one's cancer diagnosis make a difference?

This study applied the Common Sense Model of illness representations to understand the psychological reactions of Indian patients with cancer who report being aware or unaware of their cancer diagnosis. Adult Indian patients with cancer (N = 329) were asked about their understanding of their illness (to assess awareness of a cancer diagnosis), and then completed the Brief Illness Perception Questionnaire and the Hospital Anxiety Depression Scale. Patients who reported being unaware of their cancer diagnosis (54.1%) experienced higher levels of anxiety and depression. After controlling for awareness, education, income, cancer symptoms, and cancer stage, illness perceptions accounted for significant amounts of variance in anxiety (∆R(2) = 0.42) and depression (∆R(2) = 0.33). Illness coherence mediated the relationship between awareness of a cancer diagnosis and anxiety. Moderated regression analyses indicated that several relationships between illness perceptions and anxiety/depression were stronger among patients who reported being unaware of their cancer diagnosis. The Common Sense Model provides a useful framework for explaining the psychological reactions of Indian patients with cancer to their illness, particularly for those who report being unaware of their cancer diagnosis.

Examining the Media Portrayal of Obesity Through the Lens of the Common Sense Model of Illness Representations

This study examined the Irish media discourse on obesity by employing the Common Sense Model of Illness Representations. A media sample of 368 transcripts was compiled from newspaper articles (n = 346), radio discussions (n = 5), and online news articles (n = 17) on overweight and obesity from the years 2005, 2007, and 2009. Using the Common Sense Model and framing theory to guide the investigation, a thematic analysis was conducted on the media sample. Analysis revealed that the behavioral dimensions of diet and activity levels were the most commonly cited causes of and interventions in obesity. The advertising industry was blamed for obesity, and there were calls for increased government action to tackle the issue. Physical illness and psychological consequences of obesity were prevalent in the sample, and analysis revealed that the economy, regardless of its state, was blamed for obesity. These results are discussed in terms of expectations of audience understandings of the issue and the implications of these dominant portrayals and framings on public support for interventions. The article also outlines the value of a qualitative analytical framework that combines the Common Sense Model and framing theory in the investigation of illness narratives.

Illness Beliefs in African Americans With Hypertension

Guided by Leventhal's common sense model of illness representations, this study examined the relationship between hypertension beliefs and self-care behaviors necessary for blood pressure (BP) control in a sample of 111 community-dwelling African Americans with hypertension. Participants completed the revised Illness Perception Questionnaire, BP Self-Care Scale, and a demographic data sheet, and had BP measured. Analyses revealed that beliefs about the causes of hypertension differed by gender and educational level. Stress-related causal attributions accounted for 34.7% of the variance in hypertension beliefs. Participants who believed stress or external factors caused hypertension were less likely to engage in healthy self-care behaviors (e.g., keeping doctor visits, eating low-salt, low-fat diets). Results suggest that patients who are nonadherent with hypertension self-care recommendations may hold hypertension beliefs that are not consistent with the medically endorsed views of this disease. To more effectively treat and control BP, providers should assess patients' hypertension beliefs.

Theory based analysis of the effects of decision aids for surgery in early breast cancer: a systematic review

Rationale, aims and objectives: Little is understood about how decision aids achieve their reported effects or their impact on the decision-making process. We aimed to evaluate the quality of decision aids for women choosing surgery for early breast cancer and to examine how their reported effects may reflect the contribution of components suggested by an extended Theory of Planned Behaviour (TPB) and the Common Sense Model of Illness Representations (CSM) to be required for good quality decision-making in this domain. Method: We undertook a systematic review to examine the components of decision aids that influence decision-making processes for women choosing surgery for early breast cancer. The quality and theoretical underpinnings of the decision aids were appraised and reported outcomes meta-analysed. Results: Ten decision aids were obtained; 4 had been evaluated in randomised trials. The quality of the decision aids was similar, with limited evidence of theoretical base. Data linking decision aid components, design, use and outcomes to judge the effects on the decision-making process were inconsistent. Two trials suggested evidence of a reduction in Decision Conflict scores (SMD = -0.35, 95% CI -0.57 to -0.12, p = 0.002). Improvements in knowledge (4 trials) and trends towards breast conservation surgery (3 trials) were not statistically significant. Conclusions: A greater understanding of how decision aids impact on the decision-making process is needed if we are to design improved interventions that are effective on the core aspects of decision-making in this domain.

Evaluating a health behaviour model for persons with and without an intellectual disability

Based on the idea of the Common Sense Model of Illness Representations by Leventhal as well as Lohaus's concepts of health and illness, a health behaviour model was designed to explain health behaviours applied by persons with intellectual disabilities (ID). The key proposal of this model is that the way someone understands the concepts of health, illness and disability influences the way they perceive themselves and what behavioural approaches to them they take. To test this model and explain health differences between the general population and person with ID, 230 people with ID and a comparative sample of 533 persons without ID were included in this Austrian study. Data were collected on general socio-demographics, personal perceptions of illness and disability, perceptions of oneself and health-related behaviours. Psychometric analysis of the instruments used showed that they were valid and reliable and hence can provide a valuable tool for studying health-related issues in persons with and without ID. With respect to the testing of the suggested health model, two latent variables were defined in accordance to the theory. The general model fit was evaluated by calculating different absolute and descriptive fit indices. Most indices indicated an acceptable model fit for all samples. This study presents the first attempt to explore the systematic differences in health behaviour between people with and without ID based on a suggested health model. Limitations of the study as well as implications for practice and future research are discussed.

Theory-based design and field-testing of an intervention to support women choosing surgery for breast cancer: BresDex

ObjectiveDesign and undertake usability and field-testing evaluation of a theory-guided decision aid (BresDex) in supporting women choosing surgery for early breast cancer. MethodsAn extended Theory of Planned Behavior (TPB) and the Common Sense Model of Illness Representations (CSM) guided the design of BresDex. BresDex was evaluated and refined across 3 cycles by interviewing 6 women without personal history of breast cancer, 8 women with personal history of breast cancer who had completed treatment and 11 women newly diagnosed with breast cancer. Participants were interviewed for views on content, presentation (usability) and perceived usefulness towards deciding on treatment (utility). Framework analysis was used, guided by the extended TPB and the CSM. ResultsBresDex was positively received in content and presentation (usability). It appeared an effective support to decision-making and useful source for further information, particularly in clarifying attitudes, social norms and perceived behavioral control, and presenting consequences of decisions (utility). ConclusionThis study illustrates the potential benefit of the extended TPB and CSM in designing a decision aid to support women choosing breast cancer surgery. Practice implicationsBresDex could provide decision-making support and serve as an additional source of information, to complement the care received from the clinical team.

Understanding surgery choices for breast cancer: how might the Theory of Planned Behaviour and the Common Sense Model contribute to decision support interventions?

To describe the evidence about factors influencing breast cancer patients' surgery choices and the implications for designing decision support in reference to an extended Theory of Planned Behaviour (TPB) and the Common Sense Model of Illness Representations (CSM). A wide range of factors are known to influence the surgery choices of women diagnosed with early breast cancer facing the choice of mastectomy or breast conservation surgery with radiotherapy. However, research does not always reflect the complexities of decision making and is often atheoretical. A theoretical approach, as provided by the CSM and the TPB, could help to identify and tailor support by focusing on patients' representations of their breast cancer and predicting surgery choices. Literature search and narrative synthesis of data. Twenty-six studies reported women's surgery choices to be influenced by perceived clinical outcomes of surgery, appearance and body image, treatment concerns, involvement in decision making and preferences of clinicians. These factors can be mapped onto the key constructs of both the TPB and CSM and used to inform the design and development of decision support interventions to ensure accurate information is provided in areas most important to patients. The TPB and CSM have the potential to inform the design of decision support for breast cancer patients, with accurate and clear information that avoids leading patients to make decisions they may come to regret. Further research is needed examining how the components of the extended TPB and CSM account for patients' surgery choices.

Children's perceptions of obesity as explained by the common sense model of illness representation

PurposeThe aim of this paper is to qualitatively examine the ways in which primary school children, aged between 7 and 12, perceive various facets of obesity as defined by the common sense model of illness representation (CCM).Design/methodology/approachThe study was qualitative in nature. Semi‐structured interviews were conducted with 33 children on all dimensions of the CSM. Twenty four children were normal weight and nine were overweight. A drawing task formed the methodology for the “identity” section of the interview.FindingsAlthough children identified food intake as a main cause of obesity, almost half did not name sedentary behaviours as a cause of obesity. Duration (timeline) of obesity was regarded by most children as reliant on a person's undertaking of positive health behaviours. Normal weight children were found to list more severe consequences of obesity than the overweight group. It was found that experience contributed to the detailed knowledge of overweight children's perceptions of cures of obesity. Overweight children also spoke of personal incidents of barriers to cures.Practical imlicationsThe findings suggest that the CSMs can be used to classify children's perceptions of obesity. Future childhood obesity interventions can utilise these findings to create campaigns and strategies that are more consistent with children's understandings of this condition.Originality/valueTo the authors' knowledge, no previous study has examined children's perceptions of obesity beyond perceived causes.

Illness representations in patients with traumatic injury: a longitudinal study

This study aimed to elucidate the illness representations of patients with traumatic injury and to examine what extent their illness representations change over time. Traumatic injury has attracted global concern because it is the major reason for death and disability in people under 45 years old. One model, the Common Sense Model of Illness Representation (CSMIR), has the potential to help individuals adjust to changes in health status such as traumatic injury. Longitudinal study design. This study was conducted using a and collected data prior to hospital discharge and at three and six months after hospital discharge. One individual question form and the Chinese Illness Perception Questionnaire Revised (IPQ-R) (Trauma) were used to collect demographic data, clinical data and illness representations. A total of 114 participants completed the survey three times. The overall response rate was 79.7%. Six subscales of the Chinese (Trauma): identity, emotional representations, consequences, controllability, illness coherence and causes of the Chinese IPQ-R (Trauma) changed significantly over time. Two subscales, Timeline (acute/chronic) and Timeline Cyclical, did not change significantly. Based on these findings, there may be a window of opportunity to provide appropriate interventions to individuals with traumatic injury at each time point. The results of this study have implications for nursing practice and further nursing research. Understanding illness representation in patients with traumatic injury may help nurses to provide anticipatory guidance and to design nursing interventions before and after hospital discharge, ultimately to improve health outcomes of those patients.

Promoting self‐care through symptom management: A theory‐based approach for nurse practitioners

To present a theory of illness representation useful in clinical practice along with two case studies as examples of theory implementation. Literature review of relevant theory and associated literature, case studies from clinical practice. An individual asks several questions when experiencing a physical sensation: "Am I sick, stressed, or is this a sign of aging? If I'm sick, is the symptom connected with a disease label?" After asking these questions, the individual develops a cognitive and emotional illness representation that includes the dimensions of identity, cause, consequences, control, and timeline. This representation is guided by personal, cultural, and environmental contexts and determines coping strategies. By assessing the individual's cognitive and emotional representations of the illness, the nurse practitioner (NP) can use the common sense model of illness representation (CSM) to establish interventions and action plans helpful in decreasing distress in the management of symptoms. NPs frequently care for patients who present with very severe symptoms related to their health problem. This becomes a major challenge in effective disease management. Leventhal's CSM can be used as a framework to identify the cognitive and emotional illness representations individuals develop when acute and chronic symptoms are presented. By assessing the individual's cognitive and emotional representations of the illness, the NP will be able to use the CSM to establish interventions and action plans that will be helpful in decreasing the patient's distress in the management of symptoms.

Predictors of Interest in Psychological Treatment for Insomnia Among Older Primary Care Patients With Disturbed Sleep

In this study, we examined whether the common sense model of illness representation (CSMIR) could be successfully used to predict interest in cognitive-behavioral treatment for insomnia (CBT-I) among older primary care patients with disturbed sleep. The Sleep Impairment Index (C. M. Morin, 1993) was used to assess sleep disturbance and the constructs of the CSMIR in primary care patients ages 55 and older. Statistical analyses showed that the CSMIR constructs of consequences (perceived adverse consequences of sleep disturbance to functioning), causes (attributing one's insomnia to bad sleeping habits), and emotion (concern about one's sleep problem) predicted interest in CBT-I. These data provided encouraging support for the ability of the CSMIR to accurately predict patient interest in treatment for insomnia. Implications for assessment and treatment of insomnia in primary care are discussed.

Delay in seeking care for symptoms of acute myocardial infarction: Applying a theoretical model

Thirty percent of people who experience symptoms of acute myocardial infarction (AMI) do not seek care until more than 2-6 hours after onset of symptoms, increasing their risk for morbidity and mortality. Using a model based on two frameworks, the common sense model of illness representation (CSM) and goal expectancy, variables associated with delay were examined to identify the most salient predictors of delay in seeking care for AMI. Hierarchical regression analysis revealed that the set of illness representation components from the CSM was a significant predictor of time to seek care, but individually, only recognition of symptoms as being caused by the heart was significant. Providing accurate information on symptoms of AMI may lead to early recognition, reduced delay, and reduced morbidity and mortality.